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Drug-related problems identified during geriatric medication review in the community pharmacy

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Abstract

Background In line with the changing role of community pharmacists, we describe here a standardised procedure for detecting DRPs in elderly patients for use in community pharmacies. Objectives The primary aim was to describe the number and type of DRPs identified by community pharmacists in elderly patients. Secondary aims were to determine the number and type of associated pharmacist interventions (PIs) that were transmitted to the prescribers, and to identify risk factors associated with the occurrence of a PI. Setting Community pharmacies. Methods In this prospective, multicentre study, pharmacists received patients aged 65 and over. During a 30-min interview with patients who agreed to participate, patient characteristics were recorded such as age, weight, height, frailty (using the Short Emergency Geriatric Assessment grid), estimated renal function and compliance with treatment assessed by the Girerd scale. Main outcome measure DRPs characteristics. Results A total of 892 patients agreed to participate in 55 pharmacies. Among them 334 DRPs were identified and were associated with 259 PIs. Eighty-nine PIs of 259 were sent to the prescribing physicians; 70 (78%) were implemented by the general practitioner. Factors associated with the occurrence of a DRP are compliance problems [odds ratio (OR) = 1.8, 95% confidence interval (CI) (1.26–2.58)], frailty [OR = 1.3, 95% CI (1.01–1.66)], number of prescribed drugs per day [OR = 1.46, 95% CI (1.02–2.07)] and GFR < 60 mL/min [OR = 1.49, 95% CI (1.01–2.2)]. Conclusion This is the first standardised pharmaceutical assessment dedicated to the elderly carried out by community pharmacists in France. If implemented, it could help to find drug-related problems, identify frail elderly patients and ultimately decrease their exposure to iatrogenic medication errors.

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References

  1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  2. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30(3):205–11.

    Article  CAS  PubMed  Google Scholar 

  4. Morice E, Gabriel-Bordenave C, Auclair V, Juste M, Roberge C. Évaluation de la pratique d’analyse d’ordonnance dans les hôpitaux français [Evaluation of prescription checking practices by French hospital Pharmacists]. Le Pharmacien Hospitalier et Clinicien. 2011;46(3):293–5.

    Article  Google Scholar 

  5. Martin SF, Van Mil JW, Da Costa FA. The organizational framework of community pharmacies in Europe. Int J Clin Pharm. 2015;37(5):896–905.

    Article  Google Scholar 

  6. Harris IM, Phillips B, Boyce E, Griesbach S, Hope C, Sanoski C, et al. Clinical pharmacy should adopt a consistent process of direct patient care. Pharmacotherapy. 2014;34(8):e133–48.

    Article  PubMed  Google Scholar 

  7. Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. Adverse drug events prevention group. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277(4):307–11.

    Article  CAS  PubMed  Google Scholar 

  8. Gallagher J, Byrne S, Woods N, Lynch D, McCarthy S. Cost-outcome description of clinical pharmacist interventions in a university teaching hospital. BMC Health Serv Res. 2014;14:177.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dooley MJ, Allen KM, Doecke CJ, Galbraith KJ, Taylor GR, Bright J, et al. A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. Br J Clin Pharmacol. 2004;57(4):513–21.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tinetti M, Fried T, Boyd C. Designing health care for the most common chronic condition: multimorbidity. JAMA. 2012;307(23):2493–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev. 2016;(2):CD008986. https://doi.org/10.1002/14651858.CD008986.pub3.

  12. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55:809–17.

    Article  PubMed  Google Scholar 

  13. Chan DC, Chen JH, Kuo HK, We CJ, Lu IS, Chiu LS, et al. Drug-related problems (DRPs) identified from geriatric medication safety review clinics. Arch Gerontol Geriatr. 2012;54(1):168–74.

    Article  PubMed  Google Scholar 

  14. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics ans pharmacodynamics: basic principles and pratical applications. Br J Clin Pharmacol. 2004;57:6–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Charpiat B, Conort O, Juste M, Rose FX, Roubille R, Bedouch P, et al. The French Society of clinical pharmacy ACT-IP project: ten years onward, results and prospects. Le Pharmacien Hospitalier et Clinicien. 2015;50:15–24.

    Article  Google Scholar 

  16. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (ScreeningTool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.

    Article  CAS  PubMed  Google Scholar 

  17. Oubaya N, Mahmoudi R, Jolly D, Zulfiqar AA, Quignard E, Cunin C, et al. Screening for frailty in elderly subjects living at home: validation of the modified Short Emergency Geriatric assessment (SEGAm) instrument. J Nutr Health Aging. 2014;18(8):757–64.

    Article  CAS  PubMed  Google Scholar 

  18. Girerd X, Hanon O, Anagnostopoulos K, Ciupek C, Mourad JJ, Consoli S. Evaluation de l’observance du traitement anti-hypertenseur par un questionnaire: mise au point et utilisation dans un service specialisé [Assessment of antihypertensive compliance using a self-administered questionnaire: development and use in a hypertension clinic]. Presse Med. 2001;30:1044–8.

    CAS  PubMed  Google Scholar 

  19. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.

    Article  CAS  PubMed  Google Scholar 

  20. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Int Med. 1999;130(6):461–70.

    Article  CAS  PubMed  Google Scholar 

  21. Allenet B, Bedouch P, Rose FX, Escofier L, Roubille R, Juste M, et al. Validation of an instrument for the documentation of clinical pharmacists interventions. Pharm World Sci. 2006;28:181–8.

    Article  PubMed  Google Scholar 

  22. Helou R. Should we continue to use the Cockcroft–Gault formula? Nephron Clin Pract. 2010;116:c172–85.

    Article  PubMed  Google Scholar 

  23. Bell JS, Blacker N, Leblanc VT, Alderman PC, Phillips A, Rowett D, et al. Prescribing for older people with chronic renal impairment. Aust Fam Phys. 2013;42(1–2):24–8.

    Google Scholar 

  24. Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol. 2014;70(7):799–815.

    Article  PubMed  Google Scholar 

  25. Krähenbühl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharm World Sci. 2008;30(6):777–86.

    Article  PubMed  Google Scholar 

  26. Nicolas A, Eickhoff C, Griese N, Schulz M. Drug-related problems in prescribed medicines in Germany at the time of dispensing. Int J Clin Pharm. 2013;35(3):476–82.

    Article  PubMed  Google Scholar 

  27. Bedouch P, Sylvoz N, Charpiat B, Juste M, Roubille R, Rose FX, et al. Trends in pharmacists’ medication order review in French hospitals from 2006 to 2009: analysis of pharmacists’ interventions from the Act-IP© website observatory. J Clin Pharm Ther. 2015;40(1):32–40.

    Article  CAS  PubMed  Google Scholar 

  28. Bardet JD, Vo T-H, Bedouch P, Allenet B. Physicians and community pharmacists collaboration in primary care: a review of specific models. Res Soc Adm Pharm. 2015;11(5):602–22.

    Article  Google Scholar 

  29. Tan E, Stewart K, Elliott R. Pharmacist services provided in general practice clinics: a systematic review and meta-analysis. Res Soc Adm Pharm. 2014;10(4):608–22.

    Article  Google Scholar 

  30. Hirsch JD, Steers N, Adler DS. Primary care-based, pharmacist-physician collaborative medication-therapy management of hypertension: a randomized, pragmatic trial. Clin Ther. 2014;36(9):1244–54.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Taylor DG, Garfield S, Hawkins J, Newbould J, Rennie T. Greater expectations. Pharmacy based health care: the future for Europe? Policy Paper. 2007;5:1–19.

    Google Scholar 

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Acknowledgements

The authors wish to thank students and community pharmacists who participated in this study, the representatives of the bodies which supported them, the administrative and medical staffs of the Bertinot Juel Hospital Center in Chaumont-en-Vexin, who actively participate in reflections on clinical pharmacy.

Funding

This study was funded by the Agence Régionale de Santé de Picardie, the Collège Régional des Pharmaciens Maîtres de stage de Picardie, the Association de Pharmacie Hospitalière de l’Oise, la Somme et l’Aisne (APHOSA) and the Bertinot Juel Hospital Center of Chaumont-en-Vexin.

Conflicts of interest

Authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Centre Hospitalier Bertinot Juël, Service Pharmacie, 34 bis rue Pierre BUDIN, 60240, Chaumont en Vexin, France

    Mounir Rhalimi

  2. INSERM U1088, Université de Picardie Jules Verne, Amiens, France

    Mounir Rhalimi

  3. ARCOSA, 94450, Limeil-Brévannes, Val de Marne, France

    Alain Rauss

  4. Faculté de Pharmacie, 1 rue des Louvels, 80037, Amiens Cedex 1, France

    Eric Housieaux

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  1. Mounir Rhalimi
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Correspondence to Mounir Rhalimi.

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Rhalimi, M., Rauss, A. & Housieaux, E. Drug-related problems identified during geriatric medication review in the community pharmacy. Int J Clin Pharm 40, 109–118 (2018). https://doi.org/10.1007/s11096-017-0571-y

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