Types Of Medication-related Problems Research Articles

Evaluation of Pharmacy-Led Post-Discharge Follow-Up on Transitional Care Management in a Tertiary Academic Hospital: An Observational Study.

The administration of multiple medications and complex drug regimens has increased medication-related problems (MRPs) and associated factors. MRPs can occur at any stage of the medication process and are common after hospital discharge. Understanding and managing these problems are crucial for promoting safe and effective medication use. This study aimed to evaluate the prevalence of MRPs among post-discharge patients with high medication risk in the academic tertiary care hospital of King Abdulaziz University (KAUH) in Jeddah, Saudi Arabia. A prospective cross-sectional study was conducted, and data were collected through phone calls to discharged patients using validated questions. MRPs were identified based on the classification of the Pharmaceutical Care Network Europe (PCNE), and data analysis was performed using descriptive statistics. Out of 287 screened participants, 201 fulfilled the inclusion criteria. The prevalence of MRPs among high-medication-risk patients after hospital discharge was substantial, with 519 MRPs identified. The most common types of MRPs were the need for medication information, untreated symptoms or indications, and nonadherence. The most prevalent MRPs among patients in our hospital were the need for education and untreated symptoms or indications. Future studies should investigate MRPs in larger samples and explore interventions by pharmacists.

Medication-related problems among adults with chronic kidney disease in Southwest, Nigeria: A Retrospective Study

Background: There is a growing population of patients with chronic kidney disease (CKD) with a high burden of comorbidities and complications that require multiple medications which puts them at risk of medication-related problems (MRPs). This study aims to identify and describe the types of MRPs in CKD patients. Methods: Current medical records of CKD patients attending the renal clinic of a tertiary hospital in Lagos were reviewed to retrieve data on patient demographics, diagnosis, and medication prescribed. The identifified MRPs were categorized using the Pharmaceutical Care Network Europe classifification of drug-related problem tool (PCNE DRP). Multivariate regression was utilized to assess the association between the dependent (MRPs) and independent variables (number of comorbidities, doses per day, medications, age, and stage of CKD). Statistical signifificance was set at p < 0.05. Results: MRPs were identifified and categorized in 89 patients (1.54 ± 0.66 MRPs/patient). The prevalent MRPs identifified were drug use problems (38.4%), adverse drug reactions (16.2%), drug choice problems (14.1%) and dosing problems (12.1%). The odds of identifying MRPs increased with number of comorbidities [AOR 3.71 (95% CI 1.15-11.98); P<0.002], number of medications [OR 4.03(95% CI 1.53-10.65); P <0.0001], and number of doses per day [AOR 4.02 (95% CI 1.49-10.89); P <0.0001]. Conclusion: Medication-Related Problems in CKD patients are high, mandating the need for scheduled review by hospital pharmacists to identify and make interventions with the knowledge of the attending clinicians.&nbsp

What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis

BackgroundComprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown.AimThis study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews.MethodAustralian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis.ResultsSeventy-two de-identified reports from eight consultant pharmacists located in five of the eight Australian States and Territories were included for analysis. From the evaluated reports, four major categories of information were identified: (1) patient details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); (2) pharmacist assessment including assessment of the patient (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); (3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and (4) patient-centred experiences such as perspectives on medicines (n = 56, 78%). Reporting of patient-centred experiences appeared most variably in the included reports, including patient concerns (n = 38, 53%), willingness for change (n = 27, 38%), patient preferences (n = 13, 18%), and patient goals (n = 7, 10%).ConclusionPharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the patients they care for. However, variability across reports has the potential to impact consistent service delivery.

Evaluation of medication-related problems in liver transplant recipients with and without an outpatient medication consultation by a clinical pharmacist: a cohort study

BackgroundTransplant recipients undergo significant changes in their medication regimen during follow-up and are at an increased risk for medication-related problems (MRPs).AimThis study aimed to compare the prevalence and types of MRPs and interventions in liver transplant recipients with and without an outpatient medication consultation by a clinical pharmacist as well as the satisfaction with information about medicines and medication adherence.MethodWe performed a single-center, observational cohort study. A retro- and prospective cohort were used and subdivided in a group that did and did not receive a medication consultation. The prevalence and types of MRPs and interventions were identified and categorized. The satisfaction parameters were evaluated using validated questionnaires.ResultsIncluded were 291 patients. In total, 368 MRPs were identified in 197 patients in the non-medication consultation cohort (median 1; range 1–3 per patient) and 248 MRPs in 94 patients in the medication consultation cohort (median 2; range 1–4 per patient). In the medication consultation cohort, significantly fewer MRPs as unnecessary drugs (17.3% versus 58.7%, p < 0.001), suboptimal therapy (2.4% versus 9.5%, p < 0.001), untreated indication (2.8% versus 6.8%, p = 0.040) and underdosed drugs (0.4% versus 6.3%, p < 0.001) were identified. In the non-medication consultation cohort significantly more patients used unnecessary drugs (72.1% versus 39.4%, p < 0.001) compared to the medication consultation cohort. Patients in both cohorts are satisfied with the information about medicines and reported a high medication adherence.ConclusionPatients in the medication consultation cohort had significantly fewer MRPs and used significantly less unnecessary drugs. Including a clinical pharmacist to the post-transplant care has an added value.

Impact of a system to assist in clinical decision-making in primary healthcare in Catalonia: prescription Self Audit

BackgroundIn 2008, in the context of a complete computerisation of medical records, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a system in its electronic clinical workstation (ECW) to assist decision-making at the prescription level. This system is known as Self Audit, and it supports physicians in reviewing the medication of their patients. Self Audit provides lists of patients presenting medication-related problems (MRPs) that have potential for improvement, and provides therapeutic recommendations that are easy to apply from the system itself. The aim of this study was to analyse the main results derived from the use of Self Audit in primary care (PC) in Catalonia, and the effect of an incentive-based safety indicator on the results obtained.MethodsA descriptive cross-sectional study was carried out to analyse variations in the MRPs detected by Self Audit during 2016, 2017, and 2018 in PC in Catalonia. The effect of a safety indicator on the results obtained was also studied. This safety indicator includes the most clinically relevant MRPs (i.e., therapeutic duplications, safety alerts from the Spanish Medicines Agency, and incidences of polymedication in patients over 65 years of age). Variation in the MRPs was measured using the differences between two evaluation points (initial and final). An MRP was considered resolved if the recommendation specified in the alert was followed. The prescriptions of 6411 PC doctors of the ICS who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed.ResultsAnalysis of the total safety-based MRPs detected by Self Audit gave overall resolutions from April to December of 9% (21,547) in 2016, 7% (15,924) in 2017, and 1% (2392) in 2018 out of the total number of MRPs recorded in April each year. Examination of the 3 types of MRPs with the highest clinical relevance that were linked to the safety indicator gave overall resolutions of 41% in 2016 (17,358), 20% in 2017 (7655), and 21% in 2018 (8135).ConclusionsThe ICS Self Audit tool assists in reducing the number of safety-based MRPs in a systematic manner, and yields superior results for the MRPs linked to a safety indicator included in the incentives of PC physicians.

Implementation of pharmacist targeted discharge prescription review in an emergency department.

Little data has been published regarding emergency medicine pharmacist (EMP) review of discharge prescriptions. An internal retrospective review of a limited sample size of emergency department (ED) discharge prescriptions demonstrated a 13.6% potential intervention rate by EMPs. With this information, it was postulated that EMPs could provide a valuable service via a process of targeted review of ED discharge prescriptions that would yield intervention rates higher than the internal audit. The aim of this project was therefore to develop a real-time notification system within the electronic health record (EHR) for targeted discharge prescription review, to establish an associated EMP workflow, and to evaluate the intervention rate achieved through targeted discharge prescription review. This was a single-center, retrospective review of the implementation of a new pharmacist-driven clinical service over a 12 week period from February 19th, 2018 to May 14th, 2018. Criteria for prescription review were determined after an internal audit by the EMPs and included an assessment of established high-alert medications. Discharge prescriptions that met the inclusion criteria were filtered into a real-time work queue in the EHR for EMP review. When necessary, EMPs discussed recommendations with prescribers, or adjusted prescriptions according to institutional pharmacist privileges. Interventions were reviewed and categorized to assess rate of intervention and the types of medication-related problems (MRPs) identified. EMPs reviewed 378 discharge prescriptions and a total of 158 prescriptions were identified as having at least one MRP. Of these, 70 prescriptions were intervened upon thereby resulting in an 18.5% intervention rate. The most common interventions included a change in the dose/frequency, duration/refills of the medication, and patient education. The highest number of interventions were made for anticoagulant and antiinfective agents. Utilization of a real-time notification system for prospective ED discharge prescription review is feasible. Using targeted criteria for review, pharmacists intervened on 18.5% of prescriptions reviewed. Prospective discharge prescription review by EMPs using a real-time notification system within the electronic health record identified opportunities for the pharmacist to ensure safe and optimal prescribing.

Impact of clinical pharmacist services on quality adjusted life years in head and neck cancer patients.

BackgroundThe role of clinical pharmacists in the provision of patient care is evolving in developing countries such as India. However, their acceptance in health care setups remains debatable. Objective This study aims to investigate the change in quality adjusted life-years after providing clinical pharmacist services in head and neck cancer patients. Setting Oncology speciality private centre in West India. Method It was a prospective, multi-centered pre-post study. Patients were recruited into the control group and intervention group. Clinical pharmacist services were provided only to the intervention group. The quality adjusted life-years was measured by incorporating the EQ-5D-5L instrument. Patients have been provided with the EQ-5D-5L questionnaire at the pre-determined intervals i.e. before beginning of each chemotherapy cycles till the completion of treatment. The analysis was carried out using descriptive analysis and student's t-test. Main outcome measures Change in quality adjusted life-years amongst control and intervention groups of head and neck patients. Results A total of 104 patients were recruited, out of which 50 patients were in control group and 54 patients in intervention group. Docetaxel, cisplatin, 5-fluorouracul regimen, paclitaxel-carboplatin regimen and weekly cisplatin were prescribed in majority of the head and neck patients (control group: 82%; intervention group: 74.1%). The majority of patients in the control group were facing medication-related problems such as irrational administration of chemotherapy (18.9%), lack of optimal supportive care (18.9), negligence of co-morbid conditions (16.1%), improper chemo-drug calculation (14.9%) and drug interaction (13.2%). The remedial action was provided by clinical pharmacist to overcome these medication-related problems in intervention group. The quality adjusted life-years significantly decreased in the control group from 0.012 to 0.005, however, it remained constant in the intervention group from 0.013 to 0.014 after the completion of 6 chemotherapy cycles. Conclusion The incorporation of clinical pharmacist services has helped us in identifying and understanding the various types of medication-related problems and their potential causes in patients suffering from head and neck cancer. Moreover, it helped to improve the quality adjusted life-years and decrease adverse drug reactions, reflecting positive impact on patient care.

Hospital Readmissions in Hospice Patients: Evaluation of Medication-Related Causes for Readmission.

Hospital readmissions, frequent medication changes, and polypharmacy are common issues for hospice patients. It is important to consider if close monitoring of medications by pharmacists could help these patients avoid hospital readmissions. The objectives of this study were to determine the incidence and types of medication-related problems that contributed to hospital readmissions from hospice settings. A retrospective chart review was conducted from October 1, 2018 to January 31, 2020. Patients admitted from hospice settings (i.e. Home, ALF, LTCF) and who were seen by the palliative care teams at 9 Maryland and Washington DC MedStar hospitals were included. Demographic information was collected: age, gender, race, primary hospice diagnosis, prognosis determined by provider prior to hospice disposition, reason for readmission, and medication list at readmission. The primary outcomes were the incidence and types of medication-related problems. Secondary outcomes included patient characteristics associated with readmission, and classes/number of medications changed before readmission. Descriptive statistics were used to analyze data. Seventy-five hospice patients were readmitted and seen by palliative care during the study period. Forty-three patients (57%) were found to have medication-related problems at readmission. The most common problem identified was needing additional drug therapy. Dose too low, dose too high, incorrect drugs, adverse drug reactions, and non-adherence were also identified. Additional reasons for readmission were: unanticipated new medical issue (n = 46, 61%) and uncontrolled symptoms (n = 34, 34%). These findings suggest that deprescribing practices possibly contributeto readmissions from hospice settings.

Comprehensive identification of medication-related problems occurring prior to, during and after emergency department presentation: An Australian multicentre, prospective, observational study.

Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. A total of 904 patients were recruited: 14.8% aged ≥80 years, 18.9% taking more than eight regular medications; 581 MRPs were identified; 287 (49.4%, 95% confidence interval [CI] 45.3-53.5%) of moderate-high significance. Most highly significant MRPs involved high-risk medications, particularly strong opioids, insulin and anti-coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9-45.5%) had at least one MRP; 31.4% (95% CI 28.4-34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4-14.8%) had MRPs that could be identified or managed by screening at ED discharge. Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.

Impact of Pharmacist Involvement on Telehealth Transitional Care Management (TCM) for High Medication Risk Patients.

This pilot study sought to evaluate the impact of pharmacist involvement in the preexisting telehealth transitional care management (TCM) program at Atrium Health on the quality and safety of the medication discharge process for high medication risk patients. Eligible participants were those 18 years of age or older with moderate-to-high risk for hospital readmission who were contacted by a TCM Nurse, identified as high medication risk patients, and referred to the TCM Pharmacist from September 2018 through February 2019. The TCM Pharmacist contacted patients by phone, completed a comprehensive medication review, identified medication list discrepancies (MLDs) and medication-related problems (MRPs), and made interventions or recommendations to primary care providers. Primary endpoints included the number and types of MLDs identified, number and types of MRPs identified, and the rate of unplanned 30-day hospital readmissions. Seventy-six patients were enrolled, and 78 MLDs and 108 MRPs were identified. Of the identified MRPs, 74.1% were resolved. A relative risk reduction of 36.8% was achieved for 30-day hospital readmissions for those with high medication risk contacted by the TCM Pharmacist compared to those only contacted by the TCM Nurse. Overall, TCM Pharmacists identified and resolved 80 medication-related problems, improved access to medication therapy, provided comprehensive medication counseling, and bridged gaps in care following hospital discharge.

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).

Lithium-related medication problems on nonpsychiatric inpatient medical units.

Results of a study of medication-related problems (MRPs) associated with lithium use on nonpsychiatric inpatient medical units are reported. In a single-center, retrospective study, the records of all patients hospitalized over a 21-month period who received lithium or had a documented serum lithium concentration during hospitalization were evaluated. The primary objective was to identify patient-specific factors associated with lithium MRPs on nonpsychiatric inpatient medical units. Secondary objectives included characterization of lithium MRPs. Identified MRP occurrences were further evaluated to determine if an intervention was necessary to resolve the MRP and whether or not an intervention was made. A total of 150 patients were included in the study sample. One or more lithium MRPs were identified in 85% of the patients, with a total of 255 lithium MRPs identified. None of the patient-specific factors analyzed were significantly associated with MRP occurrence. Of the 128 patients in whom a lithium MRP occurred, 92.2% (n = 118) were judged to be appropriate candidates for interventions as defined per the study definitions; among those 118 patients, such interventions were documented for only 40.7% (n = 48). Lithium MRPs were found to have occurred frequently on nonpsychiatric inpatient medical units at 1 hospital. Laboratory test- related MRPs and drug-drug interactions were the most commonly identified types of MRPs. Interventions to address MRPs were not made in the majority of patients; however, interventions were more frequently made when psychiatry consultation was involved.

A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes.

Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration in order to identify, resolve, and prevent medication related problems (MRPs). Methods: The service included residents from four rural Norwegian nursing homes during August 2016–January 2017. All residents were eligible if they (or next of kin) supplied oral consent. The interdisciplinary medication review service comprised four steps: (1) patient and medication history taking; (2) systematic medication review; (3) interdisciplinary case conference; and (4) follow-up of pharmaceutical care plan. The pharmacist collected information about previous and present medication use, and clinical and laboratory values necessary for the medication review. The nurses collected information about possible symptoms related to adverse drug reactions. The pharmacist conducted the medication reviews, identified medication-related problems (MRPs) which were discussed at case conferences with the responsible physician and the responsible nurses. The main outcome measures were number and types of MRPs, percentage agreement between pharmacists and physicians and factors associated with MRPs. Results: The service was delivered for 151 (94%) nursing home residents. The pharmacist identified 675 MRPs in 146 (97%) medication lists (mean 4.0, SD 2.6, range 0–13). The MRPs most frequently identified concerned ‘unnecessary drug’ (22%), ‘too high dosage’ (17%) and ‘drug interactions’ (16%). The physicians agreed upon 64% of the pharmacist recommendations, and action was taken immediately for 32% of these. We identified no association between the number of MRPs and sex (p = 0.485), but between the number of MRPs, and the number of medications and the individual nursing homes. Conclusion: The pharmacist-led medication review service in the nursing homes was highly successfully piloted with many solved and prevented MRPs in interdisciplinary collaboration between the pharmacist, physicians, and nurses. Implementation of this service as a standard in all four nursing homes seems necessary and feasible. If such a service is implemented, effects related to patient outcomes, interdisciplinary collaboration, and health economy should be studied.

Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

"I have nine specialists. They need to swap notes!" Australian patients' perspectives of medication-related problems following discharge from hospital.

BackgroundResearch has shown that patients are most susceptible to medication‐related problems (MRPs) when transitioning from hospital to home. Currently, the literature in this area focuses on interventions, which are mainly orientated around the perspective of the health‐care professional and do not take into account patient perspectives and experiences.ObjectiveTo capture the experiences and perceptions of Australian patients regarding MRPs following discharge from hospital.DesignA cross‐sectional study was conducted using a questionnaire collecting quantitative and qualitative data. Thematic analysis was conducted of the qualitative data.Setting and participantsSurvey participants were recruited through The Digital Edge, an online market research company. Five hundred and six participants completed the survey.ResultsA total of 174 participants self‐reported MRPs. Two concepts and seven subthemes emerged from the analysis. The first concept was types of MRPs and patient experiences. Three themes were identified: unwanted effects from medicines, confusion about medicines and unrecognized medicines. The second concept was patient engagement in medication management, of which four themes emerged: informing patients, patient engagement, communication amongst health‐care professionals and conflicting advice.Discussion and conclusionThis study provides an important insight into patients’ experiences and perceptions of MRPs following discharge from hospital. Future direction for practice and research should look into implementing patient‐centred care at the time of hospital discharge to ensure the provision of clear and consistent information, and developing ways to support and empower patients to ensure a smooth transition post‐discharge from hospital.

Impact of a Clinical Pharmacist in the General Hospital: An Egyptian Trial

Medication review aims at optimizing the impact of medications while minimizing their related problems. Drug-related problems have never been properly addressed in Egyptian hospitals. The purpose of this paper is to record and compare the prevalence and types of medication related problems, the interventions provided by the clinical pharmacists and how physicians responded along with making recommendations for error prevention. This prospective study was conducted between June 2012 and December 2012, at an Egyptian general hospital. Five trained pharmacists recorded patient-specific medication related recommendations and completed quality-of-care interventions. The average number of audited doses was 81% of those prescribed. The most prevalent medication problem was prescribing errors followed by administration errors. A total of 20 patients experienced adverse drug events. The greatest error rates across the seven months were observed in the ICU and cardiology units. Numbers of interventions offered by the pharmacists ranged from 241, to 519 per month. Nurses accepted all the interventions introduced by the pharmacists aimed at reducing administration errors while physicians’ resistance rates had an average of 21%. This study showed a positive influence of the pharmacist-led medication review in reducing potential drug-related problems in an Egyptian secondary care where the hospital under study implemented new measures to minimize drug related problems according to the findings of the trained pharmacists.

Pharmacist Identification of Medication-Related Problems in the Home Care Setting

To identify medication-related problems (MRPs) in home care patients. A prospective case series involving pharmacist medication review of patient charts. A nonprofit agency serving the disabled and elderly of Rockingham County, North Carolina. Patients living in their homes, who qualify for home health care and who take eight or more medications. Patients identified received at least one medication review performed by a pharmacist. Six types of MRPs were identified. Recommendations to resolve such MRPs were sent to the prescriber for analysis. Outcome measures include MRPs identified, recommendations, and prescriber acceptance. 380 charts received medication reviews from July 2007 through June 2009, and 148 (39%) required pharmacist intervention. A total of 232 MRPs were identified during the review process. Of the problems identified, suboptimal therapy (28%) and use of unnecessary drugs (24%) were most common. Discontinuing a drug (38.6%) and consulting the prescriber (23.2%) comprised the majority of the recommendations. Pharmacists successfully identified a large number of MRPs not previously identified by other health care providers. Unnecessary drug use in home care patients was among the highest MRP noted. Discontinuation of an unnecessary drug was the most recommended resolution to the MRP. Prescribers respond positively to suggestions made by pharmacists regarding MRPs.

Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Background The quality of medication use in older adults is suboptimal, with a large percentage of individuals not receiving recommended care. Most efforts to evaluate the quality of medication use target high-risk drugs, appropriate treatment of prevalent chronic disease states, or a set of predefined quality indicators of medication use rather than the patient. It is also suggested that racial differences in the quality of medication use may exist in older adults. Objective This study was conducted to determine the prevalence, number, and types of medication-related problems in older adults, examining the impact of race on quality medication use. Methods This was a prospective cohort study involving in-home interviews and medical record reviews of community-residing older adults, stratified by race, conducted 3 times over 1 year. No intervention to address medication-related problems was performed. The quality of medication use was reported as medication-related problems by clinical pharmacists. Results Of the 200 participants (100 blacks, 100 whites), mean age was 78.3 (whites) and 75.5 (blacks), and the majority of patients were female. Although whites used more medications than blacks (mean, 11.6 vs 9.7; P < 0.01), blacks had more medication-related problems per person than whites (mean, 6.3 vs 4.9; P < 0.01). All patients had at least 1 medication-related problem. Common problems at baseline, 6 months, and 12 months for both whites and blacks were undertreatment, suboptimal drug use, suboptimal dosing, nonadherence, and less costly alternative available. Blacks had significantly higher rates of nonadherence than whites (68% vs 42%; P < 0.01). Over the 12-month study, the number of medication-related problems not only persisted but increased (adjusted P = 0.0168). Conclusions Medication-related problems were prevalent in both black and white older adults and persisted over 1 year. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in the quality of medication use in older adults and the impact of race on specific medication-related problems.

Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study

Medication-related problems are prevalent in older adults and adversely affect the quality of care. It has been suggested that racial differences exist in medication use. Most efforts to evaluate the quality of medication use target specific drugs or disease states, or a set of pre-defined quality indicators, rather than the patient. We conducted a prospective cohort study to determine the prevalence and types of medication-related problems in older adults, examining the impact of race on quality medication use. In-home interviews and medical record reviews of 200 (100 white, 100 black) older adults were conducted three times over 1 year. The quality of medication use was measured using a clinical pharmacist's assessment of quality and the Assessing Care of Vulnerable Elders quality indicators. We used logistic and negative binomial regression models to analyze the two primary endpoints of prevalence and number of medication-related problems. Mean age was 78.3 (whites) and 75.5 (blacks), with the majority being female. Although whites used more medications than blacks (11.6 versus 9.7; p < 0.01), blacks had more medication-related problems per person than whites (6.2 versus 4.9; p < 0.01). All patients had at least one medication-related problem; undertreatment, suboptimal drug, suboptimal dosing, and nonadherence were most prevalent. Blacks had significantly higher rates of nonadherence than whites (68% versus 42%; p < 0.01). Medication-related problems are prevalent in community-residing older adults. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in quality medication use.

Medication Reviews in Senior Community Housing Centers

The primary objective was to document the frequency and types of medication-related problems (MRPs) identified by a pharmacist or pharmacy student during medication reviews at senior community housing centers. The setting included five urban senior community housing centers in Chicago, Illinois. Two pharmacists and pharmacy students practicing in a community health center. The health center provides outreach to the community, with a focus on the senior population. Pharmacists and pharmacy students developed an outreach program to provide medication reviews within senior community housing centers. To show the value of the services provided by the health center to the community, a system for tracking the identified MRPs was implemented. Frequency and types of MRPs. A total of 119 MRPs were identified, with a mean of 5.2 (standard deviation +/- 4.3) MRPs per patient. The mean age of participants was 75.1 +/- 8.5 years (range 63-90); the majority of participants were female (82.6%). The average number of total medications per patient was 7.7 (range 3-16). The most frequently identified MRPs were related to laboratory monitoring (28.6%, n = 34), compliance (25.2%, n = 30), unnecessary drug therapy (13.4%, n = 16), and need for additional therapy (10.9%, n = 13). The majority of participants (57.5%, n = 13) were referred to another health care professional to resolve a problem identified by the pharmacist. In urban senior community housing centers, a MRP by pharmacists is a means to identify MRPs and to provide community service.