scholarly journals Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 24 ◽  
Author(s):  
David L. Bankes ◽  
Richard O. Schamp ◽  
Calvin H. Knowlton ◽  
Kevin T. Bain
Keyword(s):  
Medication Safety ◽  
Information Needs ◽  
Adverse Drug Events ◽  
Drug Information ◽  
Medication Management ◽  
The Elderly ◽  
Routine Practice ◽  
Safety Concerns ◽  
Care For The Elderly ◽  
Alternative Medications

Little is known about the types of drug information inquiries (DIIs) prescribers caring for older adults ask pharmacists during routine practice. The objective of this research was to analyze the types of DIIs prescribing clinicians of Programs of All-Inclusive Care for the Elderly (PACE) made to clinical pharmacists during routine patient care. This was a retrospective analysis of documented pharmacists’ encounters with PACE prescribers between March through December, 2018. DIIs were classified using a developed taxonomy that describes prescribers’ motivations for consulting with pharmacists and their drug information needs. Prescribers made 414 DIIs during the study period. Medication safety concerns motivated the majority of prescribers’ inquiries (223, 53.9%). Inquiries received frequently involved modifying drug therapy (94, 22.7%), identifying or resolving adverse drug events (75, 18.1%), selecting or adjusting doses (61, 14.7%), selecting new drug therapies (57, 13.8%), and identifying or resolving drug interactions (52, 12.6%). Central nervous system medications (e.g., antidepressants and opioids), were involved in 38.6% (n = 160) of all DIIs. When answering DIIs, pharmacists made 389 recommendations. Start alternative medications (18.0%), start new medications (16.7%), and change doses (12.1%) were the most frequent recommendations rendered. Prescribers implemented at least 79.3% (n = 268) of recommendations based on pharmacy records (n = 338 verifiable recommendations). During clinical practice, PACE prescribers commonly ask pharmacists a variety of DIIs, largely related to medication safety concerns. In response to these DIIs, pharmacists provide medication management recommendations, which are largely implemented by prescribers.

The Looming Geriatrician Shortage: Ramifications and Solutions

2019 ◽  
Vol 32 (9) ◽  
pp. 1052-1062 ◽  
Author(s):  
Paula E. Lester ◽  
T. S. Dharmarajan ◽  
Eleanor Weinstein
Keyword(s):  
Adverse Drug Events ◽  
Medication Management ◽  
Geriatric Medicine ◽  
Historical Context ◽  
The Elderly ◽  
The United States ◽  
Training System ◽  
Atypical Presentations ◽  
The Impact ◽  
Number Of Individuals

Objective: Geriatricians are skilled in the recognition of asymptomatic and atypical presentations that occur in the elderly and provide comprehensive medication management including recognizing adverse drug events, reducing polypharmacy, and de-prescribing. However, despite the increasing average age of the U.S. population, with the number of individuals above 65 years old predicted to increase 55% by 2030, the geriatric workforce capacity in the United States has actually decreased from 10,270 in 2000 to 8,502 in 2010. Method: We describe physiologic changes in older adults, historical trends in geriatric training, and propose solutions for this looming crisis. Results: Many factors are responsible for the shortage of skilled geriatric providers. Discussion: We discuss the historical context of the lack of geriatricians including changes to the training system, describe the impact of expert geriatric care on patient care and health system outcomes, and propose methods to improve recruitment and retention for geriatric medicine.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): Protocol of a Cluster Randomized Controlled Trial in Primary Care (Preprint)

2018 ◽  
Author(s):  
Katharine Ann Wallis ◽  
Carolyn Raina Elley ◽  
Arier Lee ◽  
Simon Moyes ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trial ◽  
High Risk ◽  
Adverse Drug Events ◽  
Controlled Trial ◽  
The Elderly ◽  
Drug Event ◽  
Randomized Controlled ◽  
Care For The Elderly ◽  
Cluster Randomized

