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Goedken, Amber, Sharon Huang, Randal McDonough, Michael Deninger, and William Doucette. "Medication-Related Problems Identified Through Continuous Medication Monitoring." Pharmacy 6, no. 3 (August 20, 2018): 86. http://dx.doi.org/10.3390/pharmacy6030086.
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Community pharmacists performing Continuous Medication Monitoring (CoMM) systematically monitor each new prescription and refill dispensed for medication-related problems. The objectives for this study were to describe medication-related problems identified through CoMM and drug classes involved in problems. This 12-month pilot study used dispensing and clinical records from a single independent U.S. community pharmacy. Clinical records contain medication-related problems documented by the pharmacists. Problems identified for patients filling at least one prescription at the pharmacy and having at least one medication-related problem during the study period were included. A total of 8439 medication-related problems were identified for 1566 patients, an average of 5.4 problems per patient. Over 63% of problems were nonadherence. The drug class most often involved in problems was the central nervous system and analgesic class. Community pharmacists performing CoMM identified medication-related problems that might otherwise have gone undetected.
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Stevenson, Jennifer M., J. Graham Davies, and Finbarr C. Martin. "Medication-related harm: a geriatric syndrome." Age and Ageing 49, no. 1 (October 28, 2019): 7–11. http://dx.doi.org/10.1093/ageing/afz121.
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Abstract The WHO Global Patient Safety Challenge: Medication Without Harm recognises medication-related harm (MRH) as a global public health issue. Increased life-expectancy coupled with multimorbidity and polypharmacy leads to an increased incidence of MRH, especially in older adults: at a cost of approximately £400 million to the National Health Service (NHS) in England. Harm from medicines has long been recognised by geriatricians, and strategies have been developed to mitigate harm. In general, these have focused on the challenges of polypharmacy and appropriateness of medicines, but impact on the quality of life, clinical and economic outcomes has been variable and often disappointing. The problem of MRH in older adults will continue to grow unless a new approach is adopted. Emerging evidence suggests that we need to take a broader approach as described in our conceptual model, where well-recognised physiological changes are incorporated, as well as other rarely considered psychosocial issues that influences MRH. Parallels may be drawn between this approach and the management of geriatric syndromes. We propose there must be a greater emphasis on MRH, and it, of itself, should be considered as a geriatric syndrome, to bring the spotlight onto the problem and to send a clear signal from geriatric experts that this is an important issue that needs to be addressed using a co-ordinated and tailored approach across health and social care boundaries. This requires a more proactive approach to monitor and review the medicines of older adults in response to their changing need.
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MacTavish, Pamela, Tara Quasim, Martin Shaw, Helen Devine, Malcolm Daniel, John Kinsella, Carl Fenelon, Rakesh Kishore, Theodore J. Iwashyna, and Joanne McPeake. "Impact of a pharmacist intervention at an intensive care rehabilitation clinic." BMJ Open Quality 8, no. 3 (September 2019): e000580. http://dx.doi.org/10.1136/bmjoq-2018-000580.
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ObjectiveWhile disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge.DesignConsecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation.SettingTertiary care regional centre in Scotland (UK).Participants47 patients reviewed after critical care discharge at an ICU follow-up programme.InterventionsPharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence.MeasurementsMedication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix.Main results69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03).ConclusionsMedication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.
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Patil, Anant D., Hritika Sharma, and Tanusri Tetarbe. "COVID-19 and concerns related to self-medication." International Journal of Basic & Clinical Pharmacology 9, no. 9 (August 25, 2020): 1475. http://dx.doi.org/10.18203/2319-2003.ijbcp20203638.
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The practice of self-care through self-medication is not uncommon. Self-medication is not just a problem of one country, the phenomenon is global. A systematic review has highlighted this wide spread problem. Self-medication can be based on self-belief, advice of a pharmacist or another person instead of consultation with a qualified healthcare professional. In the settings of poor access to health care services and issues related to affordability of paying for medical services, people practice self-medication as the righteous approach. Some people may consume medications without consultation of a healthcare professional citing reason of time saving. Certain drugs available as prescription medicine in one country may be available over the counter in another country. Furthermore, with digitalisation, people now have an easy access to the internet where they simply explore their symptoms and find the perceived suitable treatment for the same. Thus, the reasons and pattern of self-medications may differ based on different factors including type of population affordability, and country.
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Vervloet, Marcia, Hanneke E. Zwikker, Annemiek J. Linn, Ellen S. Koster, Suzan G. H. Gipmans, Maaike C. W. van Aarle, and Liset van Dijk. "The Development and Proof of Principle Test of TRIAGE: A Practical Question Set to Identify and Discuss Medication-Related Problems in Community Pharmacy." Pharmacy 8, no. 4 (September 27, 2020): 178. http://dx.doi.org/10.3390/pharmacy8040178.
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The pharmacy counter is a good place to identify and discuss medication-related problems. However, there is a lack of practical communication tools to support pharmacy technicians (PTs) in initiating a conversation with patients. This study aimed to develop and test a practical set of questions for PTs, called TRIAGE, to identify problems during encounters. TRIAGE was developed based on insight from the literature, focus groups with PTs and pharmacists, and input from patients and experts. In 10 community pharmacies, 17 PTs used TRIAGE during encounters with patients who collected their cardiovascular medication. For each encounter, PTs registered the identified problems and suggested solutions. A total of 105 TRIAGE conversations were held, 66 for first refill and 39 for follow-up refill prescriptions. In 15 (23%) first refill prescription encounters, a problem was identified. These problems concerned forgetting to take the medication, a complex medication regime or (fear of) side effects. In three (8%) follow-up refill prescription encounters, a problem was identified. Most of the problems were solved on the spot. Pharmacy technicians indicated that they identified medication-related problems with TRIAGE that otherwise would be left unnoticed. They appreciated TRIAGE as a useful instrument for starting the conversation with patients about medication use.
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Tharanon, Vichapat, Krongtong Putthipokin, and Phantipa Sakthong. "Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital." SAGE Open Medicine 10 (January 2022): 205031212210908. http://dx.doi.org/10.1177/20503121221090881.
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Introduction: Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists’ interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units. Methods: A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.’s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes. Results: A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists’ interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients. Conclusion: The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.
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Doran, Elizabeth. "The View from the Emergency Department: An Emergency Medicine Pharmacist's Perspective." Senior Care Pharmacist 35, no. 6 (June 1, 2020): 240–42. http://dx.doi.org/10.4140/tcp.n.2020.240.
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A medication-focused review of older patients in the emergency department is important in identifying medication-related problems, differential diagnoses, and associated complications. With rapid triage, assessment, and diagnosis, the emergency department is inherently an area of empirical prescribing. Emergency department pharmacists are uniquely placed to review patients on presentation with a focus on both acute problem management and identifying and addressing long-standing medication issues.
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Doran, Elizabeth. "The View from the Emergency Department: An Emergency Medicine Pharmacist's Perspective." Senior Care Pharmacist 35, no. 6 (June 1, 2020): 240–42. http://dx.doi.org/10.4140/tcp.n.2020.240.
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A medication-focused review of older patients in the emergency department is important in identifying medication-related problems, differential diagnoses, and associated complications. With rapid triage, assessment, and diagnosis, the emergency department is inherently an area of empirical prescribing. Emergency department pharmacists are uniquely placed to review patients on presentation with a focus on both acute problem management and identifying and addressing long-standing medication issues.
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Wright, A., M. Krousel-Wood, E. J. Thomas, J. A. McCoy, D. F. Sittig, and A. B. McCoy. "Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs." Applied Clinical Informatics 06, no. 02 (2015): 334–44. http://dx.doi.org/10.4338/aci-2015-01-ra-0010.
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SummaryBackground: Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging.Objective: We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record.Methods: We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision.Results: The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%.Conclusions: We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across health-care settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.Citation: McCoy AB, Wright A, Krousel-Wood M, Thomas EJ, McCoy JA, Sittig DF. Validation of a crowdsourcing methodology for developing a knowledge base of related problem-medication pairs. Appl Clin Inf 2015; 6: 334–344http://dx.doi.org/10.4338/ACI-2015-01-RA-0010
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Mgbahurike A. A and Wonte M. I. "Assessment of Medication Related Problems in Geriatrics Unit of Nigerian Tertiary Hospital." Journal of Medical Biomedical and Applied Sciences 8, no. 5 (May 17, 2020): 429–35. http://dx.doi.org/10.15520/jmbas.v8i5.228.
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Medication related problems are prevalent especially in the geriatric populationandcancause considerable patient morbidity and in some cases death as well as increased health expenditure. The elderly population is at increased risk for medication related problems as a result of age – related physiological changes and the presence of multiple chronic diseases. Aim: This study aimed to assess medication related problems (MRP) in University of Port Harcourt Teaching Hospital, with the objective to identify and categorize the MRP according to types as well as identify the most frequent MRP encountered and interventions made by the pharmacists. Method: The study was a retrospective study carried out among 200 geriatric patientsrandomly sampled, over 18months period (January 2018 to June 2019). Data extracted include patients’ demographic information, prescribed medication and number, medical condition, and pharmacist’s intervention (where available) using data collection form. Information collected were categorized and analyzed statistically. Result: showed that female geriatric patients (64.4%) were more than male (35.5%). Most (43%) of the studied population were in the range of 60yrs – 70yrs. Out of the 200 patients assessed, 157 (78.4%) had medication related problems. Drug- drug interaction was the most frequently (64.4%) occurred MRP, as most (62.5%) of the studied group had 6 -10 medications in one prescription, and 12.5% had more than 10 medications in one prescription. Following drug interaction was incorrect drug administration (18.5%). Of the population studied, 56.5% of the patients were using their medication inappropriately. The major contributing factors responsible for these MRPs were comorbidities, poly-pharmacy, and medication non- adherence. Conclusion: The study identified categories of medication related problem in the geriatric Unit of the hospital and the need for pharmacists’ interventions.
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Lee, Vivian WY, Kathy KW Pang, Ka Chun Hui, Jennifer CK Kwok, Siu Ling Leung, Doris Sau Fung Yu, and Diana Tze Fan Lee. "Medication adherence: Is it a hidden drug-related problem in hidden elderly?" Geriatrics & Gerontology International 13, no. 4 (March 3, 2013): 978–85. http://dx.doi.org/10.1111/ggi.12042.
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TV, Niveditha, Abhishek Pradhan, and A. R. Shabaraya. "Drug Related Problems in Geriatric Patients with Inappropriate Medication Use." International Journal of Research and Review 8, no. 5 (June 3, 2021): 487–96. http://dx.doi.org/10.52403/ijrr.20210559.
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Drug related problem (DRP) is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. Nowadays geriatric patients are at high risk of DRPs due to polypharmacy and altered physiology or due to older patients cannot manage their medication. DRPs also could arise from age related chronic diseases. The DRPs following hospital discharged cases also increased in elder people with chronic disease. Geriatric patients faces DRPs include inappropriate use of medication, polypharmacy, noncompliance, ADRs, drug–drug interaction, etc. Geriatric patients require more care because DRPs sometimes leads to hospital admission days, cost of the medication, increased morbidity rate and reduce the quality of life etc. So these category people need special consideration while selecting the drug therapy and its pattern. Like other health care services this special category of patients’ needs good care or services from a team of health care professionals including clinical pharmacists. This review article aims to understand the risk factors and different types of DRPs that are facing by the elderly people due to inappropriate medication use and pharmaceutical care by clinical pharmacists. Keywords: Geriatric patients, Polypharmacy, Non-compliance, and Drug related problems.
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Pradhan, Abhishek, Febin Benny, and A. R. Shabaraya. "Identification of Different Class of Drugs causing Medication Related Problems in the Elderly Patients of Dakshina Kannada." International Journal of Research and Review 8, no. 8 (August 26, 2021): 668–72. http://dx.doi.org/10.52403/ijrr.20210888.
