Relationship between drug-related problems and health outcomes: a cross-sectional study among cardiovascular patients

Objective To describe drug-related problems (DRPs) and expense problems (EPs) identified by a standardised community pharmacist-based medication review (MR) program among Swiss cardiovascular outpatients (56–75 years old) and to evaluate the need for collaborative pharmacy practice to achieve economic, clinical and humanistic outcomes. Setting A pilot population of 85 cardiovascular outpatients who were customers of 14 community pharmacies (members of the pharmacieplus virtual chain) and insured with Groupe Mutuel health insurance. Method Cross-sectional study of a structured medication review program, conducted by 11 pharmacists in collaboration with 61 general practitioners (GPs), with patient interviews and access to medical data. Main outcome measure Numbers and types of DRPs and EPs within the study population and odds ratios between them, as well as economic, clinical and humanistic outcomes. Results Of the included patients, 91% had at least one DRP or EP. The odds ratios indicated that not being exposed to DRPs was associated with a higher chance of reaching the clinical target (OR: 3.4; IC95%:1.1–10.5; P = 0.01), of having a better physical quality of life than the median (OR: 2.5; IC95%:0.9–7.3; P = 0.05) and having lower total health care costs (OR: 3.2; IC95%:1.1–9.8; P = 0.02). Conclusions This cross-sectional study shows that the control of cardiovascular risk factors, quality of life and healthcare costs are statistically related to the presence of DRPs detected by a community pharmacist-based MR program.     

The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals

Objective : To describe the frequency and types of drug-related problems (DRPs) in hospitalised patients, and to identify risk factors for DRPs and the drugs most frequently causing them.Methods From May to December 2002, 827 patients from six internal medicine and two rheumatology departments in five hospitals in Norway were included in this study. We recorded demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors, i.e. reduced renal function, reduced liver function, heart failure, diabetes, compliance problems, drugs with a narrow therapeutic index and drug allergy. DRPs were documented after reviewing medical records and participation in multidisciplinary team discussions. An independent quality assessment team retrospectively assessed the DRPs in a randomly selected number of the study population.Results Of the patients, 81% had DRPs, and an average of 2.1 clinically relevant DRPs was recorded per patient. The DRPs most frequently recorded were dose-related problems (35.1% of the patients) followed by need for laboratory tests (21.6%), non-optimal drugs (21.4%), need for additional drugs (19.7%), unnecessary drugs (16.7%) and medical chart errors (16.3%). The patients used an average of 4.6 drugs at admission. A multivariate analysis showed that the number of drugs at admission and the number of clinical/pharmacological risk factors were both independent risk factors for the occurrence of DRPs, whereas age and gender were not. The drugs most frequently causing a DRP were warfarin, digitoxin and prednisolone, with calculated risk ratios 0.48, 0.42 and 0.26, respectively. The drug groups causing most DRPs were B01A-antithrombotic agents, M01A-non-steroidal anti-inflammatory agents, N02A-opioids and C09A-angiotensin converting enzyme inhibitors, with risk ratios of 0.22, 0.49, 0.21 and 0.35, respectively.Conclusions The majority of hospitalised patients in our study had DRPs. The number of drugs used and the number of clinical/pharmacological risk factors significantly and independently influenced the risk for DRPs. Procedures for identification of, and intervention on, actual and potential DRPs, along with awareness of drugs carrying a high risk for DRPs, are important elements of drug therapy and may contribute to diminishing drug-related morbidity and mortality.     

Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands

Background Knowledge of drug-related problems (DRPs) identified in the medication of home-dwelling elderly patients with polypharmacy has been based predominantly on medication reviews conducted in research settings rather than in daily practice. Objective To evaluate the prevalence of DRPs identified by means of a clinical medication review (CMR) and the implementation rate of proposed interventions in a large group of older patients with polypharmacy in the daily practice of community pharmacies. Setting 318 Dutch community pharmacies. Method A cross-sectional study based on CMR-data of 3807 older patients (≥65 years) with polypharmacy (≥5 drugs) completed between January and August 2012. Data were extracted from community pharmacists’ databases and entailed: year of birth, gender, dispensing data, number and nature of identified DRPs, consultations performed, proposed and implemented interventions. Main outcome measure Prevalence of DRPs, drug classes involved in overtreatment and undertreatment, and proposed and implemented interventions. Results A median of two DRPs (interquartile range 1–4; mean 3.0) was identified per patient. The DRP-categories overtreatment (25.5 %) and undertreatment (15.9 %) were found most frequently. 46.2 % of the proposed interventions to solve DRPs were implemented as proposed, in 22.4 % of cases, the intervention differed from the proposal. In 31.3 % of cases no intervention was implemented. Conclusion By conducting a CMR community pharmacists identified a median of two DRPs in older patients with polypharmacy. Overtreatment and undertreatment accounted for 41.4 % of the DRPs identified. In dealing with DRPs, pharmacists proposed a variety of interventions of which the majority (69.9 %) was either implemented or led to alternative interventions. A set of explicit criteria should be applied during a CMR to solve and prevent DRPs.     

Characterization of drug-related problems in elderly patients on admission to a medical ward

The incidence, types, avoidability and risk factors associated with drug-related problems (DRPs) in geriatric patients on admission to a medical ward of the Toronto Hospital were assessed. The admission note and laboratory data of 150 consecutive admissions were reviewed for the presence of an adverse drug reaction, inappropriate dose, non-compliance, drug interaction, or lack of required medication. The avoidability (avoidable, possibly avoidable, or unavoidable) and contribution to hospitalization (major reason, contributing or non contributing) of each DRP was characterized. On admission, 41% of patients had a DRP identified, of which most were potentially avoidable (96.8%) and involved commonly prescribed drugs. The DRP was the major or contributing reason for admission in 31% of cases. Polypharmacy was a statistically significant risk factor for a DRP, particularly for male patients (p = 0.0010). In this elderly population, DRPs were not statistically correlated to age greater than 65 years, gender, renal function, native language, or duration of hospital stay. The incidence of DRPs and hospitalizations in the elderly can potentially be reduced by improving medication use. Enhanced communication, particularly between hospital and community pharmacists and their patients, may be a key mechanism.     

Identify and categorize drug-related problems in hospitalized surgical patients in China

International Journal of Clinical Pharmacy - Background Data is lacking on types and severities of drug-related problems (DRPs) in hospitalized surgical patients in China. Objective To identify and...     

Resolution of drug-related problems in home care patients through a pharmacy referral service.

A referral-based, pharmacist-conducted medication management program designed to identify, categorize, and resolve drug-related problems (DRPs) in a home health care (HHC) population was studied. A clinical pharmacy service model was developed to identify patients at high risk for adverse health events resulting from DRPs. Policies and procedures were developed for this service model, including explicit referral criteria, patient-consent documentation, and physician orders. All identified DRPs were categorized, and pharmacist activities relating to the discovery and resolution of DRPs were tabulated. From July 1, 2001, through March 29, 2002, 80 patients were referred for and received clinical pharmacy services, and pharmacists identified 271 DRPs. Every patient referred had a DRP, and 32% of DRPs were identified by a visit to the patient's home. Nearly 65% of pharmacist recommendations were implemented. Using a referral-based practice model in an HHC setting, pharmacists were able to identify and resolve DRPs for every patient referred.     

Clinical pharmacist interventions in managing drug-related problems in hospitalized patients with neurological diseases

International Journal of Clinical Pharmacy - Background Drug-related problems (DRPs) are common in hospitalized patients with neurological diseases. Clinical pharmacy services could minimize...     

Legal measures to combat drug-related problems in Poland

The opium poppy, traditionally cultivated for its seeds and industrial purposes, has recently been increasingly used in so called "home technology" as a raw material for the illicit production of opiates. This development has been accompanied by an increasing number of drug abusers, mainly among young people. Law enforcement authorities in Poland recorded in 1979 approximately 8,000 persons abusing drugs and 13,000 in 1983. The number of drug offences known to the police increased from 1,313 in 1979 to 3,014 in 1983, often involving illegal manufacture of opiates. A study of 110 criminals sentenced for drug offences showed that they also abused drugs over periods of several months to several years. Penal sanctions relating to drug control are provided in different legal instruments. The sentencing policy has not substantially changed over the past several years. The sentence most frequently administered has been the conditional suspension of enforcement of punishment. Effective administration of the penalty of imprisonment for a drug offender engaged in illicit drug trafficking or other criminal acts presenting an exceptional public danger, even when the offender is a drug addict, is one of the basic principles of drug legislation. The law enables the court to commit a drug-addicted offender to an institution, for a period of six months to two years, for treatment of drug dependence before the sentence is carried out, and, in case of successful treatment, the court may reassess the case with a view to reducing or waiving the penalty. A new comprehensive drug law is currently being drafted.     

A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management

International Journal of Clinical Pharmacy - Background Drug-related problems (DRPs) endanger geriatric patients’ safety. Especially a follow-up treatment with increased number of care...     

Analysis of drug-related problems in three departments of a German University hospital

Background

During the last decades, pharmaceutical care services have been developed and implemented to optimize drug therapies and ensure medication safety. To investigate the need for pharmaceutical care services, drug-related problems can be measured.

Objective

Thus, the aim of this study was to analyse number, type and occurrence of drug-related problems in different clinical departments.

Setting

A pharmaceutical care service was established on general wards in Urology, Neurology and Gastroenterology at the University Hospital RWTH Aachen, Germany.

Method

For each of a total of 306 patients, a pharmacist conducted an extended medication history, performed medication reconciliation, conducted medication safety checks and if drug-related problems were discovered, gave valid recommendations to the attending healthcare team. Drug-related problems were classified using the APS-Doc system. For statistical analyses, SAS^® 9.1.3, SAS Institute, Cary NC, USA was applied. The project was approved by the local ethics committee.

Main outcome measure

Type, occurrence and frequency of DRP in different medical departments.

Results

On average, 2.3 drug-related problems per patient were documented for all three departments. Drug-related problems were found in each category of the APS-Doc system. The most pronounced drug-related problems found were drug–drug interactions (34.6 %). 37 % of the identified drug-related problems occurred before hospital admission, 27 % during transitional care, and 36 % on the ward. Subgroup analysis revealed specific drug-related problem patterns for each clinical department. The number of drug-related problems was found to be associated with the number of drugs and age.

Conclusion

Drug-related problems frequently occur in all investigated clinical departments. A holistic pharmaceutical care service could be an option to address this issue. In case of limited resources, individual drug-related problem patterns can be used as a basis for a tailored pharmaceutical care service. As number of drugs and age have been shown to be significant risk factors, it is crucial that the healthcare team including the pharmacist pays special attention to elderly patients and those with polymedication.

     

某院药物相关问题分类系统的建立及初步验证

目的 对现有药物相关问题分类系统进行改进,在此基础上建立某院药物相关问题分类系统,为更好地监控药物相关问题,促进患者用药安全及节省医疗费用提供帮助.方法 在对公开发表的DRPs分类系统进行分析汇总的基础上,选择一相对较完善的系统,结合某院的实际情况,建立适合某院的药物相关问题分类系统,并进行初步验证.结果 建立的新系统...     

Pharmacist-led transitions of care for older adults at risk of drug-related problems: A feasibility study

BackgroundTransitions of care (TOC) is one of three key action areas identified in the World Health Organization (WHO)'s third Global Patient Safety Challenge, Medication Without Harm, released in 2017. Systematic reviews have shown that TOC interventions can improve health outcomes, although few studies have evaluated the role of the community pharmacist.ObjectiveTo evaluate the feasibility of a pharmacist-led TOC intervention for older adults at risk of drug-related problems.MethodsPragmatic feasibility study conducted in hospital and community pharmacies in a health region of Quebec, Canada. The interventions consisted of a pharmaceutical care plan developed by the hospital pharmacist and transferred at hospital discharge to the patients’ community pharmacist, who completed patient consultations in the week following discharge and monthly for six months thereafter. Feasibility evaluations included recruitment, retention, time required, types of interventions, and modified classes of medications, based on clinical data entered in an electronic health record accessible to clinicians in all settings.ResultsOf the 90 recruited patients, 76 were discharged with a pharmaceutical care plan. The mean age of these 76 subjects was 79.5 years, and 52.6% were female. The most frequent inclusion criteria were 15 or more medications (57.9%), two or more emergency department visits (past three months), or one or more hospitalization (past twelve months) (42.1%). The hospital pharmacist interventions took a mean time of 222 min. The community pharmacist interventions took a mean time of 52 min and 32 min for the first and subsequent visits, respectively. Therapeutic goals were documented for 60.5% of patients.ConclusionsThis study shows the feasibility of implementing a pharmacist-led TOC intervention in the Canadian context. Development of the TOC model in three health regions is currently being pursued along with the inclusion of primary care clinics who recently added pharmacists to their interdisciplinary teams.     

Comparing 4 classification systems for drug-related problems: Processes and functions

BackgroundCounseling patients on drug-related problems (DRPs) is a new enterprise for pharmacists. Accordingly, a variety of classification systems have been created to document DRPs. This aroused our interest in finding out how classification systems differ.ObjectiveThe objective is to explore and describe the characteristics of 4 classification systems for DRPs to understand their similarities and differences with regard to processes and functions.MethodsFour established classification systems were selected; they were Strand, Granada-II, Pharmaceutical Care Network Europe v5.0, and Apoteket. To gain experience of the use of the systems, an existing database containing documented problems that were identified during patient counseling at community pharmacies was used. The entries in the database were classified using the 4 selected classification systems, one at a time. In the following analysis, focus was set on what issues were classified and how they were classified in each system. Based on similarities and differences, 8 themes were identified and characteristics of the 4 systems were listed according to these themes. Characteristics of each system were thoroughly scrutinized and interpreted.ResultsThe processes of selecting classification categories were different in all 4 systems, and as a result the contents of categories in systems were different. The systems had different characteristics and a decisive characteristic was whether the patients were involved in the classification of problems or not. Because of the different characteristics the systems had different functions.ConclusionsTo understand the usefulness of a classification system, both structure of categories and work process must be considered. The studied systems had different functions that revealed different aims embedded in the systems. To develop the counseling role of pharmacists, a limited number of classification systems would be beneficial. To get there, common aims and common systems must be developed.