Geriatric pharmacotherapy : optimisation through integrated approach in the hospital setting

Since older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate prescribing in these patients in order to prevent misuse, overuse and underuse of drugs. Different tools and strategies have been developed to reduce inappropriate prescribing; the available measures can be divided into medication assessment tools, and specific interventions to reduce inappropriate prescribing. Implicit criteria of inappropriate prescribing focus on appropriate dosing, search for drug-drug interactions, and increase adherence. Explicit criteria are consensus-based standards focusing on drugs and diseases and include lists of drugs to avoid in general or lists combining drugs with clinical data. These criteria take into consideration differences between patients, and stand for a medication review, by using a systematic approach. Different types of interventions exist in order to reduce inappropriate prescribing in older patients, such as: educational interventions, computerized decision support systems, pharmacist-based interventions, and geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach combining different techniques, and all types seem to have positive effects on appropriateness of prescribing. Interdisciplinary teamwork within the integrative pharmaceutical care is important for improving of outcomes and safety of drug therapy. The pharmaceutical care process consists offour steps, which are cyclic for an individual patient. These steps are pharmaceutical anamnesis, medication review, design and follow-up of a pharmaceutical care plan. A standardized approach is necessary for the adequate detection and evaluation of drug-related problems. Furthermore, it is clear that drug therapy should be reviewed in-depth, by having full access to medical records, laboratory values and nursing notes. Although clinical pharmacists perform the pharmaceutical care process to manage the patient’s drug therapy in every day clinical practice, the physician takes the ultimate responsibility for the care of the patient in close collaboration with nurses

Intervenções para reduzir a prescrição de medicamentos inapropriados para idosos

OBJETIVO: Identificar e avaliar criticamente revisões sistemáticas sobre a efetividade de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos. MÉTODOS: Overview de revisões sistemáticas. A busca e a seleção dos estudos foram feitas nas bases de dados Medline, Biblioteca Cochrane, Embase, CINAHL, Biblioteca Virtual em Saúde e Web of Science, combinando os termos aged, prescriptions, inappropriate prescribing e potentially inappropriate medication list com seus sinônimos remissivos e outros descritores associados até junho de 2017. Foram incluídas revisões sistemáticas com ou sem metanálise, que tenham abordado a efetividade de qualquer intervenção ou a combinação de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos, sem restrição quanto ao desenho dos estudos primários, idioma ou data de publicação. Para avaliação da qualidade metodológica das revisões sistemáticas selecionadas, foi utilizado o instrumento A MeaSurement Tool to Assess systematic Reviews. A seleção e a avaliação da qualidade metodológica foram realizadas por dois avaliadores independentes. As divergências foram superadas por consenso. Os principais achados foram agrupados em categorias temáticas, definidas com base em análise de conteúdo e discutidas qualitativamente na forma de síntese narrativa. RESULTADOS: Vinte e quatro revisões sistemáticas foram incluídas no estudo. Quanto ao desenho do estudo e à avaliação da qualidade metodológica, prevaleceram revisões sistemáticas de ensaios clínicos controlados randomizados e estudos de qualidade moderada, respectivamente. As intervenções foram analisadas em cinco categorias temáticas: serviços de revisão de medicamentos, intervenções farmacêuticas, sistemas informatizados, intervenções educacionais e outras. As intervenções estudadas apresentaram bons resultados e a maioria contribuiu para reduzir a prescrição de medicamentos inapropriados para pacientes idosos. CONCLUSÕES: As revisões sistemáticas incluídas nesse overview apontaram benefícios potenciais de diferentes intervenções. No entanto, não foi possível determinar qual a mais efetiva. É provável que intervenções multifacetadas alcancem resultados melhores do que intervenções isoladas.OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR – A MeaSurement Tool to Assess systematic Reviews – was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions

EVALUATION OF THE PHARMACY SUPPORT SYSTEM IN THE DETECTION OF DRUG-RELATED PROBLEMS

Objective: The efficiency and speed of a system in identifying DRPs can support and optimize the performance of pharmacists. The objective of this research was to determine the time of analysis and the number of DRPs incidences identified by pharmacists with and without Pharmacy Support Systems (PSS).Methods: The present research was observational with cross-sectional design. The data collection was done prospectively in outpatients at hospital during January 2016. Observations were conducted to the difference between the analysis and the number of DRPs incidence identified by the pharmacists with and without the assistance of PSS. The research population was outpatient at a number of hospitals in Yogyakarta. The tools used in this research were PSS which were a clinical information system that can identify potential DRPs and included three main parts, namely the patients' profile, drug information, and analysis of DRPs. The identification result of DRPs was consisted of six DRPs categories, i.e. without treatment indication, treatment without indication, ineffective drug, too low dose, too high dose, and undesirable drug reactions.Results: Pharmacists without PSS require faster time to analyze the prescription of outpatients. The time majority spent by pharmacists with PSS in reviewing the patients' prescription lies in the length of time the patients enter the therapy-related data obtained manually by patients until the warning being displayed, and making clinical decision related to the DRPs. The statistical test result using Goodness of fit test and Fisher between categories of DRPs incidences detected by pharmacists with and without the assistance of PPS indicates significant differences (P <0.05). Pharmacists with PSS can detect DRPs that are not detected by the pharmacist without PSS. DRPs mostly identified by pharmacists with the assistance of PSS are drug interactions and improper doses. Improper doses primarily identified in geriatric and pediatric patients' prescription.Conclusion: Pharmacists with PSS software can detect DRPs that are not detected by pharmacists only. But pharmacists using the software PSS requires a longer time in the identification of DRPs compared to pharmacists without using PSS.Â

The Characterization Of Prescribing Errors And Assessment Of The Impact Of An Educational Interventions Among Medical Officers Working In Kuala Kangsar Hospital

The increasing trend of prescribing error in the healthcare institutes cause it became an issue of concern in Malaysia’s healthcare system. Pharmacist plays an important role to improve and prevent patients receiving these errors. Identification of prescribing errors is important to ensure the interventions successfully improve the prescribing errors. The seriousness of prescribing errors can be evaluated by assessing the errors’ severity. The objectives of the present study were to identify the five most common types of prescribing error characteristics, evaluate the severity of the prescribing errors incidence, determined the percentage of prescribing errors prevented by pharmacists and evaluate the effectiveness of the education intervention. A retrospective study reviewing newly written prescriptions with fulfilled criteria which wrote between 1st April and 30th May 2008 was conducted in a secondary care setting government hospital to analyse the type of prescribing errors. At the same time, the evaluation of severity of each error was done to identify the seriousness of prescribing errors in the hospital. Besides, the restrospective review of prescriptions provided the data on how far the pharmacists practicing their role in preventing prescribing errors. A prospective study on the prescriptions was conducted after 4 month period of educational interventions to evaluate the effectiveness of the improvement plan. Ninety four percent of prescribing errors were clinical potential prescribing errors