Innovating medication reviews through a technology-enabled process

Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed

Residential Medication Management Reviews and continuous polypharmacy among older Australian women

Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79–84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professional

A qualitative evaluation of patients understanding, expectations and experiences with HIV/AIDS treatment

Background: Treatment understanding and experiences are vital to determine HIV patients’ adherence and retention to care. Methods: In-depth patient interviews were audio-recorded, with a prior verbal and written consent and subjected to a thematic content analysis framework for data analysis. Results: Though majority of participants believed in Antiretroviral Therapy (ART) as the most effective way of treatment, they were greatly worried about its toxicities. Disease understanding and peer influence were regarded as the main reasons for treatment initiation; whereas, perceived side effects and lack of support system were among the main reasons associated with treatment delay. Almost all the patients experienced toxicities due to ARTs and viewed it negatively impacting their quality of life. Conclusion: It is vital for People Living with HIV/AIDS (PLWHA) to be retained in care; hence, the provision of optimal care with greater support to overcome treatment challenges must be focused in any HIV program

Economic evaluation of pharmacist-led medication reviews in residential aged care facilities

Introduction: Medication reviews is a widely accepted approach known to have a substantial impact on patients’ pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities

Assessing psychometric qualities of the Groningen Frailty Indicator

Introduction: Early diagnosis of frailty, a common geriatric condition, is imperative for proactive primary care. The Groningen Frailty Indicator (GFI) was developed in the Netherlands to assess frailty. However, its validity in other ethno-cultural backgrounds has not been established. This study evaluated the reliability and construct validity of the GFI among older Malaysians residing in aged care facilities.\ud \ud Methods: A cross-sectional study design was employed. Older people (>65 years; n=203) residing in aged care facilities and who met the inclusion criteria participated in an interviewer-administered comprehensive assessment. The Comprehensive Assessment Form incorporated the GFI, the Older People's Quality of Life questionnaire (OPQOL-35), the Hospital Anxiety and Depression Scale (HADS), and the Katz Index of Independence in Activities of Daily Living tool (Katz ADL).\ud \ud Results: The GFI was a reliable instrument to assess frailty (Cronbach's alpha=0.807) and produced statistically significant scores for subgroups (known group validity). As hypothesized, the total GFI scores significantly differed between subgroups: higher GFI scores were obtained among female participants (23.0%); participants between 75 and 84 years (25.5%); single participants (42.4%); and those who were married, with (18.8%) and without children(41.3%). A strong negative correlation between total GFI scores and the Katz scores (rs(203)=-0.614, p=0.001), and total GFI scores and the total OPQOL scores (rs(203)=-0.431, p=0.001) were observed. A positive correlation was observed between total GFI scores and the HADS score (rs (203)=0.281, p=0.001). These confirm the construct validity of the GFI. The participants were largely females (62.1%), and had a mean age of 76.9 ± 7.8 years. Their average GFI score was 6.53 ± 3.75.\ud \ud Conclusion: This study supports the reliability and validity of the GFI and offers an insight into the characteristics of Malaysian elderly people residing in aged care facilities