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Medication related problems (MRPs) can be defined as an event or situation involving drug therapy that potentially interferes with desired health outcome. The aim of the study was to identify the class of drugs that are commonly causing medication related problems in elderly patients. This study was conducted in 150 patients aged over 60 years for a duration of six months. The data were collected using a patient interview form and was analysed using Microsoft Excel 2016. Out of 150 patients participated in the study, 107 patients were identified with MRPs. And a total of 196 MRPs were identified from those 107 patients. The patients who were treated with cardiovascular agents where more prone to medication related problems and was found to be 57%. They were followed by endocrine agents (33%), gastro-protectants (21%), respiratory agents (17%) & others. This study concluded that, pharmacist can be helpful in identification and prevention of MRPs leading to a better healthcare outcomes. Keywords: Medication related problem, elderly population, class of drug.
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Carlton, Gaya, and Mary A. Blegen. "Medication-Related Errors: A Literature Review of Incidence and Antecedents." Annual Review of Nursing Research 24, no. 1 (January 2006): 19–38. http://dx.doi.org/10.1891/0739-6686.24.1.19.
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Patient safety has become a major concern for both society and policymakers. Since nurses are intimately involved in the delivery of medications and are ultimately responsible during the medication administration phase, it is important for nursing to understand factors contributing to medication administration errors. The purpose of this chapter is to identify the incidence of these errors and the associated factors in an attempt to better understand the problem and lessen future error occurrence. Literature review revealed both active failures and latent conditions established in Reason’s theory remain prevalent in current literature where active failures often display themselves in the form of incorrect drug calculations, lack of individual knowledge, and failure to follow established protocol. Latent conditions are evidenced as time pressures, fatigue, understaffing, inexperience, design deficiencies, and inadequate equipment and may lie dormant within a system until combined with active failures to create opportunity for error. Although medication error research has shifted in emphasis toward identification of system problems inherent in error occurrence, no one force emerges as a clear antecedent, reinforcing the need for further research and replication of existing studies with emphasis placed on more dependable reporting measures through which nurses are not threatened by reprisal.
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Irma Leonor, Ortega López, and Verdecia Rosés Miguel Ernesto. "Drug related problems associated with the psychoactive drugs used on geriatric, hospitalized patients." Brazilian Journal of Pharmaceutical Sciences 48, no. 3 (September 2012): 453–60. http://dx.doi.org/10.1590/s1984-82502012000300012.
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A prospective study was carried out, to identify the drug related problems and to prevent or to solve the negative outcomes associated with medication of the geriatric patients that consumed psychoactive drugs, who were hospitalized. The study was carried out according to the DADER Method of Pharmacotherapy Monitoring, adapted to the Hospital's environment and the theoretical rationale of the Third Consent of Granada was assumed, for the considerations related to the drug related problems and the negative outcomes associated with medication. Thirty five patients were included whose ages ranged between the 60 and 90 years. Thirty six negative associated outcomes were identified, in 34 patients that represented 97.14% incidence. A prevalence of the negative outcomes associated with the necessity was observed, followed by those associated with the security. The inadequate drug uses was the drug related problem that prevailed in the sample. The psychoactive drugs that were related with these results were mainly the anxiolytics, meprobamate and the neuroleptics. Some 82.35% of the interventions were accepted, achieving resolution of 47.06% of the negative outcomes associated with medication.
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Gavrilova, Bandere, Rutkovska, Šmits, Mauriņa, Poplavska, and Urtāne. "Knowledge about Disease, Medication Therapy, and Related Medication Adherence Levels among Patients with Hypertension." Medicina 55, no. 11 (October 28, 2019): 715. http://dx.doi.org/10.3390/medicina55110715.
