Advertisement

International Journal of Clinical Pharmacy

, Volume 40, Issue 1, pp 119–125 | Cite as

Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients

  • Christine Flagstad Bech
  • Tine Frederiksen
  • Christine Tilsted Villesen
  • Jette Højsted
  • Per Rotbøll Nielsen
  • Lene Juel Kjeldsen
  • Lotte Stig Nørgaard
  • Lona Louring ChristrupEmail author
Research Article

Abstract

Background Disagreement among healthcare professionals on the clinical relevance of drug-related problems can lead to suboptimal treatment and increased healthcare costs. Elderly patients with chronic non-cancer pain and comorbidity are at increased risk of drug related problems compared to other patient groups due to complex medication regimes and transition of care. Objective To investigate the agreement among healthcare professionals on their classification of clinical relevance of drug-related problems in elderly patients with chronic non-cancer pain and comorbidity. Setting Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen, Denmark. Method A pharmacist performed medication review on elderly patients with chronic non-cancer pain and comorbidity, identified their drug-related problems and classified these problems in accordance with an existing categorization system. A five-member clinical panel rated the drug-related problems’ clinical relevance in accordance with a five-level rating scale, and their agreement was compared using Fleiss’ κ. Main outcome measure Healthcare professionals’ agreement on clinical relevance of drug related problems, using Fleiss’ κ. Results Thirty patients were included in the study. A total of 162 drug related problems were identified, out of which 54% were of lower clinical relevance (level 0–2) and 46% of higher clinical relevance (level 3–4). Only slight agreement (κ = 0.12) was found between the panellists’ classifications of clinical relevance using a five-level rating scale. Conclusion The clinical pharmacist identified drug related problems of lower and higher clinical relevance. Poor overall agreement on the severity of the drug related problems was found among the panelists.

Keywords

Care transition Clinical relevance DRP classification Drug-related problems Inter-rater agreement Medication review 

Notes

Acknowledgements

A special thanks goes to the funders of the study. Furthermore, the investigators would like to thank all the participants in the project “Drug-Related Problems in the Frontier between Primary and Secondary Healthcare”.

Funding

This study was funded by Actavis Foundation and an unrestricted research grant from Grünenthal Denmark to the University of Copenhagen.

Conflicts of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging. 2003;20:817–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65.CrossRefPubMedGoogle Scholar
  3. 3.
    Page AT, Etherton-Beer CD, Clifford RM, Burrows S, Eames M, Potter K. Deprescribing in frail older people—do doctors and pharmacists agree? Res Soc Adm Pharm. 2016;12:438–49.CrossRefGoogle Scholar
  4. 4.
    Tangiisuran B, Auyeung V, Cheek L, Rajkumar C, Davies G. Inter-rater reliability of the assessment of adverse drug reactions in the hospitalised elderly. J Nutr Health Aging. 2013;17:700–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–24.CrossRefPubMedGoogle Scholar
  6. 6.
    Midlov P, Bergkvist A, Bondesson A, Eriksson T, Hoglund P. Medication errors when transferring elderly patients between primary health care and hospital care. Pharm World Sci. 2005;27:116–20.CrossRefPubMedGoogle Scholar
  7. 7.
    Siple JF, Joseph CL. Medication discrepancies on admission to a nursing home. Am J Health Syst Pharm AJHP Off J Am Soc Health Syst Pharm. 1992;49:397–400.Google Scholar
  8. 8.
    Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Sundhedsdatastyrelsen. Fælles medicinkort. https://fmk-online.dk/fmk/. Accessed 8 Oct 2017.
  10. 10.
    Epic Systems Corporation. Min Sundhedsplatform. https://minsundhedsplatform.dk/mychartppr1/. Accessed 23 Nov 2017.
  11. 11.
    Danish Medicines Agency. Interaktionsdatabasen. http://interaktionsdatabasen.dk/. Accessed 5 Oct 2017.
  12. 12.
    The Danish College of General Practitioners. Kliniske Vejledninger. http://www.dsam.dk/flx/vejledninger/kliniske_vejledninger/. Accessed 5 Oct 2017.
  13. 13.
    Danish Health Authority. Rational pharmacotherapy. https://www.sst.dk/en/rational-pharmacotherapy?sc_site=website. Accessed 5 Oct 2017.
  14. 14.
    Dansk Lægemiddel Information. Pro.medicin. 2017. http://pro.medicin.dk/. Accessed 5 Oct 2017.
  15. 15.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  16. 16.
    Peterson G, Tenni P. Identifying, prioritising and documenting drug-related problems. Aust Pharm. 2004;23:706–9.Google Scholar
  17. 17.
    Williams M, Peterson G, Tenni P, Bindoff I, Stafford A. DOCUMENT: a system for classifying drug-related problems in community pharmacy. Int J Clin Pharm. 2012;34:43–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76:378–82.CrossRefGoogle Scholar
  19. 19.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMedGoogle Scholar
  20. 20.
    Somers A, Robays H, De Paepe P, Van Maele G, Perehudoff K, Petrovic M. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Clin Interv Aging. 2013;8:703–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kovacevic SV, Miljkovic B, Culafic M, Kovacevic M, Golubovic B, Jovanovic M, et al. Evaluation of drug-related problems in older polypharmacy primary care patients. J Eval Clin Pract. 2017;23:860–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Frydenberg K, Brekke M. Poor communication on patients’ medication across health care levels leads to potentially harmful medication errors. Scand J Prim Health Care. 2012;30:234–40.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ Can Med Assoc J. 2005;173:510–5.CrossRefGoogle Scholar
  24. 24.
    Haavik S, Soeviknes S, Erdal H, Kjonniksen I, Guttormsen AB, Granas AG. Prescriptions from general practitioners and in hospital physicians requiring pharmacists’ interventions. Pharmacoepidemiol Drug Saf. 2011;20:50–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Redmond P, Carroll H, Grimes T, Galvin R, McDonnell R, Boland F, et al. GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland. Fam Pract. 2016;33:172–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Sjölander M, Gustafsson M, Gallego G. Doctors’ and nurses’ perceptions of a ward-based pharmacist in rural northern Sweden. Int J Clin Pharm. 2017;39:953–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Shah BM, Hajjar ER. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med. 2012;28:173–86.CrossRefPubMedGoogle Scholar
  28. 28.
    Mekonnen AB, McLachlan AJ, Brien JE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):1–14.CrossRefGoogle Scholar
  29. 29.
    Ensing HT, Koster ES, van Berkel PI, van Dooren AA, Bouvy ML. Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther. 2017;42:170–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Christine Flagstad Bech
    • 1
  • Tine Frederiksen
    • 1
  • Christine Tilsted Villesen
    • 1
    • 2
  • Jette Højsted
    • 2
  • Per Rotbøll Nielsen
    • 2
  • Lene Juel Kjeldsen
    • 3
  • Lotte Stig Nørgaard
    • 4
  • Lona Louring Christrup
    • 1
    Email author
  1. 1.Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
  2. 2.Multidisciplinary Pain CentreCopenhagen University HospitalCopenhagenDenmark
  3. 3.Amgros I/SCopenhagenDenmark
  4. 4.Department of PharmacyUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations