Medication-related problems encountered in the Program of All-Inclusive Care for the Elderly: An observational study
Autor: | Michael S Awadalla, Nishita Shah Amin, Kevin T. Bain, David L Bankes, Chandni Bardolia, Calvin H. Knowlton |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions Pharmacist MEDLINE Pharmacology (nursing) Pharmacy Pharmacists 030226 pharmacology & pharmacy Pharmacy records 03 medical and health sciences 0302 clinical medicine Communication methods medicine High doses Humans 030212 general & internal medicine music Aged Retrospective Studies Pace Pharmacology business.industry music.record_label United States Pharmaceutical Services Family medicine Observational study business |
Zdroj: | Journal of the American Pharmacists Association. 60:319-327 |
ISSN: | 1544-3191 |
Popis: | Objective To evaluate pharmacist-encountered medication-related problems (MRPs) among the participants of the Program of All-Inclusive Care for the Elderly (PACE). Design This was a retrospective analysis of proprietary pharmacy records detailing pharmacist encounters with PACE clinical staff. Setting and participants A national provider of pharmacy services to more than 75 PACE organizations. In total, 1057 PACE participants at 69 PACE sites across the United States with documented pharmacist encounters between March and May 2018. Outcome measures MRPs were classified using the Hepler-Strand taxonomy, and pharmacists’ recommendations made to prescribers to resolve these MRPs were classified using a modified Hoth taxonomy. In addition, pharmacists’ communication methods and prescribers’ responses were analyzed. Results Overall, 2004 MRPs were encountered. The most frequent MRPs identified were related to medication safety concerns, including drug interactions (720, 35.9%), adverse drug reactions (ADRs, 356, 17.8%), high doses (270, 13.5%), and unindicated drugs (252, 12.6%). Drug interactions frequently involved competitive inhibition, 3 or more drugs, opioids, anticoagulants, antiplatelets, and antidepressants. Deprescribe medication (561, 24.8%), start alternative therapy (553, 24.4%), change doses (457, 20.2%), and monitor (243, 10.7%) were the top 4 types of recommendations made by pharmacists. Among 1730 responses obtained from PACE prescribers, 78.1% (n = 1351) of pharmacists’ recommendations were accepted. Compared with electronic communication, telephonic communication was associated with more acceptance and less prescriber nonresponse (χ2 = 78.5, P Conclusion Pharmacists identified a substantial number of MRPs in PACE, especially those related to medication safety such as drug interactions and ADRs. In this practice setting, significant collaboration occured between pharmacists and PACE prescribers, as evidenced by the rate of prescribers’ acceptance of pharmacists’ recommendations. Further research is needed to fully evaluate the economic, clinical, and humanistic outcomes associated with pharmacists’ encounters in PACE. |
Databáze: | OpenAIRE |
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