Medicine › Geriatrics and Gerontology

Pharmaceutical Practices and Patient Outcomes

Works Count: 116273

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Description

This cluster of papers focuses on the challenges and consequences of polypharmacy, inappropriate medication use, and adverse drug events in the elderly population. It explores topics such as potentially inappropriate prescribing, pharmacist interventions, medication reconciliation, deprescribing, and the impact of anticholinergic burden. The research aims to address the complexities of medication management in older adults and improve patient outcomes.

Keywords

Polypharmacy; Inappropriate Medication Use; Elderly; Adverse Drug Events; Potentially Inappropriate Prescribing; Pharmacist Intervention; Medication Reconciliation; Deprescribing; Anticholinergic Burden; Clinical Pharmacy Services

Remington: The science and practice of pharmacy

1996-04-01

Alfonso R. Gennaro

STOPP (Screening Tool of Older Persons Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation

2008-02-01

Paul Gallagher , Cristín Ryan , Shauna E. Byrne +2 more

Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls … Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason. We aimed to validate a new screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions) and criteria for potentially appropriate, indicated drugs called START (Screening Tool to Alert doctors to Right, i.e. appropriate, indicated Treatment).A Delphi consensus technique was used to establish the content validity of STOPP/START. An 18-member expert panel from academic centers in Ireland and the United Kingdom completed two rounds of the Delphi process by mail survey. Inter-rater reliability was assessed by determining the kappa-statistic for measure of agreement on 100 data-sets.STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people. Inter-rater reliability is favorable with a kappa-coefficient of 0.75 for STOPP and 0.68 for START.STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.

Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States

2008-12-23

Dima M. Qato , G. Caleb Alexander , Rena M. Conti +3 more

<h3>Context</h3>Despite concerns about drug safety, current information on older adults' use of prescription and over-the-counter medications and dietary supplements is limited.<h3>Objective</h3>To estimate the prevalence and patterns of medication use among … <h3>Context</h3>Despite concerns about drug safety, current information on older adults' use of prescription and over-the-counter medications and dietary supplements is limited.<h3>Objective</h3>To estimate the prevalence and patterns of medication use among older adults (including concurrent use), and potential major drug-drug interactions.<h3>Design, Setting, and Participants</h3>Three thousand five community-residing individuals, aged 57 through 85 years, were drawn from a cross-sectional, nationally representative probability sample of the United States. In-home interviews, including medication logs, were administered between June 2005 and March 2006. Medication use was defined as prescription, over-the-counter, and dietary supplements used “on a regular schedule, like every day or every week.” Concurrent use was defined as the regular use of at least 2 medications.<h3>Main Outcome Measure</h3>Population estimates of the prevalence of medication use, concurrent use, and potential major drug-drug interactions, stratified by age group and gender.<h3>Results</h3>The unweighted survey response rate was 74.8% (weighted response rate, 75.5%). Eighty-one percent (95% confidence interval [CI], 79.4%-83.5%) used at least 1 prescription medication, 42% (95% CI, 39.7%-44.8%) used at least 1 over-the-counter medication, and 49% (95% CI, 46.2%-52.7%) used a dietary supplement. Twenty-nine percent (95% CI, 26.6%-30.6%) used at least 5 prescription medications concurrently; this was highest among men (37.1%; 95% CI, 31.7%-42.4%) and women (36.0%; 95% CI, 30.2%-41.9%) aged 75 to 85 years. Among prescription medication users, concurrent use of over-the-counter medications was 46% (95% CI, 43.4%-49.1%) and concurrent use of dietary supplements was 52% (95% CI, 48.8%-55.5%). Overall, 4% of individuals were potentially at risk of having a major drug-drug interaction; half of these involved the use of nonprescription medications. These regimens were most prevalent among men in the oldest age group (10%; 95% CI, 6.4%-13.7%) and nearly half involved anticoagulants. No contraindicated concurrent drug use was identified.<h3>Conclusions</h3>In this sample of community-dwelling older adults, prescription and nonprescription medications were commonly used together, with nearly 1 in 25 individuals potentially at risk for a major drug-drug interaction.

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Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes

2012-06-27

Danijela Gnjidic , Sarah N. Hilmer , Fiona Blyth +7 more

The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons

2008-03-10

James L. Rudolph

<h3>Background</h3> Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. To further assess this risk, we developed the Anticholinergic Risk … <h3>Background</h3> Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. To further assess this risk, we developed the Anticholinergic Risk Scale (ARS), a ranked categorical list of commonly prescribed medications with anticholinergic potential. The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management (GEM) cohort and in a primary care cohort. <h3>Methods</h3> Medical records of 132 GEM patients were reviewed retrospectively for medications included on the ARS and their resultant possible anticholinergic adverse effects. Prospectively, we enrolled 117 patients, 65 years or older, in primary care clinics; performed medication reconciliation; and asked about anticholinergic adverse effects. The relationship between the ARS score and the risk of anticholinergic adverse effects was assessed using Poisson regression analysis. <h3>Results</h3> Higher ARS scores were associated with increased risk of anticholinergic adverse effects in the GEM cohort (crude relative risk [RR], 1.5; 95% confidence interval [CI], 1.3-1.8) and in the primary care cohort (crude RR, 1.9; 95% CI, 1.5-2.4). After adjustment for age and the number of medications, higher ARS scores increased the risk of anticholinergic adverse effects in the GEM cohort (adjusted RR, 1.3; 95% CI, 1.1-1.6;<i>c</i>statistic, 0.74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5;<i>c</i>statistic, 0.77). <h3>Conclusion</h3> Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients.

EFFECT ON MORTALITY OF METOPROLOL IN ACUTE MYOCARDIAL INFARCTION

1981-10-01

Åke Hjalmarson , Johan Herlitz , I. Málek +7 more

pA, A NEW SCALE FOR THE MEASUREMENT OF DRUG ANTAGONISM

1947-09-01

H. O. Schild

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Clinical Pharmacists and Inpatient Medical Care

2006-05-08

Peter J. Kaboli , Angela B. Hoth , Brad J. McClimon +1 more

<h3>Background</h3> The role of clinical pharmacists in the care of hospitalized patients has evolved over time, with increased emphasis on collaborative care and patient interaction. The purpose of this review … <h3>Background</h3> The role of clinical pharmacists in the care of hospitalized patients has evolved over time, with increased emphasis on collaborative care and patient interaction. The purpose of this review was to evaluate the published literature on the effects of interventions by clinical pharmacists on processes and outcomes of care in hospitalized adults. <h3>Methods</h3> Peer-reviewed, English-language articles were identified from January 1, 1985, through April 30, 2005. Three independent assessors evaluated 343 citations. Inpatient pharmacist interventions were selected if they included a control group and objective patient-specific health outcomes; type of intervention, study design, and outcomes such as adverse drug events, medication appropriateness, and resource use were abstracted. <h3>Results</h3> Thirty-six studies met inclusion criteria, including 10 evaluating pharmacists' participation on rounds, 11 medication reconciliation studies, and 15 on drug-specific pharmacist services. Adverse drug events, adverse drug reactions, or medication errors were reduced in 7 of 12 trials that included these outcomes. Medication adherence, knowledge, and appropriateness improved in 7 of 11 studies, while there was shortened hospital length of stay in 9 of 17 trials. No intervention led to worse clinical outcomes and only 1 reported higher health care use. Improvements in both inpatient and outpatient outcome measurements were observed. <h3>Conclusions</h3> The addition of clinical pharmacist services in the care of inpatients generally resulted in improved care, with no evidence of harm. Interacting with the health care team on patient rounds, interviewing patients, reconciling medications, and providing patient discharge counseling and follow-up all resulted in improved outcomes. Future studies should include multiple sites, larger sample sizes, reproducible interventions, and identification of patient-specific factors that lead to improved outcomes.

Polypharmacy in elderly patients

2007-12-01

Emily Hajjar , Angela C. Cafiero , Joseph T. Hanlon

Martindale: The Complete Drug Reference

2010-02-04

Anne O’Rourke

Journal Article Martindale: The Complete Drug Reference Get access Edited by Sean Sweetman, Published by The Pharmaceutical Press, 1 Lambeth High St, London, UK. 2009, thirty-sixth edition. 2 volumes, xiii … Journal Article Martindale: The Complete Drug Reference Get access Edited by Sean Sweetman, Published by The Pharmaceutical Press, 1 Lambeth High St, London, UK. 2009, thirty-sixth edition. 2 volumes, xiii + 3694 p. Price $806. American Journal of Health-System Pharmacy, Volume 67, Issue 4, 15 February 2010, Page 321, https://doi.org/10.2146/br090004 Published: 15 February 2010

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Adverse Drug Events in Ambulatory Care

2003-04-16

Tejal K. Gandhi , Saul N. Weingart , Joshua Borus +7 more

Adverse events related to drugs occur frequently among inpatients, and many of these events are preventable. However, few data are available on adverse drug events among outpatients. We conducted a … Adverse events related to drugs occur frequently among inpatients, and many of these events are preventable. However, few data are available on adverse drug events among outpatients. We conducted a study to determine the rates, types, severity, and preventability of such events among outpatients and to identify preventive strategies.We performed a prospective cohort study, including a survey of patients and a chart review, at four adult primary care practices in Boston (two hospital-based and two community-based), involving a total of 1202 outpatients who received at least one prescription during a four-week period. Prescriptions were computerized at two of the practices and handwritten at the other two.Of the 661 patients who responded to the survey (response rate, 55 percent), 162 had adverse drug events (25 percent; 95 percent confidence interval, 20 to 29 percent), with a total of 181 events (27 per 100 patients). Twenty-four of the events (13 percent) were serious, 51 (28 percent) were ameliorable, and 20 (11 percent) were preventable. Of the 51 ameliorable events, 32 (63 percent) were attributed to the physician's failure to respond to medication-related symptoms and 19 (37 percent) to the patient's failure to inform the physician of the symptoms. The medication classes most frequently involved in adverse drug events were selective serotonin-reuptake inhibitors (10 percent), beta-blockers (9 percent), angiotensin-converting-enzyme inhibitors (8 percent), and nonsteroidal antiinflammatory agents (8 percent). On multivariate analysis, only the number of medications taken was significantly associated with adverse events.Adverse events related to drugs are common in primary care, and many are preventable or ameliorable. Monitoring for and acting on symptoms are important. Improving communication between outpatients and providers may help prevent adverse events related to drugs.

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Clinical consequences of polypharmacy in elderly

2013-09-27

Robert L. Maher , Joseph T. Hanlon , Emily Hajjar

Introduction: Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January … Introduction: Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years. Areas covered: We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy. Expert opinion: International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.

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The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication

1999-01-01

Robert Horne , John Weinman , Matthew Hankins

Abstract This paper presents a novel method for assessing cognitive representations of medication: the Beliefs about Medicines Questionnaire (BMQ). The BMQ comprises two sections: the BMQ-Specific which assesses representations of … Abstract This paper presents a novel method for assessing cognitive representations of medication: the Beliefs about Medicines Questionnaire (BMQ). The BMQ comprises two sections: the BMQ-Specific which assesses representations of medication prescribed for personal use and the BMQ-General which assesses beliefs about medicines in general. The pool of test items was derived from themes identified in published studies and from interviews with chronically ill patients. Principal Component Analysis (PCA) of the test items resulted in a logically coherent, 18 item, 4-factor structure which was stable across various illness groups. The BMQ-Specific comprises two 5-item factors assessing beliefs about the necessity of prescribed medication (Specific-Necessity) and concerns about prescribed medication based on beliefs about the danger of dependence and long-term toxicity and the disruptive effects of medication (Specific-Concerns). The BMQ-General comprises two 4-item factors assessing beliefs that medicines are harmful, addictive, poisons which should not be taken continuously (General-Horn) and that medicines are overused by doctors (General-Overuse). The two sections of the BMQ can be used in combination or separately. The paper describes the development of the BMQ scales and presents data supporting their reliability and their criterion-related and discriminant validity.

Interventions to Reduce 30-Day Rehospitalization: A Systematic Review

2011-10-18

Luke O. Hansen , Robert S. Young , Keiki Hinami +2 more

Background: About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to … Background: About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to a Medicare reimbursement penalty. Purpose: To describe interventions evaluated in studies aimed at reducing rehospitalization within 30 days of discharge. Data Sources: MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched for reports published between January 1975 and January 2011. Study Selection: English-language randomized, controlled trials; cohort studies; or noncontrolled before–after studies of interventions to reduce rehospitalization that reported rehospitalization rates within 30 days. Data Extraction: 2 reviewers independently identified candidate articles from the results of the initial search on the basis of title and abstract. Two 2-physician reviewer teams reviewed the full text of candidate articles to identify interventions and assess study quality. Data Synthesis: 43 articles were identified, and a taxonomy was developed to categorize interventions into 3 domains that encompassed 12 distinct activities. Predischarge interventions included patient education, medication reconciliation, discharge planning, and scheduling of a follow-up appointment before discharge. Postdischarge interventions included follow-up telephone calls, patient-activated hotlines, timely communication with ambulatory providers, timely ambulatory provider follow-up, and postdischarge home visits. Bridging interventions included transition coaches, physician continuity across the inpatient and outpatient setting, and patient-centered discharge instruction. Limitations: Inadequate description of individual studies' interventions precluded meta-analysis of effects. Many studies identified in the review were single-institution assessments of quality improvement activities rather than those with experimental designs. Several common interventions have not been studied outside of multicomponent "discharge bundles." Conclusion: No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization. Primary Funding Source: None.

Appropriate prescribing in elderly people: how well can it be measured and optimised?

2007-07-01

Anne Spinewine , Kenneth E. Schmader , Nick Barber +4 more

Drug-Drug Interactions Among Elderly Patients Hospitalized for Drug Toxicity

2003-04-01

David N. Juurlink , Muhammad Mamdani , Alexander Kopp +2 more

Context Drug-drug interactions are a preventable cause of morbidity and mortality, yet their consequences in the community are not well characterized. Objective To determine whether elderly patients admitted to hospital … Context Drug-drug interactions are a preventable cause of morbidity and mortality, yet their consequences in the community are not well characterized. Objective To determine whether elderly patients admitted to hospital with specific drug toxicities were likely to have been prescribed an interacting drug in the week prior to admission. Design Three population-based, nested case-control studies. Setting Ontario, Canada, from January 1, 1994, to December 31, 2000. Patients All Ontario residents aged 66 years or older treated with glyburide, digoxin, or an angiotensin-converting enzyme (ACE) inhibitor. Case patients were those admitted to hospital for drug-related toxicity. Prescription records of cases were compared with those of controls (matched on age, sex, use of the same medication, and presence or absence of renal disease) for receipt of interacting medications (co-trimoxazole with glyburide, clarithromycin with digoxin, and potassium-sparing diuretics with ACE inhibitors). Main Outcome Measure Odds ratio for association between hospital admission for drug toxicity (hypoglycemia, digoxin toxicity, or hyperkalemia, respectively) and use of an interacting medication in the preceding week, adjusted for diagnoses, receipt of other medications, the number of prescription drugs, and the number of hospital admissions in the year preceding the index date. Results During the 7-year study period, 909 elderly patients receiving glyburide were admitted with a diagnosis of hypoglycemia. In the primary analysis, those patients admitted for hypoglycemia were more than 6 times as likely to have been treated with co-trimoxazole in the previous week (adjusted odds ratio, 6.6; 95% confidence interval, 4.5-9.7). Patients admitted with digoxin toxicity (n = 1051) were about 12 times more likely to have been treated with clarithromycin (adjusted odds ratio, 11.7; 95% confidence interval, 7.5-18.2) in the previous week, and patients treated with ACE inhibitors admitted with a diagnosis of hyperkalemia (n = 523) were about 20 times more likely to have been treated with a potassium-sparing diuretic (adjusted odds ratio, 20.3; 95% confidence interval, 13.4-30.7) in the previous week. No increased risk of drug toxicity was found for drugs with similar indications but no known interactions (amoxicillin, cefuroxime, and indapamide, respectively). Conclusions Many hospital admissions of elderly patients for drug toxicity occur after administration of a drug known to cause drug-drug interactions. Many of these interactions could have been avoided.

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A method for assessing drug therapy appropriateness☆

1992-10-01

Joseph T. Hanlon , Kenneth E. Schmader , Gregory P. Samsa +5 more

The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly

1990-04-01

Nananda F. Col

We interviewed 315 consecutive elderly patients admitted to an acute care hospital to determine the percentage of elderly hospital admissions due to noncompliance with medication regimens or adverse drug reactions, … We interviewed 315 consecutive elderly patients admitted to an acute care hospital to determine the percentage of elderly hospital admissions due to noncompliance with medication regimens or adverse drug reactions, their causes, consequences, and predictors. Eighty-nine of the elderly admissions (28.2%) were drug related, 36 due to noncompliance (11.4%), and 53 due to adverse drug reactions (16.8%). One hundred three patients had a history of noncompliance (32.7%). Factors statistically associated with a higher risk of hospitalization due to noncompliance were poor recall of medication regimen, seeing numerous physicians, female, medium income category, use of numerous medications, and having the opinion that medications are expensive. Factors associated with an increased risk of an admission due to an adverse drug reaction were use of numerous different medications, higher medication costs, receiving Medicaid, and not receiving any home services. In conclusion, many elderly admissions are drug related; noncompliance accounting for a substantial fraction of these. Elders at high risk of being noncompliant are identifiable using a variety of criteria. Economic factors were important in predicting admissions due to noncompliance as well as adverse drug reactions.

Emergency Hospitalizations for Adverse Drug Events in Older Americans

2011-11-23

Daniel S. Budnitz , Maribeth C. Lovegrove , Nadine Shehab +1 more

Adverse drug events are important preventable causes of hospitalization in older adults. However, nationally representative data on adverse drug events that result in hospitalization in this population have been limited.We … Adverse drug events are important preventable causes of hospitalization in older adults. However, nationally representative data on adverse drug events that result in hospitalization in this population have been limited.We used adverse-event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project (2007 through 2009) to estimate the frequency and rates of hospitalization after emergency department visits for adverse drug events in older adults and to assess the contribution of specific medications, including those identified as high-risk or potentially inappropriate by national quality measures.On the basis of 5077 cases identified in our sample, there were an estimated 99,628 emergency hospitalizations (95% confidence interval [CI], 55,531 to 143,724) for adverse drug events in U.S. adults 65 years of age or older each year from 2007 through 2009. Nearly half of these hospitalizations were among adults 80 years of age or older (48.1%; 95% CI, 44.6 to 51.6). Nearly two thirds of hospitalizations were due to unintentional overdoses (65.7%; 95% CI, 60.1 to 71.3). Four medications or medication classes were implicated alone or in combination in 67.0% (95% CI, 60.0 to 74.1) of hospitalizations: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). High-risk medications were implicated in only 1.2% (95% CI, 0.7 to 1.7) of hospitalizations.Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate. Improved management of antithrombotic and antidiabetic drugs has the potential to reduce hospitalizations for adverse drug events in older adults.

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Potentially Inappropriate Medications in the Elderly

2010-08-09

Stefanie Holt , Sven Schmiedl , Petra Thürmann

Certain drugs are classified as potentially inappropriate medications (PIM) for the elderly because they carry an increased risk of adverse drug events in this patient group. PIM lists from other … Certain drugs are classified as potentially inappropriate medications (PIM) for the elderly because they carry an increased risk of adverse drug events in this patient group. PIM lists from other countries are of limited usefulness in Germany because different drugs are on the market in each country and prescribing practices vary as well. Thus, a list of potentially inappropriate medications for the elderly was developed specifically for use in Germany.A preliminary PIM list suitable for the German market was created on the basis of a selective literature search and a qualitative analysis of published international PIM lists. The final German PIM list was developed by means of a comprehensive, structured expert survey in two rounds (a so-called Delphi process).83 drugs in a total of 18 drug classes were rated as potentially inappropriate for elderly patients. For 46 drugs, the experts came to no clear decision after the second Delphi round. For cases in which the administration of a PIM is clinically necessary, the final PRISCUS list contains recommendations for clinical practice, e.g. monitoring of laboratory values and dose adaptation. Therapeutic alternatives are also listed.Potentially inappropriate medications carry the risk of causing adverse drug events in the elderly. A drawback of using a Delphi process to generate a PIM list, as was done for the new German list, is that little scientific evidence is currently available for the evaluation of active substances, potential therapeutic alternatives, and indicated monitoring procedures. Thus, the validity and practicability of the PRISCUS list remain to be demonstrated (and the same holds for PIM lists already published in other countries). It should be used as a component of an overall concept for geriatric pharmacotherapy in which polypharmacy and interacting medications are avoided, and doses are regularly re-evaluated.

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A Reengineered Hospital Discharge Program to Decrease Rehospitalization

2009-02-03

Brian W. Jack

Emergency department visits and rehospitalization are common after hospital discharge.To test the effects of an intervention designed to minimize hospital utilization after discharge.Randomized trial using block randomization of 6 and … Emergency department visits and rehospitalization are common after hospital discharge.To test the effects of an intervention designed to minimize hospital utilization after discharge.Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card.General medical service at an urban, academic, safety-net hospital.749 English-speaking hospitalized adults (mean age, 49.9 years).A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment.Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment.Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed.This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report.A package of discharge services reduced hospital utilization within 30 days of discharge.Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.

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Opportunities and responsibilities in pharmaceutical care

1990-03-01

Charles D. Hepler , Linda M. Strand

Pharmacy's opportunity to mature as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality is explored. Pharmacy has shed the apothecary role but has not … Pharmacy's opportunity to mature as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality is explored. Pharmacy has shed the apothecary role but has not yet been restored to its erst-while importance in medical care. It is not enough to dispense the correct drug or to provide sophisticated pharmaceutical services; nor will it be sufficient to devise new technical functions. Pharmacists and their institutions must stop looking inward and start redirecting their energies to the greater social good. Some 12,000 deaths and 15,000 hospitalizations due to adverse drug reactions (ADRs) were reported to the FDA in 1987, and many went unreported. Drug-related morbidity and mortality are often preventable, and pharmaceutical services can reduce the number of ADRs, the length of hospital stays, and the cost of care. Pharmacists must abandon factionalism and adopt patient-centered pharmaceutical care as their philosophy of practice. Changing the focus of practice from products and biological systems to ensuring the best drug therapy and patient safety will raise pharmacy's level of responsibility and require philosophical, organizational, and functional changes. It will be necessary to set new practice standards, establish cooperative relationships with other health-care professions, and determine strategies for marketing pharmaceutical care. Pharmacy's reprofessionalization will be completed only when all pharmacists accept their social mandate to ensure the safe and effective drug therapy of the individual patient.

National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events

2006-10-17

Daniel S. Budnitz , Daniel A. Pollock , Kelly N. Weidenbach +3 more

Adverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited.To describe the frequency and characteristics of … Adverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited.To describe the frequency and characteristics of adverse drug events that lead to emergency department visits in the United States.Active surveillance from January 1, 2004, through December 31, 2005, through the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project.National estimates of the numbers, population rates, and severity (measured by hospitalization) of individuals with adverse drug events treated in emergency departments.Over the 2-year study period, 21,298 adverse drug event cases were reported, producing weighted annual estimates of 701,547 individuals (95% confidence interval [CI], 509,642-893,452) or 2.4 individuals per 1000 population (95% CI, 1.7-3.0) treated in emergency departments. Of these cases, 3487 individuals required hospitalization (annual estimate, 117,318 [16.7%]; 95% CI, 13.1%-20.3%). Adverse drug events accounted for 2.5% (95% CI, 2.0%-3.1%) of estimated emergency department visits for all unintentional injuries and 6.7% (95% CI, 4.7%-8.7%) of those leading to hospitalization and accounted for 0.6% of estimated emergency department visits for all causes. Individuals aged 65 years or older were more likely than younger individuals to sustain adverse drug events (annual estimate, 4.9 vs 2.0 per 1000; rate ratio [RR], 2.4; 95% CI, 1.8-3.0) and more likely to require hospitalization (annual estimate, 1.6 vs 0.23 per 1000; RR, 6.8; 95% CI, 4.3-9.2). Drugs for which regular outpatient monitoring is used to prevent acute toxicity accounted for 41.5% of estimated hospitalizations overall (1381 cases; 95% CI, 30.9%-52.1%) and 54.4% of estimated hospitalizations among individuals aged 65 years or older (829 cases; 95% CI, 45.0%-63.7%).Adverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies.

US Pharmacists' Effect as Team Members on Patient Care

2010-08-18

Marie A. Chisholm‐Burns , Jeannie Kim Lee , Christina A. Spivey +7 more

Background: One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists. Objective: The objective of this study was to conduct a comprehensive … Background: One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists. Objective: The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes. Methods: The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria. Results: A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care. Conclusions: Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.

Trends in Prescription Drug Use Among Adults in the United States From 1999-2012

2015-11-03

Elizabeth D. Kantor , Colin D. Rehm , Jennifer S. Haas +2 more

It is important to document patterns of prescription drug use to inform both clinical practice and research.To evaluate trends in prescription drug use among adults living in the United States.Temporal … It is important to document patterns of prescription drug use to inform both clinical practice and research.To evaluate trends in prescription drug use among adults living in the United States.Temporal trends in prescription drug use were evaluated using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Participants included 37,959 noninstitutionalized US adults, aged 20 years and older. Seven NHANES cycles were included (1999-2000 to 2011-2012), and the sample size per cycle ranged from 4861 to 6212.Calendar year, as represented by continuous NHANES cycle.Within each NHANES cycle, use of prescription drugs in the prior 30 days was assessed overall and by drug class. Temporal trends across cycles were evaluated. Analyses were weighted to represent the US adult population.Results indicate an increase in overall use of prescription drugs among US adults between 1999-2000 and 2011-2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999-2000 and an estimated 59% reporting use of any prescription drugs in 2011-2012 (difference, 8% [95% CI, 3.8%-12%]; P for trend <.001). The prevalence of polypharmacy (use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012 (difference, 6.6% [95% CI, 4.4%-8.2%]; P for trend <.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants.In this nationally representative survey, significant increases in overall prescription drug use and polypharmacy were observed. These increases persisted after accounting for changes in the age distribution of the population. The prevalence of prescription drug use increased in the majority of, but not all, drug classes.

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STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

2014-10-16

Denis O’Mahony , David O’Sullivan , Stephen Byrne +3 more

Abstract Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence … Abstract Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.

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Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review

2005-08-29

Vincent C. Tam

Over a quarter of hospital prescribing errors are attributable to incomplete medication histories being obtained at the time of admission. We undertook a systematic review of studies describing the frequency, … Over a quarter of hospital prescribing errors are attributable to incomplete medication histories being obtained at the time of admission. We undertook a systematic review of studies describing the frequency, type and clinical importance of medication history errors at hospital admission.We searched MEDLINE, EMBASE and CINAHL for articles published from 1966 through April 2005 and bibliographies of papers subsequently retrieved from the search. We reviewed all published studies with quantitative results that compared prescription medication histories obtained by physicians at the time of hospital admission with comprehensive medication histories. Three reviewers independently abstracted data on methodologic features and results.We identified 22 studies involving a total of 3755 patients (range 33-1053, median 104). Errors in prescription medication histories occurred in up to 67% of cases: 10%- 61% had at least 1 omission error (deletion of a drug used before admission), and 13%- 22% had at least 1 commission error (addition of a drug not used before admission); 60%- 67% had at least 1 omission or commission error. Only 5 studies (n = 545 patients) explicitly distinguished between unintentional discrepancies and intentional therapeutic changes through discussions with ordering physicians. These studies found that 27%- 54% of patients had at least 1 medication history error and that 19%- 75% of the discrepancies were unintentional. In 6 of the studies (n = 588 patients), the investigators estimated that 11%-59% of the medication history errors were clinically important.Medication history errors at the time of hospital admission are common and potentially clinically important. Improved physician training, accessible community pharmacy databases and closer teamwork between patients, physicians and pharmacists could reduce the frequency of these errors.

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Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline

2008-03-04

Parminder Raina , Pasqualina Santaguida , Afisi Ismaila +5 more

Background: The effectiveness of the 5 U.S. Food and Drug Administration–approved pharmacologic therapies for dementias in achieving clinically relevant improvements is unclear. Purpose: To review the evidence for the effectiveness … Background: The effectiveness of the 5 U.S. Food and Drug Administration–approved pharmacologic therapies for dementias in achieving clinically relevant improvements is unclear. Purpose: To review the evidence for the effectiveness of cholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and the neuropeptide-modifying agent memantine in achieving clinically relevant improvements, primarily in cognition, global function, behavior, and quality of life, for patients with dementia. Data Sources: Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE, EMBASE, Allied and Complementary Medicine Database, CINAHL, AgeLine, and PsycINFO from January 1986 through November 2006. Study Selection: English-language randomized, controlled trials were included in the review if they evaluated pharmacologic agents for adults with a diagnosis of dementia, did not use a crossover design, and had a quality score of at least 3 on the Jadad scale. Data Extraction: Data were extracted on study characteristics and outcomes, including adverse events. Effect sizes were calculated and data were combined when appropriate. Data Synthesis: 96 publications representing 59 unique studies were eligible for this review. Both cholinesterase inhibitors and memantine had consistent effects in the domains of cognition and global assessment, but summary estimates showed small effect sizes. Outcomes in the domains of behavior and quality of life were evaluated less frequently and showed less consistent effects. Most studies were of short duration (6 months), which limited their ability to detect delay in onset or progression of dementia. Three studies directly compared different cholinesterase inhibitors and found no differences in cognition and behavior. Limitations: Limitations of available studies included short duration, inclusion of only patients with mild to moderate Alzheimer disease, poor reporting of adverse events, lack of clear definitions for statistical significance, limited evaluation of behavior and quality-of-life outcomes, and limited direct comparison of different treatments. Conclusions: Treatment of dementia with cholinesterase inhibitors and memantine can result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia.

Angiotensin II receptors and angiotensin II receptor antagonists.

1993-06-01

P.B.M.W.M. Timmermans , Pancras C. Wong , Andrew T. Chiu +7 more

Reducing Inappropriate Polypharmacy

2015-03-23

Ian Scott , Sarah N. Hilmer , Emily Reeve +7 more

Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and … Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one; (2) consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application.

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Role of Pharmacist Counseling in Preventing Adverse Drug Events After Hospitalization

2006-03-13

Jeffrey L. Schnipper , Jennifer L. Kirwin , Michael Cotugno +7 more

<h3>Background</h3> Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable … <h3>Background</h3> Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. <h3>Methods</h3> We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. <h3>Results</h3> Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (<i>P</i> = .01). No differences were found between groups in total ADEs or total health care utilization. <h3>Conclusions</h3> Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.

Drug-Related Morbidity and Mortality: Updating the Cost-of-Illness Model

2001-03-01

Frank R. Ernst , Amy J. Grizzle

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

2003-12-08

Donna M. Fick , James W. Cooper , William E. Wade +3 more

Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to … Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States.This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions.This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity.This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

A RATING SCALE FOR EXTRAPYRAMIDAL SIDE EFFECTS

1970-03-01

G. M. Simpson , M. B. , GH. B. +3 more

SUMMARY A modification of an earlier rating scale for extrapyramidal system disturbance is described, and evidence for the validity and reliability of the scale is presented. The usefulness of the … SUMMARY A modification of an earlier rating scale for extrapyramidal system disturbance is described, and evidence for the validity and reliability of the scale is presented. The usefulness of the scale in studies of neuroleptic drugs is discussed. By its application it is possible to quantify extrapyramidal side effects and to separate them into four principal factors.

Psychotropic Drug Use and the Risk of Hip Fracture

1987-02-12

Wayne A. Ray , Marie R. Griffin , William Schaffner +2 more

To assess the risk of hip fracture associated with the use of four classes of psychotropic drugs, we performed a case-control study of 1021 patients with hip fractures and 5606 … To assess the risk of hip fracture associated with the use of four classes of psychotropic drugs, we performed a case-control study of 1021 patients with hip fractures and 5606 controls among elderly Medicaid enrollees. Persons treated with hypnotics–anxiolytics having short (≤24 hours) elimination half-lives had no increased risk of hip fracture. By contrast, a significantly increased risk was associated with current use of hypnotics–anxiolytics having long (>24 hours) elimination half-lives (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.4), tricyclic antidepressants (odds ratio, 1.9; 95 percent confidence interval, 1.3 to 2.8), and antipsychotics (odds ratio, 2.0; 95 percent confidence interval, 1.6 to 2.6). The risk increased in relation to the doses of drugs in these three classes. An analysis for possible confounding by dementia did not alter the results. Previous but noncurrent use of drugs in these classes conferred no increase in risk. Although a cause- and-effect relation was not proved, these data support the hypothesis that the sedative and autonomic effects of psychotropic drugs increase the risk of falling and fractures in elderly persons. The results suggest the need for studies of this association in other populations and for evaluation of newer psychotropic drugs with fewer undesirable sedative and autonomic effects. (N Engl J Med 1987; 316:363–9.)

The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months

2006-08-09

Björn Wettermark , Niklas Hammar , C. MichaelFored +7 more

To describe the content and potentials of the new Swedish national register on prescribed and dispensed medicines.The Swedish Prescribed Drug Register contains information about age, sex and unique identifier of … To describe the content and potentials of the new Swedish national register on prescribed and dispensed medicines.The Swedish Prescribed Drug Register contains information about age, sex and unique identifier of the patient as well as the prescriber's profession and practice. Information regarding drug utilization and expenditures for prescribed drugs in the entire Swedish population was extracted from the first six months July-December 2005 and compared with total drug sales in the country including OTC and hospital use.The total quantity of drugs sold in Sweden was 2666 million DDDs, corresponding to 1608 DDD/1000 inhabitants daily. The total expenditures were 1.6 billion Euro. The prescribed drugs, included in the register, accounted for 84% of the total utilization and 77% of the total expenditures. About half of all men and two-thirds of all women in the country purchased drugs. The proportion increased by age. The most common drugs for chronic treatment were diuretics among women (8.8% of the population) and antithrombotic agents among men (7.6%). Psychotropic drugs, corticosteroids and analgesics were more common among women, while men used antithrombotic agents, antidiabetic drugs, lipid lowering agents and ACE inhibitors to a greater extent.The new register provides valuable data on exposure to drugs and is useful to study patterns of drug utilization. The possibilities for record linkage to other health registers gives from an international perspective good opportunities to explore drug and disease associations and the risks, benefits, effectiveness and health economical effects of drug use.

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Cumulative Use of Strong Anticholinergics and Incident Dementia

2015-01-26

Shelly L. Gray , Melissa L. Anderson , Sascha Dublin +6 more

Many medications have anticholinergic effects.In general, anticholinergicinduced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy.However, a few studies suggest that anticholinergics may be associated with an increased risk … Many medications have anticholinergic effects.In general, anticholinergicinduced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy.However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia.OBJECTIVE To examine whether cumulative anticholinergic use is associated with a higher risk for incident dementia. DESIGN, SETTING, AND PARTICIPANTSProspective population-based cohort study using data from the Adult Changes in Thought study in Group Health, an integrated health care delivery system in Seattle, Washington.We included 3434 participants 65 years or older with no dementia at study entry.Initial recruitment occurred from 1994 through 1996 and from 2000 through 2003.Beginning in 2004, continuous replacement for deaths occurred.All participants were followed up every 2 years.Data through September 30, 2012, were included in these analyses.EXPOSURES Computerized pharmacy dispensing data were used to ascertain cumulative anticholinergic exposure, which was defined as the total standardized daily doses (TSDDs) dispensed in the past 10 years.The most recent 12 months of use was excluded to avoid use related to prodromal symptoms.Cumulative exposure was updated as participants were followed up over time.MAIN OUTCOMES AND MEASURES Incident dementia and Alzheimer disease using standard diagnostic criteria.Statistical analysis used Cox proportional hazards regression models adjusted for demographic characteristics, health behaviors, and health status, including comorbidities. RESULTSThe most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics.During a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia (637 of these [79.9%] developed Alzheimer disease).A 10-year cumulative dose-response relationship was observed for dementia and Alzheimer disease (test for trend, P < .001).For dementia, adjusted hazard ratios for cumulative anticholinergic use compared with nonuse were 0.92 (95% CI, 0.74-1.16)for TSDDs of 1 to 90; 1.19 (95% CI, 0.94-1.51)for TSDDs of 91 to 365; 1.23 (95% CI, 0.94-1.62)for TSDDs of 366 to 1095; and 1.54 (95% CI, 1.21-1.96)for TSDDs greater than 1095.A similar pattern of results was noted for Alzheimer disease.Results were robust in secondary, sensitivity, and post hoc analyses. CONCLUSIONS AND RELEVANCEHigher cumulative anticholinergic use is associated with an increased risk for dementia.Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.

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<scp>A</scp>merican <scp>G</scp>eriatrics <scp>S</scp>ociety Updated <scp>B</scp>eers <scp>C</scp>riteria for Potentially Inappropriate Medication Use in Older Adults

2012-02-29

Potentially inappropriate medications ( PIM s) continue to be prescribed and used as first‐line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use … Potentially inappropriate medications ( PIM s) continue to be prescribed and used as first‐line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIM s in older adults. PIM s now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous B eers C riteria using a comprehensive, systematic review and grading of the evidence on drug‐related problems and adverse drug events ( ADE s) in older adults. This was accomplished through the support of The A merican G eriatrics S ociety ( AGS ) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified D elphi method to the systematic review and grading to reach consensus on the updated 2012 AGS B eers C riteria. Fifty‐three medications or medication classes encompass the final updated C riteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence‐based approach using the I nstitute of M edicine standards and the development of a partnership to regularly update the C riteria. Thoughtful application of the C riteria will allow for (a) closer monitoring of drug use, (b) application of real‐time e‐prescribing and interventions to decrease ADE s in older adults, and (c) better patient outcomes.

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AHFS Drug Information

1994-09-01

Gerald K. McEvoy

With extensive updated information on everything from treatment of hypertension to hepatitis C, AHFS (R) Drug Information (R) 2017 is a necessary addition to your pharmacy's resources. With content supported … With extensive updated information on everything from treatment of hypertension to hepatitis C, AHFS (R) Drug Information (R) 2017 is a necessary addition to your pharmacy's resources. With content supported by more than 89,000 total references and reviewed by over 500 professionals, it helps you protect your patients and your practice. The only print compendium designated by the U.S. Congress, AHFS (R) Drug Information 2017 is also the only reference published by a professional and scientific society - ensuring it is the most authoritative and best-selling reference trusted by pharmacists for 59 years. AHFS (R) Drug Information 2017 contains the most trustworthy drug information available - all in one place. It is the most comprehensive evidence-based source of drug information complete with therapeutic guidelines and off-label uses.

American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

2015-10-08

The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New … The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.

What is polypharmacy? A systematic review of definitions

2017-10-10

Nashwa Masnoon , Sepehr Shakib , Lisa M. Kalisch Ellett +1 more

Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to … Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.

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American Journal of Hospital Pharmacy

1958-01-01

Don E. Francke

Journal Article American Journal of Hospital Pharmacy Get access Don E. Francke Don E. Francke Search for other works by this author on: Oxford Academic Google Scholar American Journal of … Journal Article American Journal of Hospital Pharmacy Get access Don E. Francke Don E. Francke Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 15, Issue 1, 1 January 1958, Page 37, https://doi.org/10.1093/ajhp/15.1.37 Published: 01 January 1958

Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine

1991-09-01

Mark H. Beers

Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and … Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine<sup>2</sup>blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future. (<i>Arch Intern Med</i>.1991;151:1825-1832)

Explicit criteria for determining potentially inappropriate medication use by the elderly. An update

1997-07-28

Mark H. Beers

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

2019-01-29

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. … The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019.

Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group

1995-07-05

David W. Bates

<h3>Objectives.</h3> —To assess incidence and preventability of adverse drug events (ADEs) and potential ADEs. To analyze preventable events to develop prevention strategies. <h3>Design.</h3> —Prospective cohort study. <h3>Participants.</h3> —All 4031 adult … <h3>Objectives.</h3> —To assess incidence and preventability of adverse drug events (ADEs) and potential ADEs. To analyze preventable events to develop prevention strategies. <h3>Design.</h3> —Prospective cohort study. <h3>Participants.</h3> —All 4031 adult admissions to a stratified random sample of 11 medical and surgical units in two tertiary care hospitals over a 6-month period. Units included two medical and three surgical intensive care units and four medical and two surgical general care units. <h3>Main Outcome Measures.</h3> —Adverse drug events and potential ADEs. <h3>Methods.</h3> —Incidents were detected by stimulated self-report by nurses and pharmacists and by daily review of all charts by nurse investigators. Incidents were subsequently classified by two independent reviewers as to whether they represented ADEs or potential ADEs and as to severity and preventability. <h3>Results.</h3> —Over 6 months, 247 ADEs and 194 potential ADEs were identified. Extrapolated event rates were 6.5 ADEs and 5.5 potential ADEs per 100 nonobstetrical admissions, for mean numbers per hospital per year of approximately 1900 ADEs and 1600 potential ADEs. Of all ADEs, 1% were fatal (none preventable), 12% life-threatening, 30% serious, and 57% significant. Twenty-eight percent were judged preventable. Of the life-threatening and serious ADEs, 42% were preventable, compared with 18% of significant ADEs. Errors resulting in preventable ADEs occurred most often at the stages of ordering (56%) and administration (34%); transcription (6%) and dispensing errors (4%) were less common. Errors were much more likely to be intercepted if the error occurred earlier in the process: 48% at the ordering stage vs 0% at the administration stage. <h3>Conclusion.</h3> —Adverse drug events were common and often preventable; serious ADEs were more likely to be preventable. Most resulted from errors at the ordering stage, but many also occurred at the administration stage. Prevention strategies should target both stages of the drug delivery process. (<i>JAMA</i>. 1995;274:29-34)

Drug-related morbidity and mortality. A cost-of-illness model

1995-10-09

Jeffrey Johnson

Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents

1991-09-01

Mark H. Beers

Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly

1997-07-28

Mark H. Beers

This study updates and expands explicit criteria defining potentially inappropriate medication use by the elderly. Additional goals were to address whether adverse outcomes were likely to be clinically severe and … This study updates and expands explicit criteria defining potentially inappropriate medication use by the elderly. Additional goals were to address whether adverse outcomes were likely to be clinically severe and to incorporate clinical information on diagnoses when available. These criteria are meant to serve epidemiological studies, drug utilization review systems, health care providers, and educational efforts. Consensus from a panel of 6 nationally recognized experts on the appropriate use of medication in the elderly was sought. The expert panel agreed on the validity of 28 criteria describing the potentially inappropriate use of medication by general populations of the elderly as well as 35 criteria defining potentially inappropriate medication use in older persons known to have any of 15 common medical conditions. Updated, expanded, and more generally applicable criteria are now available to help identify inappropriate use of medications in elderly populations. These criteria define medications that should generally be avoided in the ambulatory elderly, doses or frequencies of administrations that should generally not be exceeded, and medications that should be avoided in older persons known to have any of several common conditions. Arch Intern Med. 1997;157:1531-1536

Adverse Drug Events in Hospitalized Patients<subtitle>Excess Length of Stay, Extra Costs, and Attributable Mortality</subtitle>

1997-01-22

David C. Classen

<h3>Objective.</h3> —To determine the excess length of stay, extra costs, and mortality attributable to adverse drug events (ADEs) in hospitalized patients. <h3>Design.</h3> —Matched case-control study. <h3>Setting.</h3> —The LDS Hospital, a … <h3>Objective.</h3> —To determine the excess length of stay, extra costs, and mortality attributable to adverse drug events (ADEs) in hospitalized patients. <h3>Design.</h3> —Matched case-control study. <h3>Setting.</h3> —The LDS Hospital, a tertiary care health care institution. <h3>Patients.</h3> —All patients admitted to LDS Hospital from January 1, 1990, to December 31,1993, were eligible. Cases were defined as patients with ADEs that occurred during hospitalization; controls were selected according to matching variables in a stepwise fashion. <h3>Methods.</h3> —Controls were matched to cases on primary discharge diagnosis related group (DRG), age, sex, acuity, and year of admission; varying numbers of controls were matched to each case. Matching was successful for 71% of the cases, leading to 1580 cases and 20197 controls. <h3>Main Outcome Measures.</h3> —Crude and attributable mortality, crude and attributable length of stay, and cost of hospitalization. <h3>Results.</h3> —ADEs complicated 2.43 per 100 admissions to the LDS Hospital during the study period. The crude mortality rates for the cases and matched controls were 3.5% and 1.05%, respectively (<i>P</i><.001). The mean length of hospital stay significantly differed between the cases and matched controls (7.69 vs 4.46 days;<i>P</i><.001) as did the mean cost of hospitalization ($10010 vs $5355;<i>P</i><.001). The extra length of hospital stay attributable to an ADE was 1.74 days (<i>P</i><.001). The excess cost of hospitalization attributable to an ADE was $2013 (<i>P</i><.001). A linear regression analysis for length of stay and cost controlling for all matching variables revealed that the occurrence of an ADE was associated with increased length of stay of 1.91 days and an increased cost of $2262 (<i>P</i><.001). In a similar logistic regression analysis for mortality, the increased risk of death among patients experiencing an ADE was 1.88 (95% confidence interval, 1.54-2.22;<i>P</i><.001). <h3>Conclusion.</h3> —The attributable lengths of stay and costs of hospitalization for ADEs are substantial. An ADE is associated with a significantly prolonged length of stay, increased economic burden, and an almost 2-fold increased risk of death.

Individual and Environmental Factors Associated With Polypsychotropic Medication Regimens Among Adults With Intellectual Disability

2025-06-26

Kami L. Gallus , Jennifer L. Jones , Steven R. Erickson | American Journal on Intellectual and Developmental Disabilities

Abstract Polypharmacy, the concurrent use of multiple medications, is common among adults with intellectual disability. Psychotropic medications are often implicated in polypharmacy among this population. The current study aimed to … Abstract Polypharmacy, the concurrent use of multiple medications, is common among adults with intellectual disability. Psychotropic medications are often implicated in polypharmacy among this population. The current study aimed to determine individual and environmental factors associated with polypsychotropic medication regimens using a population-based sample of adults with intellectual disability who receive Home and Community-Based Services waivers in Oklahoma. The following questions guided the study: a) What is the prevalence of polypsychotropic medication regimens? b) What are the individual and environmental factors significantly associated with polypsychotropic medication regimens? Findings confirmed high prevalence rates of polypsychotropic medication regimens among adult participants and highlighted significant associated individual and environmental factors.

ASHP National Survey of Pharmacy Practice in Hospital Settings: Clinical Services and Workforce—2024

2025-06-25

Craig A. Pedersen , Ryan W. Naseman , Philip J. Schneider +2 more | American Journal of Health-System Pharmacy

Abstract Purpose Results of the 2024 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. Methods Pharmacy directors at 1,497 general and children’s medical-surgical hospitals in the United … Abstract Purpose Results of the 2024 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. Methods Pharmacy directors at 1,497 general and children’s medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online using Qualtrics. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database. Results The response rate was 16.7%. Pharmacists routinely provide clinical pharmacy services to a majority of inpatients in over 75% of hospitals and are most commonly assigned to general medical-surgical (73.3%), critical care (68.5%), oncology (56.9%), cardiology (48.5%), infectious disease/antimicrobial stewardship (48.1%) units and the emergency department (46.5%). Pharmacists independently prescribe in 18.5% of hospitals. Progress towards the ASHP Practice Advancement Initiative (PAI) 2030 goals has been mixed; except for technicians performing more advanced roles, measures have remained relatively stable over the past 5 years. Over 80% of pharmacy directors reported perceived shortages of experienced technicians, and about 60% reported perceived shortages of clinical specialists and clinical coordinators. Conclusion Hospital pharmacy departments are facing many challenges, including worsening shortages of pharmacists and pharmacy technicians, drug shortages, reimbursement and formulary concerns, and regulatory compliance. Despite these challenges, inpatient and ambulatory care clinical pharmacy services continue to expand across the country, with most hospitals routinely providing care to a majority of patients in over three-quarters of hospitals. While progress toward other PAI 2030 focused initiatives has been mixed over the past 5 years, responsibilities of pharmacy technicians are trending toward advanced roles.

Train-the-trainer programme building clinical pharmacy workforce capacity in Sri Lanka: Design and evaluation

2025-06-25

Ian Coombes , Judith Coombes , Helena Knowles +7 more | Pharmacy Education

Background: Clinical pharmacy services in Sri Lanka are a component of the response to the WHO’s Medication Without Harm. Visiting Australian clinical pharmacy academics have supported Sri Lankan colleagues to … Background: Clinical pharmacy services in Sri Lanka are a component of the response to the WHO’s Medication Without Harm. Visiting Australian clinical pharmacy academics have supported Sri Lankan colleagues to address the limited clinical training available in hospital and university settings with undergraduate teaching since 2009 and Train-the-trainer (TtT) programmes in 2010 and 2016. A workshop in 2018 identified gaps in the capacity to upskill existing hospital pharmacy staff and spread clinical teaching across all universities. Programme description: In 2023, a 4-day TtT programme was attended by 20 pharmacists, nine academics from five universities and eleven hospital pharmacists. Learning outcomes included: demonstration of medication history taking, medication reconciliation, problem identification and resolution with interdisciplinary colleagues and patient education. A range of pedagogies (aligned with FIP Pharmacy Development Goals and Global Competency Framework) were used, including role plays, mock-wards, ward teaching, case-based-discussions, and entrustable-professional-activities. Evaluation: Overall satisfaction with the programme was high and trainees perceived an increase in their clinical skills relevant to their roles. After 10-months, All described implementation of components of the TtT into their university courses or clinical pharmacy activities, with 50% taking on roles as local trainers. Future plans: To enable trainees to facilitate sessions and participate in delivering future TtT programs; therefore, demonstrating sustainability.

Community Pharmacists’ Attitudes Toward the Implementation of Good Pharmacy Practice Guidelines in Jordan: A Cross-Sectional Survey

2025-06-25

Tahani Alwidyan , Rawan Abudalo , M. Odeh +2 more | Jordan Journal of Pharmaceutical Sciences

Good Pharmacy Practice (GPP) guidelines have been adopted in many countries around the globe to improve the quality of services. However, there is a lack of evidence regarding the extent … Good Pharmacy Practice (GPP) guidelines have been adopted in many countries around the globe to improve the quality of services. However, there is a lack of evidence regarding the extent to which community pharmacists (CPs) adhere to the implementation of GPP guidelines, as reported in the literature. This study aimed to assess CPs’ attitudes toward the implementation of GPP guidelines in Jordan. A probabilistic stratified random sampling approach was used to recruit eligible CPs. A validated Good Pharmacy Practice among Community Pharmacists (GPP-CP) questionnaire was administered to evaluate participants’ attitudes toward GPP implementation. A total of 241 participants completed the GPP-CP questionnaire (response rate: 68.1%). Of these, 65.1% were females, and 91.7% reported having knowledge about GPP. The study findings demonstrated that good knowledge of GPP significantly influenced CPs’ attitudes toward adherence to the profession’s essentials and requirements (φc = 0.16, P = 0.047), administrative professional performance (φc = 0.20, P = 0.015), and patient counseling practices (φc = 0.22, P = 0.003). Among participants, the lowest level of agreement (52.3%) was reported regarding the documentation process of dispensed medications to patients. This study highlights the imperative need for establishing structured indicators to monitor the implementation of GPP in community pharmacy settings. Documentation of pharmaceutical care should also be prioritized. Educational programs and workshops are recommended to enhance pharmacists’ practice in community settings. However, since these research findings on pharmacists' attitudes were gathered from Jordanian respondents within Arab society, they may not be generalizable to pharmacists in non-Arab societies where GPP guidelines could differ.

Impact of Knowledge on Analgesic Self-Medication Practices Among Pharmacy Students

2025-06-25

Lidya Pratiwi Afri Tjaja , Fahrida Nuraziza Supandi , Gina Aulia +1 more | Journal Syifa Sciences and Clinical Research

Self-medication using analgesics is a common practice among pharmacy students, where knowledge is assumed to play a critical role in guiding behavior. This study aims to investigate the relationship between … Self-medication using analgesics is a common practice among pharmacy students, where knowledge is assumed to play a critical role in guiding behavior. This study aims to investigate the relationship between students’ knowledge levels and their self-medication practices involving analgesic drugs. A cross-sectional study was conducted involving 294 pharmacy students at STIKes Widya Dharma Husada Tangerang, using a structured and validated questionnaire to assess demographic data, knowledge levels, and self-medication behaviors. Results showed that 45.2% of students had good knowledge, while 51.7% demonstrated responsible self-medication behavior, with paracetamol being the most frequently used analgesic (35%). Chi-square analysis revealed a statistically significant association between knowledge level and self-medication behavior (p 0.05), indicating that higher knowledge correlates with safer medication practices. These findings underscore the importance of strengthening educational programs on rational drug use to promote safe and informed self-medication behaviors among future healthcare professionals.

Identifying risks in dementia care: Insights from a qualitative study with clinical pharmacists

2025-06-24

Alice Burnand , Kumud Kantilal , Abi Woodward +7 more | PLoS ONE

Introduction People with dementia experience complex healthcare needs. Clinical pharmacists play a crucial role in optimising medication management and ensuring patient safety within the primary care setting. However, little is … Introduction People with dementia experience complex healthcare needs. Clinical pharmacists play a crucial role in optimising medication management and ensuring patient safety within the primary care setting. However, little is known about the specific barriers and challenges they face when delivering dementia care. This study investigates the safety of dementia care in the community, focusing on the experiences of clinical pharmacists. Methods A qualitative study using semi-structured interviews with clinical pharmacists. Data analysis employed codebook thematic analysis, guided by the SEIPS 2.0 framework. Results Thirteen clinical pharmacists were interviewed. Key risks include variations in pharmacist expertise, communication barriers, limited resources, and systemic challenges. Using the SEIPS 2.0 framework, the complex interactions between work systems (people, tools, tasks, organisation and environment) and work processes were identified, which impact safety outcomes for both clinical pharmacists and people with dementia. Conclusions Interviews revealed a spectrum of risks associated with dementia care in primary care. This study highlights the complex interplay of factors influencing the safety of dementia care. A proactive, multifaceted approach addressing training, interprofessional collaboration, and system-level adaptations is crucial to mitigate these risks and enhance patient safety in dementia care.

Pharmacists’ Perspectives on Deprescribing Psychotropic Medicines in People with Intellectual Disabilities

2025-06-24

Danielle Adams , Richard P. Hastings , Ian Maidment +2 more | Journal of Mental Health Research in Intellectual Disabilities

Evolving role of clinical pharmacists in modern health care

2025-06-24

Zeenath Unnissa , Madeeha Mudassir , Ali Jafri +1 more | International Journal of Basic & Clinical Pharmacology

Clinical pharmacy is a pharmacy profession in which clinical pharmacists provide direct patient care to maximise medication use while also improving health, wellbeing, and disease prevention. Clinical pharmacists work in … Clinical pharmacy is a pharmacy profession in which clinical pharmacists provide direct patient care to maximise medication use while also improving health, wellbeing, and disease prevention. Clinical pharmacists work in many settings, including hospitals, clinics, long-term care facilities, and community pharmacies. Clinical pharmacists work directly with patients in a variety of ways. They utilise their understanding of pharmaceuticals (including dose, drug interactions, side effects, cost-effectiveness, and so on) to assess if a medication plan is appropriate for their patients. Patient education and counselling on effective pharmaceutical usage are critical components of pharmacists' increasingly important duties. Pharmacists can detect and address any drug-related issues during counselling, as well as offer information that enhances patients' treatment compliance and raises the standard of care. Pharmacists have a critical role in detecting, identifying, preventing, and managing adverse drug reactions. Pharmacists play a crucial role in reporting adverse drug reactions (ADRs), which can lead to product withdrawal or label modifications. Clinical pharmacist can improve medication review, identify drug-related issues, provide treatment suggestions, and promote medication compliance. Pharmacists can also help enhance drug safety by working with other healthcare providers to create patient-centered medication management regimens. In this position, chemists can analyse prescription histories, identify potential drug-related issues, and provide recommendations to optimise medication management.

Morbidity, Mortality, and Improvement Rounds: Overlooked Risk in Cancer Care: Failure of Medical Reconciliation

2025-06-24

Niharika Dixit , Jessica McGuire , Therese M. Mulvey +1 more | JCO Oncology Practice

Medication reconciliation is a critical part of providing safe oncology care. Small errors in medication management can affect patients' outcomes. Optimal cancer care requires multiple disciplines to act in concert. … Medication reconciliation is a critical part of providing safe oncology care. Small errors in medication management can affect patients' outcomes. Optimal cancer care requires multiple disciplines to act in concert. Too often, disciplines do not communicate efficiently or rely on assumptions of patient knowledge to coordinate care. This case study examines one patient's course that was compromised by such assumptions and suggests systems-based improvements which can prevent similar occurrences.

Response to the Letter on “Surveillance of QTc-Interval Prolonging Medications Upon Admission Throughout Hospitalization in a Tertiary Care Geriatric Ward"

2025-06-24

Ivana Knežević , Milena Kovačević , Katarina Stefanović +4 more | Medical Principles and Practice

The 100 Most-cited Articles on Intracanal Medication: A Bibliometric Analysis

2025-06-24

Hebertt Gonzaga dos Santos Chaves , Pedro César Gomes Titato , Ana Carolina Soares Mendes +7 more | Journal of Advances in Medicine and Medical Research

Aims: To examine the 100 most cited papers on intracanal medication in endodontics and determine the major research trends, authors, institutions, and study types. Study Design: Bibliometric analysis. Methodology: Systematic … Aims: To examine the 100 most cited papers on intracanal medication in endodontics and determine the major research trends, authors, institutions, and study types. Study Design: Bibliometric analysis. Methodology: Systematic literature search was performed in the Web of Science Core Collection to determine the 100 most cited papers on intracanal medication. Citations, publication year, journal, authorship, country, institution, study design, type of medication, and keywords were extracted. VOSviewer software was employed to create bibliometric maps. Analysis was performed using descriptive statistics, Spearman correlation, and Poisson regression (p < 0.05). Results: The number of citations among the top 100 articles ranged from 1 to 429, with a positive correlation observed across citation counts in different databases. The years 2021 and 2022 had the highest concentration of highly cited articles (n = 13 each). The Journal of Endodontics was the most frequently represented journal (n = 33). Brazil was the leading contributor, with 47 articles, followed by the United States (n = 8), and Canada and Saudi Arabia (n = 5 each). In total, 28 countries were represented. São Paulo State University (UNESP) was the most productive institution (n = 11), and J.F. Siqueira Jr. was the most prolific author (n = 5). In vitro studies were the most common (n = 53). The most frequently used keywords were “endodontics” and “calcium hydroxide” (n = 42). Calcium hydroxide was the most studied medication, whether as control group or in association with other medicaments/vehicle, followed by 2% chlorhexidine gel. Other studies evaluated plant extracts, nanoparticles, bioactive glass, DAP, sodium hypochlorite, and corticosteroid-antibiotic combinations. Poisson regression showed that older articles were cited 5.83% more, while literature reviews were cited 47% less compared to systematic reviews. Conclusion: This is the first bibliometric evaluation of the most-highly-cited articles on intracanal medication that identifies key studies, authors, and institutions, providing significant insight into research trends and gaps in endodontics.

A NASSS Framework-Guided Review of Technology Supported Medicines Optimization for Geriatric Polypharmacy: Challenges, Opportunities, and Implementation Strategies

2025-06-24

Arun Vamadevan , P. V. Vijesh , Christine L. Cole +3 more

<title>Abstract</title> Background: Polypharmacy is a growing challenge in older adults with multimorbidity, increasing the risk of adverse drug events, hospital admissions, and healthcare utilisation. Technology-supported interventions, such as clinical decision … <title>Abstract</title> Background: Polypharmacy is a growing challenge in older adults with multimorbidity, increasing the risk of adverse drug events, hospital admissions, and healthcare utilisation. Technology-supported interventions, such as clinical decision support systems (CDSS) and digital deprescribing tools, offer new opportunities to optimize medication use. However, adoption and sustainability remain variable across healthcare settings. Objective: This review systematically examines the adoption, scale-up, and sustainability of technology-supported medicines optimization interventions for older adults, guided by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. Methods: A systematic search was conducted across Scopus, PubMed, Cochrane Library, and CINAHL. After screening and eligibility assessment, 30 studies were included. A narrative synthesis was performed, mapping intervention characteristics and outcomes to NASSS domains. An exploratory predictive modelling, including logistic regression and decision tree analysis, were used to identify factors influencing intervention success. This review was registered with PROSPERO (CRD420251006170). Results: The included studies evaluated diverse interventions such as CDSS, electronic prescribing platforms, pharmacist-led deprescribing systems, and telehealth-supported medication reviews. Thematic synthesis revealed that successful adoption was associated with user-centred technology design, strong clinical leadership, integration into clinical workflows, and organizational readiness for change. Interventions that incorporated multidisciplinary collaboration, continuous feedback mechanisms, and iterative adaptation to clinical contexts showed stronger patterns of sustainability. Common barriers included technological complexity, poor interoperability with existing systems, lack of provider engagement, insufficient training for end-users, and external regulatory and policy constraints. Predictive modelling using logistic regression and decision tree analysis supported the thematic findings, identifying usability, early stakeholder engagement, organizational alignment, and system adaptability as consistent factors associated with successful adoption and sustainability. Conclusion: This is the first review to integrate the NASSS framework with predictive modelling to evaluate technology-supported medicines optimization for older adults with multimorbidity and polypharmacy. The findings emphasize that successful implementation requires a formative, contextually sensitive approach that addresses technological, organizational, and policy-level complexities.

Barriers to, and enablers of, medication taking among Chinese adults living with type 2 diabetes mellitus in Australia: a qualitative study

2025-06-24

Olumuyiwa Omonaiye , Alemayehu Mekonnen , Christopher Gilfillan +7 more | International Journal of Clinical Pharmacy

Diabetes prevalence among individuals of Chinese background in Australia is about three times higher than the general population. The aim of this study was to identify specific barriers and enablers … Diabetes prevalence among individuals of Chinese background in Australia is about three times higher than the general population. The aim of this study was to identify specific barriers and enablers of medication-taking among adults of Chinese background living with type-2 diabetes mellitus (T2DM) in Australia. Qualitative semi-structured interviews were conducted with: (1) adults (18 + years) with T2DM of Chinese heritage currently prescribed diabetes medications; (2) health professionals involved in the care of people with T2DM of Chinese heritage. Participants were recruited from a national registry and single specialist clinic. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive content analysis based on the 14 domains of the Theoretical Domains Framework (TDF). The most relevant TDF domains were identified based on frequency counts across cohorts. A total of 25 people living with T2DM (60% male; age range: 31-72), and 11 healthcare professionals (5 endocrinologists; 5 pharmacists; 1 credentialled diabetes educator; 10 of Chinese background) participated. Barriers and enablers influencing medication-taking behaviors were identified across 13/14 TDF domains (except for 'Reinforcement'). Relevant domains most frequently identified were: Social Influences; Environmental Context and Resources; Beliefs About Consequences, and Behavioral Regulation. Drawing on the TDF, potential targets for future interventions aimed at improving the uptake and maintenance of medication-taking behavior among adults with T2DM of Chinese heritage were identified. These data may support the development of culturally relevant and theoretically informed healthcare professional strategies and diabetes education programs, and ultimately, improve health outcomes for individuals with T2DM.

Knowledge domain and emerging trends in medication literacy research from 2003 to 2024: a scientometric and bibliometric analysis using CiteSpace and VOSviewer

2025-06-24

Penghong Deng , Xiaoxia Liu , Caiyun Li +4 more | Frontiers in Public Health

Background Medication literacy (ML) has emerged as a critical global public health concern, garnering growing scholarly attention over the past two decades. To delineate major research domains, identify evolving trends, … Background Medication literacy (ML) has emerged as a critical global public health concern, garnering growing scholarly attention over the past two decades. To delineate major research domains, identify evolving trends, and inform future research priorities, we conducted a scientometric analysis of the scientific literature on ML. Methods A systematic search was performed to retrieve publications on ML from the Web of Science Core Collection, covering the period from 2003 to 2024. Scientometric analyses were executed using CiteSpace and VOSviewer to visualize and evaluate collaborative networks, including co-citation references, co-occurring keywords, and contributions by countries, institutions, authors, and journals. Results The analysis incorporated 1,968 eligible publications. A rapidly growing trend in research interest in ML was observed, with an average annual growth rate of 46.1% in publications between 2003 and 2022. Three major research trends were identified: relationship between ML and medication adherence, the development of ML-specific assessment tools, and investigation of psychosocial factors associated with ML. The United States of America, Northwestern University, Davis Tc, and Patient Education and Counseling were identified as the most cited and influential entities within this field, representing the leading country, institution, author, and journal, respectively. Conclusion Scientometric analysis provides invaluable insights to clinicians and researchers involved in ML research by identifying leading contributors, intellectual bases and research trends. ML is evolving from unidimensional analysis to multidisciplinary exploration of dynamic mechanisms. Future research on ML is facing significant challenges, including the exploration of adherence mechanisms, validation of digital assessment tools, and the moderating effect model of socio-psychological factors on ML.

Folia Pharmacotherapeutica juli 2025

2025-06-24

| Tijdschrift voor Geneeskunde

Pharmacovigilance in the Geriatric Population: Analysis of Risk Management Plans for Medicinal Products in Russia in 2024

2025-06-24

N. V. Tereshkina , N. Yu. Velts , Е. О. Журавлева +3 more | Safety and Risk of Pharmacotherapy

INTRODUCTION. Geriatric patients are the fastest growing demographic group, accounting for over half of all medicinal product users. Pharmacovigilance in this population is influenced by age-related physiological changes and social … INTRODUCTION. Geriatric patients are the fastest growing demographic group, accounting for over half of all medicinal product users. Pharmacovigilance in this population is influenced by age-related physiological changes and social factors. Risk management plans (RMPs), developed by marketing authorisation holders, play a preventive role in managing the risks associated with the use of medicinal products in elderly patients. AIM. This study aimed to evaluate the completeness of information on the geriatric group within target populations in RMPs for medicinal products launched in the Russian pharmaceutical market in 2024. MATERIALS AND METHODS. This study analysed 110 RMPs for medicinal products potentially applicable to geriatric populations, submitted to the Scientific Centre for Expert Evaluation of Medicinal Products between January and December 2024. All the documents included full modules and sections. RESULTS. The analysis revealed critical gaps in RMPs data for geriatric populations, including the epidemiology of indication(s) and target population(s) (these data were missing in 52.0% of cases); clinical trial exposure (patients over 60 years were excluded from clinical trials in 47.3% of cases); populations not studied in clinical trials (these data were unreported in 63.6% of cases); post-authorisation experience in elderly or senile patients (these data were missing in 83.6% of cases); and potential harm from overdose (risk warnings were absent in 96.4% of cases). There were no additional risk minimisation measures for emphasising the considerations for medicinal product use in the geriatric population in the analysed documents. CONCLUSIONS. When drafting RMPs, marketing authorisation holders and medicinal product developers do not pay sufficient attention to geriatric populations and often underestimate the risks associated with medicinal product use in elderly and senile patients. The issues associated with the use of medicinal products in geriatric patients can be mitigated through rigorous risk management practices applied during pharmacotherapy. The parties concerned should consider this when drafting the summary of medicinal product characteristics and the patient information leaflet, labelling the medicinal product, and selecting the package size.

Advanced Pharmacy Australia general medicine standards

2025-06-24

Paul Firman , Marianne Jovanovic , S J McPhee +3 more | Journal of Pharmacy Practice and Research

Right Message and Right Time: Maximizing Effect of Patient‐Directed Education to Promote Deprescribing

2025-06-24

Amy M. Linsky , Kristin M. Zimmerman | Journal of the American Geriatrics Society

Clinical Outcomes of Pharmacist Involvement in Cardiac Arrest and Trauma Resuscitations: A Scoping Review

2025-06-24

Hrishikesh Patel , Myles Wee , Aaron M Tejani +1 more | Pharmacy

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective … Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of pharmacists on medication and patient outcomes during cardiac and trauma resuscitations and to identify barriers to integration. Methods: A literature search of databases in September 2024 identified randomized and non-randomized control trials, evaluating the impact of pharmacists’ involvement in cardiac or trauma resuscitations. Excluded were studies on acute stroke, acute hemorrhage, and sepsis. Data were extracted and analyzed for primary (e.g., medication errors and Advanced Cardiovascular Life Support [ACLS] compliance) and secondary outcomes (e.g., pharmacists’ education and training). Results: Of the 560 records screened, 26 records were included in the final analysis. Due to heterogeneity, quantitative analysis was not feasible. Among primary outcomes, ACLS guideline compliance and medication errors were commonly reported; mortality and length of stay were less commonly reported. ACLS certification improved pharmacists’ confidence in their tasks. Pharmacists’ presence also correlated with reduced healthcare costs. Conclusions: Our analysis suggests that the involvement of pharmacists in the context of emergency cardiac or trauma resuscitations may benefit direct patient outcomes and indirect outcomes.

Primary, secondary and tertiary prevention of long-term benzodiazepine receptor agonists use in Belgium: a policy Delphi

2025-06-23

Pauline Van Ngoc , Béatrice Scholtes , Jean-Luc Belche +1 more | Archives of Public Health

The long-term use of benzodiazepine receptor agonists (BZRAs) poses a significant public health challenge in Belgium because of the associated risks of physical and psychological dependence. Despite guidelines recommending short-term … The long-term use of benzodiazepine receptor agonists (BZRAs) poses a significant public health challenge in Belgium because of the associated risks of physical and psychological dependence. Despite guidelines recommending short-term use, BZRAs are frequently prescribed beyond the recommended duration, leading to chronic use and associated harm. To address this issue, a policy Delphi study was conducted to assess targeted strategies for preventing long-term BZRA use through the lenses of primary, secondary, and tertiary prevention. The study involved a panel of experts, including healthcare professionals and patients, who participated in two rounds of questionnaires to evaluate 27 policy recommendations. These recommendations were assessed for feasibility, support, and importance, and participants were also asked whether the necessary conditions were in place to implement each recommendation. This approach aimed to identify areas of consensus and divergence among participants. Key findings reveal a strong consensus on the need for awareness campaigns aimed at healthcare professionals and the general public to highlight the risks associated with BZRA withdrawal. There was also significant support for implementing training programs to equip healthcare providers with the skills needed to manage BZRA withdrawal effectively. However, some recommendations, such as increasing remuneration for long follow-up consultations and establishing a peer support "benzo-buddy" system, garnered less agreement, suggesting that these proposals require further refinement. This study highlights the complexity of addressing long-term BZRA use and advocates for a comprehensive, multifaceted approach. This approach should integrate education, awareness, and tailored healthcare practices to increase prevention efforts. The findings emphasise the importance of coordinated interventions across different levels of prevention to effectively mitigate long-term use on BZRAs in Belgium. By refining and implementing these strategies, the likelihood of achieving meaningful improvements in the management and reduction of chronic BZRA use could be significantly increased, contributing to better public health outcomes.

Role of Extemporaneous Medications in Inpatient Care: A Comparative Analysis with Their Industrial Counterparts

2025-06-23

Yuri V. Miroshnichenko , Ekaterina Yu. Alekseychuk , Rimma A. Enikeeva | Bulletin of the Russian Military Medical Academy

BACKGROUND: Currently, regarding the continuously rising healthcare expenditures, the search for ways to optimize costs and improve budget spending efficiency is becoming increasingly relevant. Unlike pharmaceuticals mass-produced by chemical and … BACKGROUND: Currently, regarding the continuously rising healthcare expenditures, the search for ways to optimize costs and improve budget spending efficiency is becoming increasingly relevant. Unlike pharmaceuticals mass-produced by chemical and pharmaceutical manufacturers, their pharmacy-compounded counterparts have significant competitive advantages. AIM: The study aimed to assess the advantages of extemporaneous medications over their industrial counterparts using the example of a multidisciplinary medical institution — Pokrovskaya City Hospital (St. Petersburg). METHODS: The study’s theoretical and methodological basis included legislative and regulatory acts governing the circulation of medicines and pharmaceutical activities. This includes compounding and quality control of extemporaneous medications; scientific works on organizing pharmaceutical supply, pharmaceutical technology, and quality control of medicinal products and other scientific, methodological, and reference data on the topic under study; and reporting documentation from Pokrovskaya City Hospital. RESULTS AND DISCUSSION: This study substantiates the significance of certain extemporaneous medications over their industrial equivalents based on the needs of medical institutions. It demonstrates how pharmacy-based compounding contributes to more rational use of financial resources and improved quality of medical care. The study emphasizes that pharmacy compounding should comply with current legislation and regulatory acts governing pharmaceutical activities and be based on clearly defined instructions, protocols, and quality standards. Furthermore, collaboration with regulatory authorities and participation in the pharmacovigilance system ensure that extemporaneous medications meet safety and efficacy requirements. A comprehensive analysis is required to assess the advantages of extemporaneous medications over their industrial counterparts — one that considers the cost of raw materials, pharmaceutical personnel labor, equipment depreciation, and quality control expenses. A crucial factor is comparing the production cost of extemporaneous medications with the prices of industrial equivalents, including logistics, storage, and related expenses. CONCLUSION: Pharmacy compounding is a promising and potentially cost-effective direction, provided that it is implemented with due consideration of all critical factors. Proper planning, quality control, and compliance with legal regulations will enable pharmacies to optimize the healthcare system, reduce medication procurement cost, enhance the flexibility and responsiveness of drug supply, and provide opportunities for individualized dosing and composition adjustments to meet specific patient needs.

Drug-related Problems in Prescribing for Outpatients with Type 2 Diabetes at a District General Hospital in Hanoi

2025-06-23

Nguyen Thi Thao , Vu Hai Ha , Le Thi Thuy Hoa +2 more | VNU Journal of Science Medical and Pharmaceutical Sciences

Objectives: This study aimed to identify drug-related problems (DRPs) in prescriptions for outpatients with type 2 diabetes mellitus (DM) at a district general hospital in Hanoi. Methods: The study included … Objectives: This study aimed to identify drug-related problems (DRPs) in prescriptions for outpatients with type 2 diabetes mellitus (DM) at a district general hospital in Hanoi. Methods: The study included type 2 DM outpatients who underwent HbA1c testing between June 1 and June 30, 2023. A cross-sectional, whole-sample study design was utilized, with disease and medication data collected from patient medical records. DRPs were identified using a level 2B medication review based on the Pharmaceutical Care Network Europe (PCNE) classification. Initial DRP identification was conducted by pharmacists, followed by discussions with prescribing physicians for consensus. Results: A total of 289 patients were included in the analysis, resulting in the identification of 497 DRPs, averaging 1.7 DRPs per prescription. The most common DRPs involved lipid-lowering medications (55.6%) and hypoglycemic medications (37.2%). The majority of DRPs (89.1%) were attributed to insufficient treatment effectiveness (PCNE code P1), predominantly due to inappropriate drug according to guidelines (PCNE code C1.1, accounting for 85.3%). Conclusions: DRPs in outpatient prescribing for type 2 DM primarily involve hypoglycemic and lipid-lowering medications. Enhanced clinical pharmacy services are essential to optimize prescribing practices in this patient population.

Optimizing chronic disease management through community-based pharmaceutical care for older adults in China: a systematic review and meta-analysis of randomized controlled trials

2025-06-23

Qingming Liu , Yushan Guo , Y. Zhang +5 more | International Journal of Clinical Pharmacy

Estudio de interacciones farmacológicas en pacientes internados en un hospital universitario

2025-06-23

| Revista Médica del Uruguay

Attitudes and impediments of the implementation of clinical pharmacy services and pharmaceutical care in Ethiopia: a systematic review

2025-06-21

Tasissa A. Wokuma , Gemechu G. Ararame , Korinan F. Taressa | International Journal of Scientific Reports

Clinical pharmacy services are firmly established in many countries, associated with reduced adverse drug events, medication errors, length of hospital stay, mortality rates, and costs. However, implementation of clinical pharmacy … Clinical pharmacy services are firmly established in many countries, associated with reduced adverse drug events, medication errors, length of hospital stay, mortality rates, and costs. However, implementation of clinical pharmacy is in its infancy in many developing countries including Ethiopia. The aim of this systematic review was to identify attitudes and factors influencing the implementation of clinical pharmacy services and pharmaceutical care in Ethiopia. A systematic review of published articles was conducted using databases such as PubMed, EMBASE, Scopus and Google scholar. A search was conducted from 01 July 2021 to 11 October 2021. The studies published in peer-reviewed journals in the English language, their full texts available and those done in Ethiopia were included. For this review, eleven articles were accepted and considered. From the included studies, about 52.6% of physicians and half of other health care professionals were of the opinion that pharmacists should concentrate on drug product and patient care should be left to other health care providers. Lack of clearly defined roles and responsibilities for the clinical pharmacists, lack of a support from the hospital management, lack of awareness, hesitance to have clinical pharmacists in the health care team, lack of proper communication and lack of incentives for the service are common factors influencing the implementation of clinical pharmacy services and pharmaceutical care.

<b>A STUDY OF DRUG-DRUG INTERACTIONS AMONG PATIENTS RECEIVING MULTIDRUG THERAPY IN THE INTERNAL MEDICINE UNIT</b>

2025-06-21

Muhammad Ali , S. Zaheer , Umbreen Farrukh +5 more | Journal of medical & health sciences review.

Background: Drug-drug interactions (DDIs) are a significant but often under-recognized cause of adverse drug events, particularly in hospitalized patients receiving multidrug therapy. Objective: To evaluate the prevalence, severity, and patterns … Background: Drug-drug interactions (DDIs) are a significant but often under-recognized cause of adverse drug events, particularly in hospitalized patients receiving multidrug therapy. Objective: To evaluate the prevalence, severity, and patterns of drug-drug interactions among hospitalized patients receiving multidrug therapy and to identify factors associated with increased DDI risk. Methods: This descriptive, cross-sectional study was conducted at Tertiary Care Hospital ,Karachi from 1st December 2024 to 10 May 2025. A total of 235 patients were included in the study. Data were collected using a structured proforma designed to capture demographic information, clinical diagnosis, prescribed medications, and duration of hospital stay. Prescriptions were manually reviewed to identify all concurrent medications, and drug interaction screening was carried out using trusted, evidence-based drug interaction checkers.Results: Out of 235 patients, 184 (78.3%) had at least one potential DDI, with a total of 527 interactions identified. Moderate interactions accounted for 40.2%, minor for 30.9%, and major for 28.9%. A statistically significant association was found between the number of prescribed drugs and the presence of DDIs (p < 0.001). Older age (≥65 years) and multiple comorbidities were also significantly associated with a higher frequency and severity of interactions. Conclusion: It is concluded that DDIs are highly prevalent among patients on multidrug therapy, especially in older adults and those with polypharmacy.

Prescribing Pattern of Antiepileptic Drugs and Patients Compliance to Treatment; A Prospective Study in a Tertiary Care Hospital, Bengaluru

2025-06-20

Bhavana Bhavana B , S. Lal , Ankitha Ankitha A +1 more | Indian Journal of Pharmacy Practice

Potential Drug-Drug Interactions and Gender-Based Comparative Analysis of Chemotherapy-Related Side Effects in Oncology Patients: A Prospective, Comparative Study at a Tertiary Care Hospital in Urban India

2025-06-20

Trupti Tuse , Rahul Surve , Ketakee Gosavi +2 more | Indian Journal of Pharmacy Practice

Optimizing Hemostatic and Antithrombic Therapies: A Comprehensive Stewardship Strategies

2025-06-20

R. Ismail , Ramya Jayabal , Raveena Rajesh Kumar +1 more | Indian Journal of Pharmacy Practice

Revolutionizing Healthcare in India: Impact of Clinical Pharmacists in Enhancing Patient Outcomes

2025-06-20

Vishal Chauhan , Maitri Shah , Kushal Shah +1 more | Indian Journal of Pharmacy Practice

Research priorities of the European Society of Clinical Pharmacy (ESCP): a questionnaire-based study

2025-06-20

Betül Okuyan , Martin Henman , Vibhu Paudyal +7 more | International Journal of Clinical Pharmacy

Abstract Introduction It is important for health professional societies to involve members in defining their roles and future activities including research priorities. Aim This study aimed to identify members’ views … Abstract Introduction It is important for health professional societies to involve members in defining their roles and future activities including research priorities. Aim This study aimed to identify members’ views on the areas of research that European Society of Clinical Pharmacy (ESCP) should prioritise in delivering research support, research projects and education. Method An online questionnaire was initially developed by the ESCP Research Committee and reviewed by the research team. It included structured and open-ended items related to respondents’ demographics, research experience, views on future research priorities, topics that ESCP should prioritise, and barriers to research involvement. After testing face and content validity, the questionnaire was sent to all ESCP members (N = 417). Descriptive statistics and summative content analysis were used. Results Eighty-two responses were received (response rate: 19.7%). Research on real-world processes that facilitate the implementation of clinical pharmacy services into every-day practice was the priority for most respondents (n = 77, 93.9%). Respondents believed that ESCP should focus on research support for implementation science (n = 52, 63.4%) and methods to analyse clinical judgement and decision-making (n = 48, 58.5%). The perceived barriers to developing high-quality research in clinical pharmacy were reported as a lack of knowledge, skills and training, limited funding opportunities and insufficient time. Conclusion Research topics identified will help to inform ESCP and its committees on the priorities for research activities of the society in the near future, as well as other collaborating professional organisations of the current priority research objectives of ESCP in the international context.

Application and evaluation of the global trigger tool approach to adverse drug event monitoring in the high-risk elderly inpatients with multiple chronic diseases

2025-06-20

Na Li , Xiaomin Lv , Chenyang Jiao +4 more | Frontiers in Pharmacology

Objective To establish a Global Trigger Tool (GTT) method suitable for monitoring adverse drug events (ADEs) in the high-risk elderly inpatients with multiple chronic diseases, and to evaluate its sensitivity, … Objective To establish a Global Trigger Tool (GTT) method suitable for monitoring adverse drug events (ADEs) in the high-risk elderly inpatients with multiple chronic diseases, and to evaluate its sensitivity, specificity and feasibility. Methods A total of 38 triggers were established by searching the literature and combining the characteristics of elderly hospitalized patients with multiple chronic diseases in Taizhou People’s Hospital. A total of 480 elderly patients with multiple chronic diseases were sampled from January to December 2023, and the cases were reviewed. Adverse event grades were determined, and drug classes and organ-systems involved were analyzed; binary logistic regression and Receiver Operating Characteristic curves were adopted for analysis. Results Among the 480 cases, 123 cases were detected as having one or more positive triggers. ADEs occurred in 65 patients, with a total of 93 occurrences of ADEs; the highest number of ADE cases was observed in the administration of cardiovascular drugs, with 36 cases (38.71%). The highest organ-system involved in ADE was metabolic and nutritional disorders, with 47 cases (50.54%). The number of ADEs occurring in 1,000 patient-days was 22.90. The number of ADEs occurring in 100 patients was 19.38. Using binary logistic regression analysis, the risk factors were age and number of positive trigger detections for predicting the occurrence of ADEs. The GTT method had a sensitivity of 78.46%; specificity of 82.65%; compliance rate of 82.00%; Kappa value of 44.40%; and the Positive Predictive Value (PPV) was 41.46%. Conclusion The GTT method has high sensitivity and specificity and is feasible; it has a relatively high PPV and is suitable for detecting ADEs in the high-risk elderly inpatients with multiple chronic diseases.

Trends of potentially inappropriate prescribing among older outpatients in China between 2015–21

2025-06-19

Fangyuan Tian , Zhaoyan Chen , Ying Zhang +1 more | Journal of Global Health

Potentially inappropriate medication (PIM) remains a significant global concern due to its association with adverse drug events in older adults. The prevalence of potentially inappropriate prescriptions (PIPs) varies considerably across … Potentially inappropriate medication (PIM) remains a significant global concern due to its association with adverse drug events in older adults. The prevalence of potentially inappropriate prescriptions (PIPs) varies considerably across different countries. However, there is a lack of evidence using standardised Chinese national criteria to explore variations in prescribing trends. We aimed to evaluate the trends in the prevalence of PIP based on these criteria. In this descriptive epidemiological study, we utilised prescription data from older outpatients across 59 hospitals in six major geographic regions of China. We analysed the prevalence of PIP overall, as well as the prevalence of PIP caused by varying numbers of PIMs and high-risk PIMs (clopidogrel, estazolam, zolpidem, sliding-scale insulin, alprazolam) for the period between 2015-21. We calculated the average annual percent change (AAPC) using joinpoint regression to examine temporal trends. A total of 982 605 prescriptions for older outpatients between 2015-21 were included in the analysis. The prevalence of PIP related to multiple PIMs increased from 4.70% to 6.09% (AAPC = 4.45). Notably, the prevalence of PIP associated with estazolam (AAPC = 3.71), zolpidem (AAPC = 13.51), and alprazolam (AAPC = 8.86) demonstrated a steady upward trend, while the prevalence of PIP linked to clopidogrel (AAPC = -4.70) consistently declined. We observed an increasing trend in PIP associated with sedative-hypnotic medications. It demands heightened attention in subsequent use to ensure drug safety.

Exploring the Interactions between Drugs and Metabolic Disturbances in CKD

2025-06-19

Touria Mernissi , Stéphane Jaisson , Pierre Spicher +7 more | Kidney360

Background: The metabolic disturbances associated with chronic kidney disease might alter drug distribution, decrease albumin drug binding, and thus increase the free (unbound) drug concentrations. Uremic toxins can affect the … Background: The metabolic disturbances associated with chronic kidney disease might alter drug distribution, decrease albumin drug binding, and thus increase the free (unbound) drug concentrations. Uremic toxins can affect the pharmacokinetic or pharmacodynamic activity of certain drugs. Vitamin K antagonists (VKA) are interesting candidates for the evaluation of potential interactions between uremic toxins and drugs. The primary objective of the present study was to investigate the association between free VKA concentrations and the estimated glomerular filtration rate (eGFR). Furthermore, we sought to determine whether this relationship was mediated by protein carbamylation (measured by homocitrulline levels) and/or the accumulation of protein-bound uremic toxins (PBUTs). Methods: In this prospective cross-sectional study, 389 adult patients treated with VKA were included between May 2021 and June 2023. Levels of free VKAs, total VKAs, homocitrulline and PBUTs were assayed using liquid chromatography-tandem mass spectrometry. We used a linear regression model to explore the association between kidney function and free VKA levels and mediation analyses to determine whether the association between kidney function and free VKA levels was mediated (at least partly) by PBUTs and/or protein carbamylation. Results: Patients with an eGFR < 40 mL/min/1.73 m 2 or those on chronic hemodialysis had lower total VKA levels, higher free VKA levels and thus a higher of free/total VKA ratio than those with an eGFR ≥ 40 mL/min/1.73 m 2 . Kidney function was independently associated with free VKA levels (β 1 =0.31 [0.19; 0.42], p<0.001). Twenty one percent [95%CI, 1%-35%] of the association between kidney function and free VKA levels was mediated by homocitrulline, but not by PBUTs. Conclusions: Our results showed that a low kidney function was associated with an elevation in the free drug fraction. This association was independent of blood albumin levels and appeared to be partly mediated by protein carbamylation.

Association of Korean Medicine and polypharmacy with fall risk and mortality in older adults with stroke

2025-06-19

Ye‐Seul Lee , Bo-Hyoung Jang , Jin Pyeong Jeon +3 more | Frontiers in Pharmacology

Background Stroke survivors often take multiple medications (polypharmacy), raising concerns about falls and mortality in older adults. This study investigated whether Korean Medicine (KM)—primarily acupuncture—is associated with fall risk and … Background Stroke survivors often take multiple medications (polypharmacy), raising concerns about falls and mortality in older adults. This study investigated whether Korean Medicine (KM)—primarily acupuncture—is associated with fall risk and mortality among older adults with stroke and polypharmacy. Methods A population-based retrospective cohort study using South Korea’s National Health Insurance Service (NHIS) claims database. Adults aged 65 or older with a first stroke in 2015 were included if they had five or more prescribed medications (polypharmacy) or ten or more (hyper-polypharmacy) for at least 270 days. KM users received acupuncture or electroacupuncture (≥3 outpatient visits or ≥1 inpatient stay) within a year of stroke onset. The primary outcome was falls resulting in fracture; the secondary outcome was all-cause mortality—both assessed over 3 years. Propensity score matching balanced demographics, comorbidities, and medication use. Cox proportional hazards and subgroup analyses were conducted. Subgroup and sensitivity analyses explored effect modification. Results Among 25,034 older stroke patients, 10,011 had polypharmacy; of those, 6,809 used KM. After matching, 3,127 KM users were compared with 3,127 non-users. KM users with polypharmacy had a higher rate of falls but lower all-cause mortality than non-users. In hyper-polypharmacy, KM use did not significantly affect falls but was associated with lower mortality. Sensitivity analyses of the unmatched cohort, alternative outcome definitions, and interactions yielded consistent patterns. Conclusion In older adults with stroke and polypharmacy, KM may improve functional recovery and mobility, potentially increasing falls if balance training is inadequate, yet simultaneously confer survival advantages—perhaps through neuro-immune or systemic effects—irrespective of medication load. Among the more frail hyper-polypharmacy group, KM reduced mortality without altering falls, suggesting that functional gains and competing-risk dynamics differ by medication intensity. Prospective studies with granular functional measures, drug–drug interaction data, and formal competing-risk models are needed to optimize the safe integration of KM into comprehensive stroke care.

Research and scholarly methods: Mixed methods studies

2025-06-19

Jacqueline E. McLaughlin , Sandra L. Kane‐Gill , Margie E. Snyder | JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY

Abstract Pharmacy research focuses on increasingly complex health care challenges, requiring various research designs to generate findings that enable us to advance clinical practice. Mixed methods research combines quantitative and … Abstract Pharmacy research focuses on increasingly complex health care challenges, requiring various research designs to generate findings that enable us to advance clinical practice. Mixed methods research combines quantitative and qualitative research to provide a deeper and more nuanced understanding of research problems by leveraging the strengths of each method. Researchers may use one method before the other (e.g., explanatory sequential, exploratory sequential) or use both at the same time (e.g., convergent parallel). While some key steps for conducting mixed methods research align with other common methodologies (e.g., clear purpose and rationale, appropriate design and rigor, transparent data collection), mixed methods studies also include a point of interface that demonstrates how the quantitative and qualitative data were utilized to answer the research question. Within pharmacy practice research, mixed methods research may require unique considerations. As examples, pharmacy dispensing systems vary in how specific data fields are collected and reported, and demographic data can be difficult to standardize given different variable definitions and data collection methods. Further, scheduling interviews with patients and providers requires thoughtful scheduling, which may need to be during appointments or working hours. When combining quantitative and qualitative data from various sources, consistent identifiers may also need to be applied to ensure linkage of subjects' data. Given the increasing use of mixed methods in pharmacy practice research, scholars and readers must ensure they understand how and why mixed methods might be utilized. The purpose of this article is to describe mixed methods research, offer special considerations for its use in pharmacy practice research, and detail contemporary challenges and considerations for those interested in conducting or reading mixed methods studies.

Beneficial outcomes of medication review in patients with hip fractures: a systematic review

2025-06-19

Dina Aprillia Ariestine , Taro Kojima , Fakhriza Hidayati Siregar +1 more | European Geriatric Medicine

Advancing neurological care: The emerging role of pharmacists in patient-centered management

2025-06-18

Irma Wati Ngadimon , Rose Aniza Rusli , Farah Waheeda Tajurudin | Advanced Neurology

The role of pharmacists in healthcare is rapidly evolving, extending beyond traditional dispensing to encompass critical clinical functions within interdisciplinary teams. In neurological care, where patients often face complex, long-term … The role of pharmacists in healthcare is rapidly evolving, extending beyond traditional dispensing to encompass critical clinical functions within interdisciplinary teams. In neurological care, where patients often face complex, long-term pharmacotherapy, pharmacists remain an underutilized resource despite their specialized expertise. This perspective article explores the growing involvement of pharmacists in managing neurological disorders such as epilepsy, Parkinson&rsquo;s disease, stroke, and dementia. It highlights their expanding contributions across medication optimization, adherence support, patient education, adverse effect monitoring, and integration of digital tools, including artificial intelligence and pharmacogenomics. Drawing on recent evidence and international models, the article illustrates how pharmacist-led interventions improve therapeutic outcomes, reduce hospitalizations, and enhance safety in both hospital and community settings. The discussion emphasizes the importance of embedding pharmacists more fully into neurology teams to meet the increasing demand for patient-centered, coordinated care. In addition, it calls for strategic investments in pharmacist training, supportive policies, and future research to realize the full potential of pharmacists in neurology. By recognizing pharmacists as integral partners in neurological care, healthcare systems can advance quality, equity, and efficiency in managing these complex disorders. This perspective aims to spark dialog and innovation around an emerging frontier in collaborative neuropharmaceutical practice.

Level of public knowledge on the principle of DAGUSIBU in antacid drugs at thalhah pharmacy

2025-06-17

Herman Herman , Sulfiyana H. Ambo Lau | JURNAL ILMIAH KESEHATAN SANDI HUSADA

Introduction: Antacids are commonly used over-the-counter medications for treating gastritis, yet public knowledge regarding their proper use remains limited. The DAGUSIBU (Obtain, Use, Store, Dispose) campaign by the Indonesian Pharmacists … Introduction: Antacids are commonly used over-the-counter medications for treating gastritis, yet public knowledge regarding their proper use remains limited. The DAGUSIBU (Obtain, Use, Store, Dispose) campaign by the Indonesian Pharmacists Association aims to improve rational drug use among the community. However, initial observation at Thalhah Pharmacy in Makassar revealed a lack of counseling related to DAGUSIBU principles. This study aims to assess the level of public knowledge regarding the DAGUSIBU principles related to antacid use at Thalhah Pharmacy. Method: This was a descriptive study using a survey method. A total of 48 respondents were selected from 90 pharmacy visitors through accidental sampling using the Slovin formula. Data were collected using a Likert-scale questionnaire and analyzed using Microsoft Excel, with results presented in percentage tables and categorized into three levels: good, fair, and poor. Results: Findings show that 73.25% of respondents had good knowledge, 20.82% had fair knowledge, and 5.91% had poor knowledge of DAGUSIBU principles. Knowledge of obtaining antacids was good (77.8%), while use (59%), storage (58%), and disposal (43.7%) scored moderately. Conclusion: The public demonstrates adequate knowledge in obtaining antacids, but further education is needed in the areas of usage, storage, and disposal to support safe and responsible self-medication practices

Improving usability of the STOPP/START version 3 criteria: development of a practice tool for clinicians, students and researchers

2025-06-17

Olivia Dalleur , François‐Xavier Sibille , A Mouzon +4 more | European Geriatric Medicine

Abstract Background The STOPP/START criteria are aimed to be used by clinicians to perform medication review to optimize pharmacotherapy in older adults. The STOPP/START.version 3 (SS.v3) published in European Geriatric … Abstract Background The STOPP/START criteria are aimed to be used by clinicians to perform medication review to optimize pharmacotherapy in older adults. The STOPP/START.version 3 (SS.v3) published in European Geriatric Medicine in 2023 updated and significantly extended the previous version. SS.v3 is more open to criticism for its poor usability in daily clinical practice. The present study aimed at contributing to SS.v3 by highlighting the new content of its criteria and by providing clinicians, students and researchers with a user-friendly presentation to facilitate medication review. Methods The SS.v3 criteria were reviewed by seven geriatricians and clinical pharmacists with expertise in pharmacotherapy in older adults. The 190 SS.v3 criteria were carefully compared to the 115 SS.v2 criteria in order to identify the new ones and those with clinically significant modifications. A single-entry table was developed for the medications (STOPP.v3) and the medical conditions (START.v3). Results Among the 133 STOPP.v3 criteria, we identified 54 new (41%) and 25 modified (19%) ones. The 57 START.v3 criteria include 24 new (42%) and 17 modified (30%) ones. The single-entry table is a comprehensive presentation of SSv3 in 3 pages. It is systematically organized and upfront presents the medication for the STOPP criteria and the condition for the START criteria, enhancing its usability. Conclusion This work highlights many new and modified SS.v3 criteria that clinicians, students and researchers should be aware of. The single-entry table for STOPP medications and START clinical conditions may facilitate medication review for older adults in daily clinical practice.