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Background and Objectives: A particular problem in cardiology is poor adherence to pharmacological treatment among patients with hypertension. It is known that approximately half of these patients do not use their medications as prescribed by their doctor. Patients may choose not to follow the doctor’s recommendations and regularly do not control their blood pressure, owing to many factors. A convenient method for measuring the level of adherence is the Morisky Medication Adherence Scale, which also provides insight into possible remedies for low adherence. We investigated their therapy, knowledge about the disease and its control, and demographic differences to assess the adherence of patients with hypertension. Materials and Methods: This was a cross-sectional observational study. Data were collected through a survey of 12 pharmacies in Latvia. The study involved 187 participants with hypertension. Results: The prevalence of non-adherence was 46.20% in Latvia. The oldest patients were the most adherent (p = 0.001, β = 0.27). The higher the self-rated extent from 0 to 10, to which the patient takes their antihypertensives exactly as instructed by their physician, the higher the level of adherence (p < 0.0001, β = 0.38), where at “0”, the patient does not follow physician instructions at all, and at “10”, the patient completely follows the physician’s instructions. Non-adherent patients tend to assess their medication-taking behavior more critically than adherent patients. The longer the patient is known to suffer from hypertension, the more adherent he or she is (p = 0.014, β = 0.19). Conclusions: Medication non-adherence among patients with hypertension is high in Latvia. Further investigations are needed to better understand the reasons for this and to establish interventions for improving patient outcomes.
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Schlichtig, Katja, Lisa Cuba, Pauline Dürr, Laura Bellut, Norbert Meidenbauer, Frank Kunath, Peter J. Goebell, et al. "New Oral Antitumor Drugs and Medication Safety in Uro-Oncology: Implications for Clinical Practice Based on a Subgroup Analysis of the AMBORA Trial." Journal of Clinical Medicine 11, no. 15 (August 4, 2022): 4558. http://dx.doi.org/10.3390/jcm11154558.
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Oral antitumor therapeutics (OAT) bear a high risk for medication errors, e.g., due to drug–drug or drug–food interactions or incorrect drug intake. Advanced age, organ insufficiencies, and polymedication are putting uro-oncological patients at an even larger risk. This analysis sets out to (1) investigate the frequency and relevance of medication errors in patients with prostate cancer or renal cell carcinoma treated with OAT and (2) compile recommendations for clinical practice. This post-hoc subgroup analysis used data collected in the randomized AMBORA trial (2017–2020; DRKS00013271). Clinical pharmacologists/pharmacists conducted advanced medication reviews over 12 weeks after initiation of a new oral regimen and assessed the complete medication process for drug–related problems. Medication errors related to either the OAT, prescribed or prescription-free concomitant medication, or food were classified regarding cause and severity. We identified 67 medication errors in 38 patients within the complete medication within 12 weeks. Thereof, 55% were detected at therapy initiation, 27% were caused by the patients, and 25% were drug–drug or drug–food interactions. Problem-prone issues are summarized in a ‘medication safety table’ to provide recommendations for clinical practice in uro-oncology. Tailored strategies including intensified care by clinical pharmacologists/pharmacists should be implemented in clinical practice to improve medication safety.
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Wróbel, Krzysztof, Maciej Sikora, Maciej Chęciński, Maria Jas, and Dariusz Chlubek. "Medication-Related Osteonecrosis of the Jaw—A Continuing Issue." Applied Sciences 11, no. 17 (August 24, 2021): 7781. http://dx.doi.org/10.3390/app11177781.
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Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition that is becoming more common in the everyday practice of both dental and maxillofacial surgeons. Materials and methods: This paper aims to provide a comprehensive and easy to read by clinicians presentation of comprehensive, accessible, and up-to-date data on MRONJ. The individual chapters focus on the etiology, epidemiology, diagnosis, prevention, treatment, and recurrence of MRONJ. Results and discussion: It has been observed over the years that among drugs that increase the risk of the disease, apart from bisphosphonates, angiogenesis inhibitors and anti-RANKL monoclonal antibodies should also be included. A thorough physical and subjective examination, periodic correction of dental prostheses, and an adequate preparation for even the simplest of procedures in the oral cavity area can prevent or minimize the risk of MRONJ. Conclusions: It is extremely difficult to treat once it occurs and oftentimes is a recurring problem that leads to a multitude of symptoms that gradually decrease the quality of a patient’s life.
