The role of the pharmacist in optimizing pharmacotherapy in older people.
ABSTRACT Prescription of medicines is a fundamental component of the care of older people, but evidence suggests that pharmacotherapy in this population is often inappropriate. Pharmacists have been involved in different approaches for the optimization of prescribing and rational medication use in older people. This article describes the different models of care in which pharmacists are involved in the optimization of pharmacotherapy in older people, and reviews the impact of these approaches on both process and outcome measures. The provision of pharmaceutical care, medication reviews and educational interventions by pharmacists in the nursing home, ambulatory and acute care settings are discussed. We selected systematic reviews, reviews and original studies, and for the latter, we focused more specifically on European publications published between 2001 and 2011. From the literature reviewed, it is clear that when pharmacists play a proactive role in performing medication reviews and in the active education of other healthcare professionals, pharmacotherapy for older patients is improved. However, the evidence of the impact of pharmacists' interventions on health outcomes, quality of life or cost effectiveness of care is mixed. Better results have been reported when pharmacists are skilled and work in the context of a multidisciplinary team. Opportunities remain for multicentre, European-based, pharmacist-intervention trials in all settings, to determine the effectiveness and economic benefit of pharmacist involvement in the optimization of pharmacotherapy in older people.
- SourceAvailable from: Arjun Poudel[Show abstract] [Hide abstract]
ABSTRACT: Background: The frequency of prescribing potentially inappropriate medications (PIMs) in older patients remains high despite evidence of adverse outcomes from their use. Little is known about whether admission to hospital has any effect on appropriateness of prescribing. Objectives: This study aimed to identify the prevalence and nature of PIMs and explore the association of risk factors for receiving a PIM. Methods: This was a prospective study of 206 patients discharged to residential aged care facilities from acute care. All patients were at least 70 years old and were admitted between July 2005 and May 2010; their admission and discharge medications were evaluated. Results: Mean patient age was 84.8 ± 6.7 years; the majority (57%) were older than 85 years, and mean (SD) Frailty Index was 0.42 (0.15). At least 1 PIM was identified in 112 (54.4%) patients on admission and 102 (49.5%) patients on discharge. Of all medications prescribed at admission (1728), 10.8% were PIMs, and at discharge, of 1759 medications, 9.6% were PIMs. Of the total 187 PIMs on admission, 56 (30%) were stopped and 131 were continued; 32 new PIMs were introduced. Of the potential risk factors considered, in-hospital cognitive decline and frailty status were the only significant predictors of PIMs. Conclusions: Although admission to hospital is an opportunity to review the indications for specific medications, a high prevalence of inappropriate drug use was observed. The only associations with PIM use were the frailty status and in-hospital cognitive decline. Additional studies are needed to further evaluate this association.Annals of Pharmacotherapy 09/2014; 48(11):1425-1433. · 2.92 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Quality prescribing for older adults involves multiple considerations. We evaluated multiple aspects of prescribing quality in older veterans to develop an integrated view of prescribing problems and to understand how the prevalence of these problems varies across clinically important subgroups of older adults.Journal of General Internal Medicine 07/2014; · 3.42 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Oral medication for patients with type 2 diabetes mellitus plays an important role in diabetes care and is associated with a high level self-care behavior and self-management. However, poor adherence to diabetes treatment is common which causes severe health complications and increased mortality. Barriers to adherence may consist of complex treatment regimens often along with long-term multi-therapies, side effects due to the medication as well as insufficient, incomprehensible or confusing information or instructions provided by the health care provider. Multidisciplinary approaches can support adherence success and can enable a more effective management of diabetes care. One approach in diabetes care can be the involvement of a pharmacist. The aim was to analyze the effectiveness of adherence-enhancing pharmacist interventions for oral medication in type 2 diabetes mellitus.BMC Endocrine Disorders 07/2014; 14(1):53. · 1.67 Impact Factor