BACKGROUND High-risk prescribing, adverse drug events, and avoidable adverse drug event hospitalizations are common. The single greatest risk factor for high-risk prescribing and adverse drug events is the number of medications a person is taking. More people are living longer and taking more medications for multiple long-term conditions. Most on-going prescribing occurs in primary care. The most effective, cost-effective, and practical approach to safer prescribing in primary care is not yet known. OBJECTIVE To test the effect of the Safer Prescribing And Care for the Elderly (SPACE) intervention on high-risk prescribing of nonsteroidal anti-inflammatory and antiplatelet medicines, and related adverse drug event hospitalizations. METHODS This is a protocol of a cluster randomized controlled trial. The clusters will be primary care practices. Data collection and analysis will be at the level of patient. RESULTS Recruitment started in 2018. Six-month data collection will be in 2018. CONCLUSIONS This study addresses an important translational gap, testing an intervention designed to prompt medicines review and support safer prescribing in routine primary care practice. CLINICALTRIAL Australian New Zealand Clinical Trials Registry: ACTRN12618000034235 http://www.ANZCTR.org.au/ACTRN12618000034235.aspx (Archived with Webcite at http://www.webcitation.org/6yj9RImDf)

The Medication Information Line for the Elderly: An 8-Year Cumulative Analysis

1998 ◽  
Vol 32 (7-8) ◽  
pp. 743-748 ◽  
Author(s):  
Ruby E Grymonpre ◽  
John W Steele
Keyword(s):  
Information Needs ◽  
Drug Information ◽  
Information Service ◽  
The Elderly ◽  
Care Providers ◽  
Standard Format ◽  
Older Consumers ◽  
Medication Information ◽  
Nonsteroidal Antiinflammatory Agents ◽  
The University

OBJECTIVE: To present an 8-year (1985–1992) cumulative analysis of the 12 743 calls received by the Medication Information Line for the Elderly (MILE), a consumer-oriented drug information service. DESIGN: Data on all calls received by MILE were documented using a standard format. Certain calls were selected by the pharmacist for follow-up based on the nature and predicted severity of the inquiry. SETTING: MILE is located within the Faculty of Pharmacy of the University of Manitoba and staffed by experienced, practicing pharmacists. Calls were received from the elderly and their care providers. Calls were initially taken on a local Winnipeg line, although in 1987 a toll-free number was made available to rural Manitoba residents. RESULTS: The majority of the calls received by MILE were from women aged 65 years or older who accessed MILE on their own initiative. Ninety-one percent of the calls were rated as not serious. Only 6% of calls were from outside Winnipeg. Although 94% of the older consumers reported having a regular pharmacist, they commonly never thought of using their pharmacist for inquiries. The drugs cited most often by consumers, nurses, physicians, and dentists were the nonsteroidal antiinflammatory agents, cardiac drugs, diuretics, antihypertensives, benzodiazepines, and antidepressants. The types of inquiries most frequently involved adverse drug reactions, drug interactions, and therapeutic use. The drugs cited and inquiries made by pharmacist callers were more diverse than those of consumers and other healthcare professionals. CONCLUSIONS: Many older drug consumers have medication information needs that are not being met. Since a large proportion of the callers appeared to be self-motivated women, MILE may not be accessing all older consumers in need of information. This analysis also suggests that many older consumers are not aware that the pharmacist is available and capable of providing drug information.

Text automation tool to improve pharmacist productivity and work capacity in a digital hospital: user feedback survey (Preprint)

2019 ◽  
Author(s):  
Aaron Van Garderen ◽  
Centaine L. Snoswell
Keyword(s):  
User Experience ◽  
Medication Safety ◽  
Positive Impact ◽  
Medication Management ◽  
Daily Practice ◽  
Work Capacity ◽  
Medication Administration ◽  
Digital Systems ◽  
Routine Practice ◽  
User Experiences

BACKGROUND Hospitals and health services are increasingly using digital systems to improve medication safety. Electronic medication management (EMM) systems support medication management by enabling doctors, nurses and pharmacists to digitally prescribe, order, check, reconcile, dispense and record medication administration detail. Yet, despite many gains, negative user experiences and increased documentation time have been recognised as the main barriers to successful adoption of an EMM in routine practice. OBJECTIVE To assess if a customised text automation tool improves clinical pharmacist productivity, capacity and user experience when using an Electronic Medication Management system (EMM). METHODS A four-week trial was completed. Participants were educated on how to use a customised automation tool within their daily practice. Following completion, the participants were asked to rate their experience with using the tool and how its use could impact their workflow using a Likert questionnaire. RESULTS Key findings Fifteen pharmacists completed the trial. The automation tool was considered to have a positive impact on productivity, capacity and user experience. CONCLUSIONS The findings highlighted that the autotext tool could help enhance pharmacist workflow and be an acceptable clinical application. CLINICALTRIAL Not applicable

scholarly journals Risk of Adverse Drug Events Following the Virtual Addition of COVID-19 Repurposed Drugs to Drug Regimens of Frail Older Adults with Polypharmacy

2020 ◽  
Vol 9 (8) ◽  
pp. 2591
Author(s):  
Sweilem Al Rihani ◽  
Matt Smith ◽  
Ravil Bikmetov ◽  
Malavika Deodhar ◽  
Pamela Dow ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
The Elderly ◽  
Risk Scores ◽  
Drug Induced ◽  
Care For The Elderly ◽  
Simulation Based ◽  
Drug Regimens ◽  
Repurposed Drugs ◽  
Novel Coronavirus

Determination of the risk–benefit ratio associated with the use of novel coronavirus disease 2019 (COVID-19) repurposed drugs in older adults with polypharmacy is mandatory. Our objective was to develop and validate a strategy to assess risk for adverse drug events (ADE) associated with COVID-19 repurposed drugs using hydroxychloroquine (HCQ) and chloroquine (CQ), alone or in combination with azithromycin (AZ), and the combination lopinavir/ritonavir (LPV/r). These medications were virtually added, one at a time, to drug regimens of 12,383 participants of the Program of All-Inclusive Care for the Elderly. The MedWise Risk Score (MRSTM) was determined from 198,323 drug claims. Results demonstrated that the addition of each repurposed drug caused a rightward shift in the frequency distribution of MRSTM values (p < 0.05); the increase was due to an increase in the drug-induced Long QT Syndrome (LQTS) or CYP450 drug interaction burden risk scores. Increases in LQTS risk observed with HCQ + AZ and CQ + AZ were of the same magnitude as those estimated when terfenadine or terfenadine + AZ, used as positive controls for drug-induced LQTS, were added to drug regimens. The simulation-based strategy performed offers a way to assess risk of ADE for drugs to be used in people with underlying medical comorbidities and polypharmacy at risk of COVID-19 infection without exposing them to these drugs.

Medication Safety in the Elderly: Translating Research Into Practice

2010 ◽  
Vol 3 (1) ◽  
pp. 43-48
Author(s):  
Julie A. Lindenberg
Keyword(s):  
Cause Of Death ◽  
Medication Safety ◽  
Adverse Drug Events ◽  
Quality Care ◽  
The Elderly ◽  
The United States ◽  
Institute Of Medicine ◽  
Drug Related Problems ◽  
Common Error ◽  
Inappropriate Drugs

In 1999, the Institute of Medicine (IOM) reported that medication errors are the most common error in health care. If medication-related problems were ranked as a disease by cause of death, it would be the fifth cause of death in the United States. The elderly, a rapidly increasing segment of the population, are at greatest risk for adverse drug events. Suboptimal prescribing in the elderly may involve overuse (poly-pharmacy), the use of inappropriate drugs, and/or omission of drugs that are indicated. The provision of quality care requires that clinicians recognize and prevent drug-related problems in the elderly.

Characterization of dayshift tele-ICU pharmacist activities

2020 ◽  
pp. 1357633X2091371
Author(s):  
Carrie L Griffiths ◽  
Desiree E Kosmisky ◽  
Sonia S Everhart
Keyword(s):  
Adverse Drug Events ◽  
Drug Information ◽  
Medication Management ◽  
Multidisciplinary Teams ◽  
Pharmacy Services ◽  
Intervention Delivery ◽  
Care Services ◽  
Lactate Levels ◽  
Improving Patient Care

Background Critical care services have expanded over the last decade to include tele-ICU. In 2015, Atrium Health’s pharmacy services began covering tele-ICU patients from 3–11 PM. In 2017, dayshift tele-ICU pharmacy services were added on Monday, Wednesday and Friday from 8 AM to 12 PM. Cutting-edge technology and software integration allow alerts to be generated in areas of abnormal glucose, electrolyte and lactate levels. This analysis was conducted to describe the interventions recommended during dayshift hours. Methods Data collected from 1 August 2017 to 30 June 2018, the first 11 months of dayshift pharmacist coverage, include number of charts reviewed per shift, interventions and specific types logged, if the intervention was tied to an alert and if it was accepted or rejected. Interventions can originate from alerts or from proactive assessment by the pharmacist. Descriptive statistics were reported. Results On average, 41 charts were reviewed per shift. Over an 11-month period, 1024 interventions were made for 634 patient chart reviews. Some 89% of all interventions were accepted or accepted with modifications. Of the total interventions, 37 (3.6%) were adverse drug events avoided and 658 (64.4%) were interventions unrelated to alert data. Medication management accounted for 44.3% of all interventions. Discussion Proactive assessment rather than alert review resulted in the majority of interventions, demonstrating that reviewing every ICU patient is vital for improving patient care. Determining optimal avenues for intervention delivery and integration with the bedside multidisciplinary teams remains one of the biggest challenges. Dayshift innovations included weekly virtual rounds and providing drug information for the bedside teams.

scholarly journals Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 87 ◽  
Author(s):  
David L. Bankes ◽  
Hubert Jin ◽  
Stephanie Finnel ◽  
Veronique Michaud ◽  
Calvin H. Knowlton ◽  
...  
Keyword(s):  
Risk Score ◽  
Adverse Drug Events ◽  
Adult Population ◽  
The Elderly ◽  
Medical Expenditures ◽  
Hospital Length Of Stay ◽  
Linear Regression Models ◽  
Care For The Elderly ◽  
Ed Visits ◽  
Medication Risk

Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the MedWise Risk Score™ (MRS), is associated with ADEs and other pertinent outcomes in participants of the Programs of All-Inclusive Care for the Elderly (PACE). Unlike other risk predictors, this tool produces actionable information that pharmacists can easily use to reduce ADE risk. This was a retrospective cross-sectional study that analyzed administrative medical claims data of 1965 PACE participants in 2018. To detect ADEs, we identified all claims that had ADE-related International Classification of Diseases and Health Related Problems, 10th revision (ICD-10) codes. Using logistic and linear regression models, we examined the association between the MRS and a variety of outcomes, including the number of PACE participants with an ADE, total medical expenditures, ED visits, hospitalizations, and hospital length of stay. We found significant associations for every outcome. Specifically, every point increase in the MRS corresponded to an 8.6% increase in the odds of having one or more ADEs per year (OR = 1.086, 95% CI: 1.060, 1.113), $1037 USD in additional annual medical spending (adjusted R2 of 0.739; p < 0.001), 3.2 additional ED visits per 100 participants per year (adjusted R2 of 0.568; p < 0.001), and 2.1 additional hospitalizations per 100 participants per year (adjusted R2 of 0.804; p < 0.001). Therefore, the MRS can risk stratify PACE participants and predict a host of important and relevant outcomes pertaining to medication-related morbidity.

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