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OKUYAMA, Harumi. "Needs to Change the Direction of Cholesterol-related Medication—A Problem of Great Urgency." YAKUGAKU ZASSHI 125, no. 11 (November 1, 2005): 833–52. http://dx.doi.org/10.1248/yakushi.125.833.
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O'Connell, Mary Beth, Feng Chang, Ashley Tocco, Megan E. Mills, Jamie M. Hwang, Candice L. Garwood, Hanan S. Khreizat, and Nishi S. Gupta. "Drug-Related-Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review." Journal of the American Geriatrics Society 63, no. 9 (August 27, 2015): 1900–1905. http://dx.doi.org/10.1111/jgs.13597.
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R., Apoorva, K. Vasundara, and Umadevi R. S. "A study on medication adherence, medication related challenges faced and coping strategies adopted by visually impaired subjects in a tertiary care hospital." International Journal of Basic & Clinical Pharmacology 6, no. 10 (September 23, 2017): 2323. http://dx.doi.org/10.18203/2319-2003.ijbcp20174100.
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Background: Visual impairment poses a significant threat to proper medication practice leading to medication related challenges and some adopted self coping strategies with substantial impact on medication adherence. Visually impaired are potentially more likely to have unsafe medicine related practice which by itself is more rampant in general population. Studies related to them are largely unexplored and can provide data to improve disease management and health related quality of life. Objectives was to study the level of medication adherence, medication related challenges and self adopted coping strategies in visually impaired people.Methods: A cross sectional descriptive study enrolling 204 subjects with VI was done. Medication adherence was assessed using MMAS. Medication related challenges and self-adopted coping strategies was assessed by using pre-validated semi-structured questionnaire.Results: Majority of the subjects showed medium medication adherence with forgetfulness to take medicine as the main reason for non adherence. Difficulty in remembering the instructions, spilling of liquid medicine, taking wrong dose, difficulty in using topical medications were the most common challenges faced by them in daily drug administration. To overcome challenges locating the drugs at different places, finger felt volume for liquid medication, textural feeling of the drug or container, time tracking were the major self adopted coping strategies by the visually impaired subjects.Conclusions: Creating awareness of the medication related problem faced by visually impaired helps to provide adequate assistance to medication use and improve proper health care services in them.
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Elkhadragy, Nervana, Amanda P. Ifeachor, Julie B. Diiulio, Karen J. Arthur, Michael Weiner, Laura G. Militello, Peter A. Glassman, Alan J. Zillich, and Alissa L. Russ. "Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis." BMJ Open 9, no. 5 (May 2019): e027439. http://dx.doi.org/10.1136/bmjopen-2018-027439.
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BackgroundMany studies identify factors that contribute to renal prescribing errors, but few examine how healthcare professionals (HCPs) detect and recover from an error or potential patient safety concern. Knowledge of this information could inform advanced error detection systems and decision support tools that help prevent prescribing errors.ObjectiveTo examine the cognitive strategies that HCPs used to recognise and manage medication-related problems for patients with renal insufficiency.DesignHCPs submitted documentation about medication-related incidents. We then conducted cognitive task analysis interviews. Qualitative data were analysed inductively.SettingInpatient and outpatient facilities at a major US Veterans Affairs Medical Centre.ParticipantsPhysicians, nurses and pharmacists who took action to prevent or resolve a renal-drug problem in patients with renal insufficiency.OutcomesEmergent themes from interviews, as related to recognition of renal-drug problems and decision-making processes.ResultsWe interviewed 20 HCPs. Results yielded a descriptive model of the decision-making process, comprised of three main stages: detect, gather information and act. These stages often followed a cyclical path due largely to the gradual decline of patients’ renal function. Most HCPs relied on being vigilant to detect patients’ renal-drug problems rather than relying on systems to detect unanticipated cues. At each stage, HCPs relied on different cognitive cues depending on medication type: for renally eliminated medications, HCPs focused on gathering renal dosing guidelines, while for nephrotoxic medications, HCPs investigated the need for particular medication therapy, and if warranted, safer alternatives.ConclusionsOur model is useful for trainees so they can gain familiarity with managing renal-drug problems. Based on findings, improvements are warranted for three aspects of healthcare systems: (1) supporting the cyclical nature of renal-drug problem management via longitudinal tracking mechanisms, (2) providing tools to alleviate HCPs’ heavy reliance on vigilance and (3) supporting HCPs’ different decision-making needs for renally eliminated versus nephrotoxic medications.
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Alshamrani, Majed, Abdullah Almalki, Mohamed Qureshi, Oyindamola Yusuf, and Sherine Ismail. "Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing." Pharmacy 6, no. 3 (July 25, 2018): 76. http://dx.doi.org/10.3390/pharmacy6030076.
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Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%–99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients.
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Sleath, Betsy, Susan J. Blalock, David Covert, Asheley Cockrell Skinner, Kelly W. Muir, and Alan L. Robin. "Patient Race, Reported Problems in Using Glaucoma Medications, and Adherence." ISRN Ophthalmology 2012 (November 21, 2012): 1–7. http://dx.doi.org/10.5402/2012/902819.
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Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.
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S, Satish, Manju Jose, and A. R. Shabaraya. "Adherence to Antihypertensive Medications and Its Determinants in Hypertensive Patients - A Complete Review." International Journal of Research and Review 8, no. 2 (May 19, 2021): 42–48. http://dx.doi.org/10.52403/ijrr.20210208.
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Hypertension is a global health problem, it causes complications of cardiovascular diseases, stroke, and renal failure leading to early mortality and disability. Adherence to antihypertensive medications helps to control blood pressure levels. WHO defines adherence as ''the extent to which a person's behavior taking medication, following a diet, and / or executing lifestyle changes-corresponds with agreed recommendations from a health care provider. Poor adherence is the major cause of uncontrolled BP. Common barriers to adherence are under the patient's control, so that attention to them is a necessary and important step in improving adherence. The factors driving patients’ adherence to medication are multifactorial, but can be grouped under five main domains including socioeconomic factors, healthcare system related factors, disease related factors, therapy-related factors and patient-related factors. Identifying factors that affect medication adherence is the first step towards improving adherence. This article covers various factors influencing medication non adherence among hypertensive patients. Keywords: Hypertension, medication adherence.
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Zhu, YuJun, Marsha Meyer, Denise Likar, and Susan Enguidanos. "Association Between Medication-Related Problems and Emergency Room Visits Among Community-Dwelling Older Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 434. http://dx.doi.org/10.1093/geroni/igaa057.1401.
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Abstract Medication-related problems (MRPs) remain one of the largest health risks for older adults, yet there are few studies that identify the complete myriad of problems associated with medication use among community-dwelling older adults with chronic diseases. The aim of this study is to identify the range and quantity of MRPs among community-dwelling older adults and determine the relationship between number of MRPs and emergency room (ER) visits. Primary data were collected from a community medication program for diverse older adults (N=206). A comprehensive medication review was conducted to identify MRPs including adverse drug reaction, inappropriate storage, and non-adherence. We conducted multivariate logistic regression to examine the relationship between the number of MRPs and ER visits controlling for health conditions and demographic information including age, gender and race. The mean age of participants was 74.2 (SD=8.8) and 65% were female. Racial groups include Whites (39%), Blacks (21%), Hispanics (29%) and Asian/Pacific Islanders (11%). On average, participants had 5.3 (SD=2.3) health conditions and 18.8 (SD=5.9) MRPs, among which adherence (36%) and coordination of care (28%) were most commonly identified. About 30% had at least 1 ER visit in the previous 6 months. The number of MRPs was significantly associated with ER visits (OR=1.08, p=.03). Older adults experienced a variety of MRPs and for each problem experienced, the odds of having an ER visit increased by 8%. Interventions are needed to assess the myriad of MRPs among community-dwelling older adults and address those potential risks.
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Spalla, Luana de Rezende, and Selma Rodrigues de Castilho. "Medication reconciliation as a strategy for preventing medication errors." Brazilian Journal of Pharmaceutical Sciences 52, no. 1 (March 2016): 143–50. http://dx.doi.org/10.1590/s1984-82502016000100016.
