Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care: a systematic literature review and international consensus development

Background Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general defnition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020. Aim This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC. Method A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modifed Delphi technique to develop the definition of QIs for PhC. Results A total of 182 QI definitions were identifed from 174 articles. Of these, 63 QI definitions (35%) cited one of fve references as the source. Sixteen aspects that construct QI definitions were derived from the identifed definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence defnition of QIs for PhC: “quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists”. Conclusion Building upon existing defnition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC

The influence of medication and alcohol use on frailty syndrome among older adults

Staranje populacije je velik izziv sodobne družbe. Pričakovana življenjska doba ob rojstvu v Evropi se je v zadnjih sto letih skoraj podvojila, povečujejo pa se tudi pričakovana leta življenja z oviranostjo. Prav zato veliko raziskav in projektov naslavlja izzive staranja populacije, da bi zagotovili zdravo in kakovostno starost v čim večji meri. V ta kontekst spada tudi raziskovanje bremena zdravljenja z zdravili med starejšimi odraslimi in raziskovanje sindroma krhkosti. Zdravljenje z zdravili je v prvi vrsti eden najučinkovitejših načinov spopadanja z boleznijo in tudi pri starejših odraslih prinaša veliko koristi. Hkrati pa niso zanemarljivi niti neželeni zdravstveni izidi kot posledica neustrezne farmakoterapije, kar se med vsemi starostnimi skupinami najpogosteje pojavlja pri starejših odraslih. Spremljanje bremena zdravljenja z zdravili nam tako omogoča ustrezno načrtovanje preventivnih storitev in javnozdravstvenih ukrepov za zmanjševanje težav povezanih z zdravili med starejšimi odraslimi. Na voljo so različni kriteriji spremljanja bremena zdravljenja z zdravili, med najbolj znanimi in najpogosteje uporabljenimi pa so polifarmakoterapija, potencialne interakcije med zdravili, potencialno neprimerno predpisovanje ter antiholinergično in sedativno breme. Sindrom krhkosti je s starostjo povezan upad funkcije fizioloških sistemov, ki se odraža v zmanjšanih intrinzičnih rezervah in povečani dovzetnosti za stresne dejavnike, kar poveča tveganje za številne neželene zdravstvene izide. Posamezniki s krhkostjo imajo zmanjšano kakovost življenja in povečano tveganje za padce in zlome, invalidnost, težave povezane z zdravili, depresijo, kognitiven upad, demenco, hospitalizacije, sprejem v dom starejših občanov in umrljivost. Sindrom krhkosti ni neizogiben del staranja. Nekateri starejši odrasli lahko doživijo visoko starost brez prisotnosti krhkosti. Poleg tega gre za dinamičen proces in je torej možno tudi izboljšanje stanja ob ustreznem prepoznavanju in ukrepanju. Zato je pomembno prepoznavanje dejavnikov tveganja, še posebej takih dejavnikov tveganja, na katere lahko vplivamo z ukrepi. Med slednje spadata tudi uživanje alkohola in uporaba zdravil. Raziskave v okviru doktorske disertacije lahko razdelimo v tri sklope. Namen prvega dela doktorske naloge je z nizom farmakoepidemioloških raziskav ovrednotiti obremenjenost zdravljenja z zdravili na celotni populaciji starejših odraslih v Sloveniji. V drugem delu smo se osredotočili na analizo prevalence, incidence in značilnosti sindroma krhkosti med starejšimi odraslimi v Sloveniji. Namen tretjega dela doktorske naloge pa je s pomočjo kohortne raziskave ovrednotiti povezavo med sočasno uporabo zdravil in alkohola ter sindromom krhkosti, kar do zdaj še ni bilo raziskano.Population aging is a major challenge of modern society. Life expectancy in Europe has almost doubled in the last hundred years, and years lived with disability are also increasing. Therefore, several researches and projects address the challenges of population aging in order to ensure good health and good quality of life in old age. Studies on frailty syndrome and medication use and burden form an important part of these research. Medication treatment is primarily one of the most effective strategies for disease management. Nevertheless, the adverse health consequences resulting from inappropriate pharmacotherapy were recognized as an important public health challenge with the highest prevalence among older adults. Therefore, evaluation of medication use and burden enables development of appropriate preventive services and public health interventions to reduce drug-related problems in older adults. There are several criteria for monitoring the burden of medication treatment, and among the best known and most commonly used are polypharmacy, potential drug-drug interactions, potentially inappropriate prescribing, the anticholinergic burden and sedative load. Frailty syndrome is an age-related decline in the function of physiological systems, reflected in reduced intrinsic reserves and increased vulnerability to stressor events, which increases the risk of adverse health outcomes. Individuals with frailty have a decreased quality of life and increased risk for falls and fractures, disability, drug-related problems, depression, cognitive decline, dementia, hospitalization, institutionalization, and mortality. Frailty syndrome is not an inevitable result of aging. Some people may experience frailty very early and some older adults may live to very old age without the presence of frailty. Moreover, frailty is a dynamic process, with the possibility of improvement through appropriate detection and interventions. Therefore, it is important to identify risk factors for frailty, especially such risk factors that can be influenced by interventions. The latter include alcohol consumption and the use of medication. Research within the doctoral thesis can be divided into three parts. The aim of the first part is to evaluate the burden of medication treatment on the entire population of older adults in Slovenia with a series of pharmacoepidemiological database studies. In the second part, we focused on the analysis of the prevalence, incidence and characteristics of frailty syndrome among older adults in Slovenia. The aim of the third part of the doctoral thesis is to evaluate the association between the use of medication and alcohol, and frailty syndrome, which has not been studied before

The association between medication or alcohol use and the incidence of frailty

Background: Understanding potentially modifiable factors that influence the risk of frailty is a key concern for the management of this urgent contemporary public health challenge. This study evaluates the association between the use of various medications or alcohol and the incidence of frailty among older adults. Methods: This study was a retrospective cohort study on older adults (≥ 65 years) using data from the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE survey, 28 countries). Medication use was measured as taking several different groups of medications. Alcohol use was assessed with SHARE questions corresponding to AUDIT-C. The outcome measure was the incidence of frailty after two years, defined by frailty index (FI) and frailty phenotype (FP). A multiple logistic regression model was used to evaluate the association with adjustment for several potential confounding factors. Results: Of the 14,665 FI-population participants, 1800 (12.3%) developed frailty within two years. Of the 8133 FP-population participants, 2798 (34.4%) developed pre-frailty and 247 (3.0%) developed frailty within two years of baseline. After adjustment for potential confounding variables, non-hazardous alcohol use (adjusted OR95% CI for the FI-population: 0.680.60–0.77) and hazardous alcohol use (0.800.68–0.93) are associated with lower incidence of frailty compared to no alcohol use. The odds of frailty are increased when taking medicationsthe largest effect size was observed in older adults taking medication for chronic bronchitis (adjusted OR95% CI for the FI-population: 2.451.87–3.22), joint pain and other pain medication (2.262.00–2.54), medication for coronary and other heart disease (1.721.52–1.96), medication for diabetes (1.691.46–1.96), and medication for anxiety, depression and sleep problems (1.561.33–1.84). Additionally, the risk of frailty was increased with stroke, Parkinson’s disease and dementia. Conclusions: Taking certain groups of medication was associated with increased incidence of frailty and pre-frailty, which might be due to either medication use or the underlying disease. Alcohol use was associated with a lower risk of pre-frailty and frailty compared to no alcohol use, which might be due to reverse causality or residual confounding. There was no significant interaction effect between medication groups and alcohol use on frailty incidence

Comparative bioavailability of different coenzyme Q10 formulations in healthy elderly Individuals

Coenzyme Q10 (CoQ10) plays a central role in mitochondrial oxidative phosphorylation. Several studies have shown the beneficial effects of dietary CoQ10 supplementation, particularly in relation to cardiovascular health. CoQ10 biosynthesis decreases in the elderly, and consequently, the beneficial effects of dietary supplementation in this population are of greater significance. However, most pharmacokinetic studies have been conducted on younger populations. The aim of this study was to investigate the single-dose bioavailability of different formulations of CoQ10 in a healthy geriatric population. A randomized, three-period, crossover bioavailability study was conducted on 21 healthy older adults (aged 65-74). The treatment was a single dose with a one-week washout period. Three different formulations containing the equivalent of 100 mg of CoQ10 were used: Q10Vital^® water-soluble CoQ10 syrup (the investigational product—IP)ubiquinol capsules (the comparative product—CP)and ubiquinone capsules (the standard product—SP). Ubiquinone/ubiquinol was followed in the plasma for 48 h. An analysis of the ratio of the area under the baseline-corrected concentration curve (∆AUC$_{48}$) for total CoQ10 and a comparison to SP yielded the following: The bioavailability of CoQ10 in the IP was 2.4-fold higher (95% CI: 1.3-4.5p = 0.002), while the bioavailability of ubiquinol (CP) was not significantly increased (1.7-fold95% CI: 0.9–3.1, p = 0.129). No differences in the redox status of the absorbed coenzyme Q10 were observed between formulations, showing that CoQ10 appeared in the blood mostly as ubiquinol, even if consumed as ubiquinone

Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care : a systematic literature review and international consensus development.

BACKGROUND: Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general definition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020. AIM: This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC. METHOD: A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modified Delphi technique to develop the definition of QIs for PhC. RESULTS: A total of 182 QI definitions were identified from 174 articles. Of these, 63 QI definitions (35%) cited one of five references as the source. Sixteen aspects that construct QI definitions were derived from the identified definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence definition of QIs for PhC: "quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists". CONCLUSION: Building upon existing definition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC