Tejal Patel

• Doctor of Pharmacy
• Professor (Associate) at University of Waterloo

BACKGROUND Medication management among older adults continues to be a challenge and has led to the development of innovative electronic medication adherence products (eMAPs) to address this need. OBJECTIVE The aim of this study was to examine user experience, with particular emphasis on the features, usefulness, and preference for eMAPS. METHODS...

Background: A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are...

Introduction Persons with intellectual disabilities (ID) often have complex health needs due to the development of multiple comorbidities. Given the higher associated use of problematic medications, such as antipsychotics, and polypharmacy, persons with ID may be particularly vulnerable to adverse side effects. With their medication expertise, phar...

Background The Medication Review in Cognitive Impairment and Dementia (MedRevCiD) checklist is a new tool designed to assist health care professionals in optimizing medication use in individuals with Mild Cognitive Impairment (MCI) or dementia. It consists of 6 domains, each of which addresses a specific medication use issue such as medication mana...

Background The use of potentially inappropriate medications (PIMs) in older adults with dementia and/or Mild Cognitive Impairment (MCI) has been associated with increased adverse events, drug‐related problems (DRPs), prolonged hospitalization, risk of falls, and increased length of stay. This study aimed to identify which explicit tool, Beers crite...

Background Up to 30% of hospitalizations in older adults living with Mild Cognitive Impairment (MCI) and dementia are attributed to drug‐related problems (DRPs), including adverse drug reactions, drug interactions, potentially inappropriate medication (PIM) use, and medication non‐adherence. This study categorizes the identified DRPs according to t...

Background Multispecialty Interprofessional Team (MINT) Memory Clinics manage dementia care in primary care, allowing for more efficient use of limited specialist resources. This study examined the characteristics of patients on their initial assessment in the MINT clinic and investigated the five‐year trajectory of patients with mild cognitive imp...

We evaluated the feasibility and acceptability of frailty screening using handgrip strength with gait speed measures within four primary care-based memory clinics in Ontario. This mixed methods quality improvement initiative examined the reach, effectiveness, adoption, implementation, and maintenance of frailty screening from the perspective of pat...

Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations, resulting in medication non-adherence. While automated medication dispensing technologies...

Background Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia). With many healthcare providers typically involved in care, there are additional challenges with care fragmentation and self-management. Prior res...

Background Older adults with dementia who are on polypharmacy are more vulnerable to the use of potentially inappropriate medications (PIM), which can significantly increase the risk of adverse events and drug-related problems (DRPs). Objective This systematic review and meta-analysis were conducted to map the prevalence of PIM use, polypharmacy,...

Background/Objectives: Optimizing medication use is particularly important in persons with cognitive impairment and dementia. Pharmacists in primary-care-based memory clinics (PCMC) are trained to conduct structured medication reviews, focusing on medication-related problems encountered in per-sons with dementia (PWD). Unfortunately, the impact of...

Background/Objectives: Persons with cognitive impairment and dementia are at risk for a multitude of drug-related problems making them vulnerable to adverse outcomes. Pharma-cists integrated within interdisciplinary primary-care based memory clinics conduct medication reviews in older adults with dementia. Despite the integration of pharmacists wit...

Background: Shared decision-making (SDM) is a dynamic, patient-engaged approach to collaborative medical care. Limited SDM tools exist in pregnancy. We aimed to examine the need and usability of a novel SDM tool for pharmaco-therapeutic treatment of neurological conditions in pregnancy. Methods: This is an exploratory mixed-methods study. Non-pregn...

Introduction Older adults with dementia who are on multiple medications are more vulnerable to the use of potentially inappropriate medications (PIMs), which can significantly increase the risk of adverse events and drug-related problems. PIMs use is prevalent and varies among older adults with dementia or cognitive impairment (CI) attending memory...

Background Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify app...

Aim: To describe clinician and researcher perceptions of a new, patient preference focused approach to recruiting patients for research from primary care-based memory clinics. Methods: Memory clinic clinicians completed a survey and key informants completed an individual interview to gather their perceptions of this new program. Results: The majori...

Background Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders...

Background: Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations resulting in medication non-adherence. While automated medication dispensing te...

Background Persons with traumatic spinal cord injury (SCI) are often experience polypharmacy, the use of multiple medications, to manage secondary complications and concurrent conditions. Despite the prevalence of polypharmacy and challenges associated with managing medications, there are few tools to support persons with SCI with medication self-m...

Background Adults with spinal cord injury/dysfunction (SCI/D) are commonly prescribed multiple medications to manage secondary complications. Significant challenges managing medications have been highlighted, with the need for more support with medication self-management. Objective The objective of this study is to co-develop a toolkit to assist w...

Citation: Sharma, R.; Mahajan, N.; Fadaleh, S.A.; Patel, H.; Ivo, J.; Faisal, S.; Chang, F.; Lee, L.; Patel, T. Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review. Pharmacy 2023, 11, 168. https://doi. Abstract: Persons diagnosed with dementia are often faced with challenges related to polypharmacy and inappropriate...

Recruiting persons with dementia for clinical trials can be challenging. Building on a guide initially developed to assist primary-care-based memory clinics in their efforts to support research, a key stakeholder working group meeting was held to develop a standardized research recruitment process, with input from patients, care partners, researche...

BACKGROUND Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders...

The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported...

Background: Multiple sclerosis (MS) is an autoimmune disease that is often treated with multiple medications. Managing multiple medications, also known as polypharmacy, can be challenging for persons with MS. Toolkits are instructional resources designed to promote behaviour change. Toolkits may support medication self-management for adults with M...

Background Persons with traumatic spinal cord injury (SCI) use multiple medications (polypharmacy) to manage the high number of secondary complications and concurrent conditions. Despite the prevalence of polypharmacy and challenges associated with managing medications, there are few tools to support medication self-management for persons with SCI....

Objectives: To examine the cost-effectiveness of Multi-specialty INterprofessional Team (MINT) Memory Clinic care in comparison to the provision of usual care. Design: Using a Markov-based state transition model, we performed a cost-utility (costs and quality-adjusted life years, QALY) analysis of MINT Memory Clinic care and usual care not invol...

Background: Little is known about the prevalence of frailty among patients with memory concerns attending a primary care-based memory clinic. Objective: This study aims to describe the prevalence of frailty among patients attending a primary care-based memory clinic and to determine if prevalence rates differ based on the screening tool that is...

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been sc...

Smart adherence products enable the monitoring of medication intake in real-time. However, the value of real-time medication intake monitoring to different stakeholders such as patients, their caregivers, clinicians, and insurers is not elucidated. The aim of this study was to explore the value different stakeholders place on the availability of sm...

Aim: To understand clinician attitudes and the barriers that impede research recruitment from specialized primary care-based memory clinics. Materials & methods: Clinicians completed a survey on attitudes and barriers to research recruitment from memory clinics. Results: Comfort and willingness to recruit for research were low to moderate and were...

Background/objectives The ability to manage medications independently may be affected in older adults due to physical and cognitive limitations. Numerous electronic medication adherence products (eMAPs) are available to aid medication management. Unfortunately, there are no available guidelines to support clinicians in recommending eMAPs. The objec...

Smart adherence products are marketed to assist with medication management. However, little is known about their in-home integration by older adults. It is necessary to investigate the facilitators and barriers older adults face when integrating these products into their medication taking routines before effectiveness can be examined. The aim of th...

Background: Computer-based education has been widely implemented in healthcare professional development education. However, there has been little examination of the potential for computer-based education to enhance pharmacists' knowledge. This study aims to assess the effectiveness of computer-based education on improving pharmacists' knowledge co...

Background: Innovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients' homes. One such smart medication dispenser, spencer, provides alerts to patients to take their medications and allows for tracking and...

BACKGROUND Innovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients’ homes. One such smart medication dispenser, spencer , provides alerts to patients to take their medications and allows for tracking and r...

Objective: To describe the proportion and identify predictors of community-dwelling individuals with traumatic spinal cord injury (TSCI) who were dispensed ≥1 publicly funded opioid in the year after injury using a retrospective cohort study. Setting: Ontario, Canada. Participants, interventions, outcome measures: We used administrative data t...

Background Medication mismanagement can lead to non-optimal management of chronic diseases and poor health outcomes. Objective The purpose of this study was to better understand meanings associated with in-home medication management and storage practices of older adults with chronic diseases. Methods A modified ethnographic approach using digital...

Background Smart medication adherence products (smart MAPs) capture and transmit real-time medication intake by using various means of connectivity, allowing for remote monitoring. Numerous such products with different features are available to address medication nonadherence. A comparison of the features of these products is needed for clinical de...

Background The Case-finding for Complex Chronic Conditions in Adults 75+ (C5-75) involves annual frailty screening in primary care using dual-trait screening measures of handgrip strength and gait speed, with additional screening for co-existing conditions in those deemed frail. Objective To identify low-risk individuals who could be screened for...

Innovative dispensing products offering real-time medication intake monitoring are being developed to address medication non-adherence. However, implementation of these interventions within the workflow of a community pharmacy is unknown. The purpose of this study was to explore factors affecting implementation of a real-time adherence-monitoring,...

This study explored whether working within Multispecialty INterprofessional Team (MINT) memory clinics has an impact on health care professionals’ perceptions of the challenges, attitudes, and level of collaboration associated with providing dementia care. Surveys were completed by MINT memory clinic members pre- and 6-months post-clinic launch. A...

Background: For older adults, the capacity to self-manage medications may be limited by several factors. However, currently available tools do not permit a comprehensive assessment of such limitations. The Domain Specific Limitation in Medication Management Capacity (DSL-MMC) was developed to address this need. This study aimed to establish the fa...

Study design: Cohort study. Objective: To determine the prevalence and to identify predictors of prescription opioid use among persons with nontraumatic spinal cord dysfunction within 1 year after discharge from inpatient rehabilitation. Setting: Ontario, Canada. Methods: We conducted a retrospective cohort study using administrative data to...

Background Medication non-adherence is a leading cause of non-optimal disease management, resulting in poor health outcomes, poor quality of life, and increased healthcare costs. Smart oral multidose dispensing systems (SOMDS) are being developed to address non-adherence; however, little is known about their integration into daily use by patients....

Background Medication management among older adults continues to be a challenge, and innovative electronic medication adherence products have been developed to address this need. Objective The aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and prefere...

Objectives: To examine prescription opioid claims among individuals with traumatic spinal cord injury (SCI) and to identify factors associated with both chronic opioid and chronic high-dose opioid use. Design: Retrospective cohort study using population-level administrative data. Setting: Ontario, Canada. Participants: Individuals (N=1842) w...

Background Practices related to the handling of controlled substances (CS) in Ontario hospices have not been previously published and therefore, are unknown. Objective The objective of this study was to determine current practices, and policies, standard operating procedures (SOPs) and guidelines related to handling and disposal of CS at hospices a...

Purpose To compare the attitudes and preferences of persons with spinal cord injury/dysfunction (SCI/D) and healthcare providers regarding prescription medications, over-the-counter medications, and natural health products (NHPs). Materials and methods A qualitative study involving semi-structured interviews with healthcare providers (n = 32) and...

Retrospective cohort study. To examine the prevalence of polypharmacy for individuals with nontraumatic spinal cord dysfunction (NTSCD) following inpatient rehabilitation and to determine associated risk factors. Ontario, Canada. Administrative data housed at ICES, Toronto, Ontario were used. Between 2004 and 2015, we investigated prescription medi...

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist...

Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) is a systematic approach to identify frailty using gait speed and hand-grip strength and to screen for co-morbid conditions. We identified the C5-75 features offering the highest yield for identifying frailty and to streamline the screening program. Analyses included 1,948 C5-75 ass...

Purpose: To explore the attitudes, beliefs and experiences pertaining to the management of prescribed and unprescribed medications among community-dwelling adults with spinal cord injury/dysfunction (SCI/D) in Ontario, Canada. Materials and Methods: In-depth semi-structured interviews were conducted by telephone. Each interview was audio-recorded,...

Background: Patients suffering from chronic pain frequently ask pharmacists for advice. Aims: This study was prompted by inadequacies in the available body of literature reporting on pharmacists’ experiences with providing care for patients with chronic pain in the community setting. Methods: A qualitative investigation of Ontario community pharmac...

Introduction: Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. M...

BACKGROUND A decreased capacity to self-manage medications results in non-adherence, medication errors and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products (eMAPs) available to assist patients with self-management of medications. Unfortunately, the usability and workload of these produc...

Rationale: Spinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/servic...

Background: Persons with spinal cord injury/dysfunction (SCI/D) often take multiple medications to treat their secondary complications and chronic conditions (multimorbidity). Multiple healthcare and service providers are often involved in care, which can result in increased risk of fragmentation of care. Optimal medication therapy management (MTM...

Objective Adults aged 50 years and older with epilepsy face an increased risk of fracture associated both with age and with the use of antiepileptic drugs. Lifestyle behaviors, such as physical activity and calcium and vitamin D intake, have been found to be beneficial to bone health. The aim of this study is to investigate these osteoprotective be...

Context: People with spinal cord injury and dysfunction (SCI/D) often take multiple medications (i.e. polypharmacy) to manage secondary health complications and multiple chronic conditions. Numerous healthcare providers are often involved in clinical care, increasing the risk of fragmented care, problematic polypharmacy, and conflicting health advi...

Context: People with spinal cord injury and dysfunction (SCI/D) often take multiple medications (i.e. polypharmacy) to manage secondary health complications and multiple chronic conditions. Numerous healthcare providers are often involved in clinical care, increasing the risk of fragmented care, problematic polypharmacy, and conflicting health advi...

Purpose: The purpose of this scoping review was to map the scope of the literature on polypharmacy among individuals with spinal cord injury or dysfunction (SCI/D). Material and methods: Five electronic databases were searched for literature published between January 1990 and July 2018. The following keywords were searched using Boolean operators,...

Context: Pain and depression are two prevalent secondary complications associated with spinal cord injury (SCI) that negatively impact health and well-being. Self-management strategies are growing in popularity for helping people with SCI to cope with their pain and depression. However, there is still a lack of research on which approaches are best...

Background Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. Objectives To identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. Methods Four focus groups with 35 team members pract...

Objectif: Passer en revue les symptômes de la toxicité sérotoninergique (communément appelée le syndrome sérotoninergique), les médicaments causatifs et leurs mécanismes d’action, et proposer aux médecins de soins primaires des stratégies pratiques pour prévenir et dépister la toxicité sérotoninergique. QUALITÉ DES DONNÉES: Une recherche documentai...

Objective: To review the symptoms of serotonin toxicity (commonly referred to as serotonin syndrome) and the causative drugs and their mechanisms of action, and to equip primary care providers with practical strategies to prevent and identify serotonin toxicity. Quality of evidence: PubMed and Google Scholar were searched for relevant articles o...

Objective: To provide primary care physicians with an approach to medication optimization in older adults with cognitive impairment. Sources of information: The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. Main message: Dementia increases...

With the aging population, escalating demand for seniors' care and limited specialist resources, new care delivery models are needed to improve capacity for primary health care for older adults. This paper describes the "C5-75" (Case-finding for Complex Chronic Conditions in Seniors 75+) program, an innovative care model aimed at identifying frailt...

Objective: Several antiepileptic drugs (AEDs) have been associated with a detrimental effect on bone health through a reduction in serum vitamin D. Subsequently, several studies have investigated the effect of vitamin D supplementation in persons with epilepsy being treated with AEDs. The present systematic review of published literature was condu...

Background: Adherence to evidence-based therapies such as medications and exercise remains poor among patients after a myocardial infarction (MI). Text message reminders have been shown to improve rates of adherence to medication and exercise, but the existing studies have been of short duration. Objective: Two single-center randomized controlle...

Medication errors involving antiepileptic drugs (AEDs) are not well studied but have the potential to cause significant harm. We investigated the occurrence of medication incidents in Canadian hospitals that involve AEDs, their severity and contributing factors by analyzing data from two national databases. Our multi-incident analysis revealed that...

The Opioid Education Partnership is a Health Canada-funded interprofessional initiative that developed and tested a pilot education program, consisting of 8 interactive online modules, designed to help physicians, pharmacists, students and trainees enhance understanding of prescription opioid use and promote collaborative management.

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropria...

Aim: Identification of frailty in the primary care setting could be improved with the availability of easily identifiable markers of frailty. The purpose of this article was to systematically review markers for frailty or risk tools that have been validated in the ambulatory care setting. Methods: Medline, PubMed, CIHAHL and Embase databases wer...

Background: Falls are a major cause of morbidity and mortality in older adults. About a third of those aged 65 years or older fall at least once each year, which can result in hospitalizations, hip fractures and nursing home admissions that incur high costs to individuals, families and society. The objective of this clinical review was to assess t...

Objective To examine the accuracy of individual Fried frailty phenotype measures in identifying the Fried frailty phenotype in primary care. Design Retrospective chart review. Setting A community-based primary care practice in Kitchener, Ont. Participants A total of 516 patients 75 years of age and older who underwent frailty screening. Main outcom...

Objective: To examine the accuracy of individual Fried frailty phenotype measures in identifying the Fried frailty phenotype in primary care. Design: Retrospective chart review. Setting: A community-based primary care practice in Kitchener, Ont. Participants: A total of 516 patients 75 years of age and older who underwent frailty screening....

The treatment of chronic pain consumes a significant share of primary care. Community and family health team pharmacists frequently see patients with chronic pain, thus have the opportunity to improve their care. To assess the knowledge, perceptions, and attitudes of Ontario pharmacists, we invited 5,324 Ontario pharmacists, to participate in an on...

Representativeness of population of pharmacists who responded to survey (N = 392) to the Ontario pharmacist population at large. (DOCX)