Open Access to Antipsychotics in State Medicaid Programs: Effect on Healthcare Resource Utilization and Costs among Patients with Serious Mental Illness

2025-06-17

Rashmi Patel , O. Başer , Heidi C. Waters +4 more | Journal of health economics and outcomes research

Background: The restrictive consequences of Medicaid formulary restriction policies on antipsychotic medications may lead to higher healthcare utilization and costs among beneficiaries with serious mental illness (SMI). Objectives: This study … Background: The restrictive consequences of Medicaid formulary restriction policies on antipsychotic medications may lead to higher healthcare utilization and costs among beneficiaries with serious mental illness (SMI). Objectives: This study compared outcomes among patients with SMI accessing antipsychotic medications through state Medicaid programs with open access (OA) policies (Michigan) vs 5 states without Medicaid OA policies (California, Colorado, Florida, Illinois, Wisconsin). Methods: A retrospective analysis was conducted using Kythera Labs Medicaid data (Jan. 1, 2016–Dec. 31, 2023). Outcomes were assessed for patients with SMI (>18 years of age, ≥1 antipsychotic medication claim during the identification period (Jan. 1, 2017–Dec. 31, 2022), ≥1 SMI claim in the 12-month baseline). Continuous medical and pharmacy benefits were required for 12 months pre- and post-index date. Outcomes included SMI-related hospital admissions, length of hospital stay, emergency department and outpatient visits, and associated costs. Results: A greater proportion of beneficiaries with SMI resided in Michigan than in the other states. After matching, significantly more antipsychotics users experienced SMI-related hospitalizations in California (18.25% vs 9.47%, P < .0001), Colorado (11.41% vs 7.33%, P =.0004), Florida (19.70% vs 10.17%, P < .0001), Illinois (23.57% vs 8.79%, P < .0001), and Wisconsin (15.21% vs 10.02%, P = .0046) than in Michigan. Length of stay was lower in Michigan than in California, Colorado, and Illinois. Inpatient costs related to SMI were significantly lower in Michigan, yet pharmacy costs were higher. Total SMI-related costs were higher in all non-OA states than in Michigan, except Colorado. Discussion: State Medicaid programs without OA to antipsychotics were associated with higher rates of SMI-related resource utilization and costs vs Michigan. Conclusions: Policy makers should consider the potential downstream cost implications of restrictive access policies and evaluate whether OA could result in improved health outcomes for patients and savings for Medicaid programs.

Medication Discrepancies and Medication-Related Problems in Psychiatric Patients: A Medication Reconciliation Study

2025-06-17

Mozhdeh Shahabi , Mahsa Panahishokouh , Niayesh Mohebbi | Research Square (Research Square)

<title>Abstract</title> <bold>Background:</bold> Medication discrepancies (MDs) are common medication errors that can lead to adverse drug events (ADEs) and suboptimal treatment. Medication reconciliation (MR) programs are implemented in many countries, including … <title>Abstract</title> <bold>Background:</bold> Medication discrepancies (MDs) are common medication errors that can lead to adverse drug events (ADEs) and suboptimal treatment. Medication reconciliation (MR) programs are implemented in many countries, including Iran, to identify, resolve, and prevent MDs and other medication-related problems (MRPs). In the psychiatric setting, the importance of identifying and addressing MRPs is even greater due to the high prevalence of polypharmacy, limited patient cooperation, and other factors. This study aimed to investigate the prevalence of MDs and MRPs in psychiatric patients. <bold>Methods:</bold> This study included 302 psychiatric patients receiving at least two systemic medications daily. Their medications were reviewed at discharge using the Pharmaceutical Society of Australia (PSA) guidelines to identify MRPs. The collected data were analyzed statistically. <bold>Results: </bold>In this study, patients were taking a total of 1421 medications (4.71 medications per patient). A total of 493 MDs and 392 MRPs were identified. The most common MRPs were, in decreasing order, medication underuse or non-adherence by the patient (175 cases, 44.64% of all MRPs) and drug interactions (168 cases, 42.85%). The number of drug interactions significantly increased with the increasing number of underlying diseases and the number of medications used (P < 0.001 in both cases). A total of 594 interventions were made by the pharmacist, of which the most common were referrals to the physician for medication adjustments (193 cases, 32.27% of all interventions) and increasing the medication dose or prescribing a missed medication (172 cases, 28.95%). <bold>Conclusion:</bold> This study showed that the prevalence of MRPs in psychiatric settings is considerable and that implementing an MR program and pharmacist intervention in MRPs can significantly improve the quality of care.

Regular Medications Administered to Older Adults in Aged Care Facilities: A Retrospective Descriptive Study

2025-06-16

Stephanie Garratt , Mukesh Kumar Prasad , Kelly Ottosen +1 more | Journal of Clinical Nursing

ABSTRACT Aim(s) To explore which regularly prescribed medications are most commonly administered to older adults in aged care facilities in Australia, by whom and when, and to identify the prevalence … ABSTRACT Aim(s) To explore which regularly prescribed medications are most commonly administered to older adults in aged care facilities in Australia, by whom and when, and to identify the prevalence of polypharmacy in this population group. Design Retrospective descriptive study. Methods This study involved exploratory analysis of de‐identified medication administration records from March 17, 2023–March 18, 2024. Older adults' demographic and medication administration data were requested from two electronic medication chart providers in Australia. For inclusion, older adults must have been living in an aged care facility for the entire timeframe. Data were analysed using descriptive statistics, activity pattern analysis, Welch two sample t‐tests, ANOVA and independent sample t‐tests. The STROBE checklist was used to report this study. Results In all, 12,438 older adults were included, with a median age of 87, spanning 287 aged care facilities across Australia. Nervous system medications (over 16 million doses) and alimentary tract/metabolism medications (over 12 million doses) were the most administered. Within these, paracetamol 500 mg tablets and docusate sodium 50 mg + sennoside B 8 mg tablets were the most common. Quetiapine, a strong anticholinergic medication, was also present in the top 30 most administered medications. Certified nursing staff were the primary administrators of medication (66% of actions), followed by non‐nursing staff (27%). Medications were predominantly administered before 10 am and after 10 pm. With a median of 8 regular medications administered per older adult per day, 78% experienced polypharmacy. Conclusion The most common regular medications administered in aged care facilities were non‐opioid analgesics and laxatives. Many medications were administered in the late evening, where staffing levels were likely to be limited. There was a high prevalence of polypharmacy, and non‐nursing staff were involved in medication administration. Implications for the Profession and/or Patient Care This study offers important insights and new knowledge around use of regular medications in aged care facilities, using a nationally representative sample from Australia. It highlights the high volume of non‐opioid analgesics and laxatives administered to older adults, some of which may be optimised, modified or replaced with nonpharmacological alternatives to reduce medication burden. This study also notes that not all regular medications are being administered in Australia by certified nursing staff, and that medication administration activity peaks during both breakfast and late evening rounds. These are important considerations for aged care facilities when assessing staffing ratios, rostering, and how to reduce competing demands for aged care staff. Although much attention has been placed on reducing polypharmacy and optimising medications for older adults, this study also identifies that polypharmacy is prevalent, with 78% of older adults experiencing this through use of regular medications alone. The findings of this study will enable more informed discussions between nursing staff, prescribers, pharmacy and potentially older adults and their families around regular medication and its administration in aged care facilities. Reporting Method The STROBE checklist was followed. Patient or Public Contribution No patient or public contribution.

From apothecary to ‘McPharmacist’? Skills utilisation amongst community pharmacists in England

2025-06-16

Peter Butler , Anjuman Walele , Steven Parker +1 more | Economic and Industrial Democracy

This article speaks to ongoing sociological debate around the fast-changing organisation of medicine and the implications for skills utilisation – with a specific focus on community pharmacy. While the professional … This article speaks to ongoing sociological debate around the fast-changing organisation of medicine and the implications for skills utilisation – with a specific focus on community pharmacy. While the professional status of pharmacists has been the subject of much debate, the closely related theme of skills deployment has been significantly overlooked. Any coverage of skills has largely been restricted to the deskilling effect of technology; analysis of the role other contextual factors might play has been piecemeal and fragmented. Drawing on qualitative data, this article aims to offer a more nuanced view of the skills trajectory, exploring employer and national policy and professional drivers of change. The results show these factors constrain and enable human agency, depending on the setting, opening up possibilities for both reskilling and deskilling. As such, the findings stress the important mediating influence exerted by ‘place’, i.e. the clinical setting on opportunities for skills development.

Prescribing Patterns and Pharmacotherapeutic Risk Among Community-Dwelling Older Adults in Brazil: A Cross-Sectional Study

2025-06-16

Isadora F Odebrecht , A. M. Nascimento , Denise Silva da Silveira +7 more | Cureus

Background Prescribing for older adults can be particularly challenging, as treatment regimens are often complex in geriatric patients, increasing the likelihood of polypharmacy, escalating the risk of exposure to potentially … Background Prescribing for older adults can be particularly challenging, as treatment regimens are often complex in geriatric patients, increasing the likelihood of polypharmacy, escalating the risk of exposure to potentially inappropriate medications (PIMs), and to a pharmacotherapeutic risk. Therefore, this study aims to identify prescribing patterns and the pharmacotherapeutic risk in community-dwelling older adults in Brazil. Methodology This cross-sectional study included 504 physically independent older individuals who self-reported sociodemographic characteristics, comorbidities, and data on current pharmacologic therapies. To analyze the pharmacotherapy, all medications used by the patients were recorded, including complementary alternative medications and over-the-counter medications (OTC). The Beers 2023 criteria were used to identify PIMs. Pharmacotherapeutic risk was stratified into two categories based on the presence of PIMs or OTC on the medication regimen. Results This study included 504 older adults (mean age = 69.5 ± 6.4 years), 339 women (67.3%), and 165 men (32.7%). Polypharmacy was observed in 136 (26.98%) individuals, while 180 (36.0%) individuals were using PIMs. Moreover, 97 (19.2%) individuals used OTC medication. Notably, 205 (40.7%) older individuals were classified as being at pharmacotherapeutic risk. In logistic regression, individuals with polypharmacy had nearly five times increased risk of being at pharmacotherapeutic risk (odds ratio = 4.9, p = 0.001), after controlling for sociodemographic and clinical variables. Conclusions A marked pharmacotherapeutic risk was observed, driven chiefly by polypharmacy among community-dwelling older adults. Thus, medical education regarding rational use of medication and deprescribing practices can help mitigate adverse outcomes in older adults. Moreover, future research should focus on user-centered design of technological solutions to support clinicians and patients in safely managing and discontinuing high-risk medications.

Assessing Medication Management Practices at University Hospital of Ibn Sina: A Cross-Sectional Study

2025-06-16

Mamat Jasseh , Koye Balogun , Samuel Inshutiyimana +7 more | Research Square (Research Square)

<title>Abstract</title> Background Medication-related harm accounts for approximately 50% of all preventable harm in healthcare and incurs an estimated global cost of US$42 billion annually. The WHO’s “Medication Without Harm” initiative … <title>Abstract</title> Background Medication-related harm accounts for approximately 50% of all preventable harm in healthcare and incurs an estimated global cost of US$42 billion annually. The WHO’s “Medication Without Harm” initiative targets a 50% reduction in severe avoidable medication-related harm within five years. In Morocco, data on medication management practices in public hospitals remain scarce. This study evaluates the medication management at the University Hospital of Ibn Sina (CHU Ibn Sina) to identify strengths and areas for improvement. Methods A cross-sectional survey of 432 physicians, pharmacists, nurses, nurse assistants, and pharmacy assistants with ≥ 1 year of medication-management experience was conducted from September to December 2024 across 11 CHU facilities. A French-language questionnaire—pilot-tested and distributed via email, messaging apps, and printed QR-coded forms—assessed policy awareness, satisfaction, prescribing, dispensing, preparation, and administration practices. Data were anonymized and analyzed descriptively using Excel. Ethical approval was granted by CHU Ibn Sina (No. 5939). Results Respondents included doctors (37%), nurses (29%), and pharmacists (14%). Only 16% were aware of the hospital’s medication policy, and 45% reported low satisfaction with the medication management. Clinical protocols (35%) and manual guidelines (31%) were more frequently used than decision-support systems (8%) or formularies (4%). In dispensing, 53.5% consistently verified prescriptions and 78% employed traceability systems, yet only 17.8% had automated cabinets. During administration, 46% always verified orders, but just 25% used error-reduction tools; 76% reported post-administration monitoring. Conclusion Although basic safety practices exist, limited technology uptake, low policy awareness, and inconsistent protocol adherence reveal the need for an integrated, patient-centered, system-wide medication management strategy tailored to local needs.

Medication error reporting system: barriers and challenging issues among HCPs in Saudi Arabia – a cross-sectional study

2025-06-16

Md. Mokshead Ali , S Asmari , Jawharah Mubarak Alqhtani +4 more | Hospital Practice

Medication errors pose a significant threat to patient safety globally, including in Saudi Arabia. This study aimed to assess healthcare professionals' (HCPs) understanding, attitudes, and challenges regarding medication error reporting … Medication errors pose a significant threat to patient safety globally, including in Saudi Arabia. This study aimed to assess healthcare professionals' (HCPs) understanding, attitudes, and challenges regarding medication error reporting in Saudi hospitals. A cross-sectional study was conducted using a self-administered online questionnaire among HCPs (physicians, pharmacists, and nurses) from various hospitals across Saudi Arabia. The questionnaire explored their knowledge, attitudes, and experiences related to medication error reporting. A total of 170 HCPs participated in the study, with the majority being under 35 years old (67.06%), female (70.59%), and Saudi nationals (74.71%). A majority of participants (87.06%) had heard of the medication error report form, and 73.53% reported medication errors before. Participants aged less than 35 years had significantly lower knowledge scores compared to those aged 35-45 years (p = 0.021), and male participants had significantly higher knowledge scores compared to female participants (p = 0.005). Pharmacists had the highest knowledge scores among all health professions (p < 0.001), and participants working in government hospitals had significantly higher knowledge scores compared to those working in private hospitals (p = 0.034). In terms of attitude scores, male participants had significantly higher attitude scores compared to female participants (p = 0.046). This study highlights progress in medication error reporting among HCPs in Saudi Arabia but identifies gaps in knowledge, reporting, and systemic barriers. Addressing these challenges through education, process optimization, and a non-punitive reporting culture is key to improving safety. Future research should expand beyond hospitals and assess policy and training impacts over time.