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ABSTRACT One of the current barriers proposed to avoid possible medication errors, and consequently harm to patients, is the medication reconciliation, a process in which drugs used by patients prior to hospitalization can be compared with those prescribed in the hospital. This study describes the results of a pharmacist based reconciliation conducted during six months in clinical units of a university hospital. Fourteen patients (23.33%) had some kind of problem related to medicine. The majority (80%) of medication errors were due to medication omission. Pharmaceutical interventions acceptance level was 90%. The results suggest that pharmacists based reconciliation can have a relevant role in preventing medication errors and adverse events. Moreover, the detailed interview, conducted by the pharmacist, is able to rescue important information regarding the use of drugs, allowing to avoid medications errors and patient injury.
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Ma, Guiyue, Aijing Luo, Zhiying Shen, Yinglong Duan, Shuangjiao Shi, and Zhuqing Zhong. "The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study." Internal and Emergency Medicine 15, no. 3 (October 24, 2019): 409–19. http://dx.doi.org/10.1007/s11739-019-02187-0.
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Abstract The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.
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Watanabe, Jonathan H., Terry McInnis, and Jan D. Hirsch. "Cost of Prescription Drug–Related Morbidity and Mortality." Annals of Pharmacotherapy 52, no. 9 (March 26, 2018): 829–37. http://dx.doi.org/10.1177/1060028018765159.
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Background: Public attention and recent US Congressional activity has intensified focus on escalating medication prices. However, the actual cost of medication use extends beyond the up-front cost of purchasing medicines. It also encompasses the additional medical costs of morbidity and mortality resulting from nonoptimized medication regimens, including medication nonadherence. Objectives: Applying the most current nationally representative data sources, our goal was to estimate the cost of prescription drug–related morbidity and mortality in the United States. Methods: Total costs of nonoptimized prescription drug use and average pathway costs for a patient who experienced a treatment failure (TF), a new medical problem (NMP), or a TF and NMP were modeled in Microsoft Excel (Microsoft Corporation, Redmond, WA) and TreeAge Pro Healthcare, v2014 (TreeAge Software, Inc, Williamstown, MA), respectively. Results: The estimated annual cost of prescription drug–related morbidity and mortality resulting from nonoptimized medication therapy was $528.4 billion in 2016 US dollars, with a plausible range of $495.3 billion to $672.7 billion. The average cost of an individual experiencing TF, NMP, or TF and NMP after initial prescription use were $2481 (range: $2233, $2742), $2610 (range: $2374, $2848) and $2572 (range: $2408, $2751), respectively. Conclusions: The estimated annual cost of drug-related morbidity and mortality resulting from nonoptimized medication therapy was $528.4 billion, equivalent to 16% of total US health care expenditures in 2016. We propose expansion of comprehensive medication management programs by clinical pharmacists in collaborative practices with physicians and other prescribers as an effective and scalable approach to mitigate these avoidable costs and improve patient outcomes.
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Lewis, Kelsey Lackey, Barnabas John, Michelle Condren, and Sandra M. Carter. "Evaluation of Medication-related Self-care Skills in Patients With Cystic Fibrosis." Journal of Pediatric Pharmacology and Therapeutics 21, no. 6 (December 1, 2016): 502–11. http://dx.doi.org/10.5863/1551-6776-21.6.502.
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BACKGROUND: As the life expectancy of patients with cystic fibrosis (CF) increases, the focus on ensuring success with medication therapies is increasingly important. The ability of patients to autonomously manage medications and related therapies is poorly described in the literature. OBJECTIVE: The goal of this project was to assess the level of medication-related knowledge and self-care skills in patients with CF. METHODS: This project took place in a Cystic Fibrosis Foundation accredited affiliate center. Eighty-nine patients between the ages of 6 and 60 were eligible to participate based on inclusion and exclusion criteria. Pharmacists administered a 16-item questionnaire and detailed medication history during clinic visits from January through May 2014. RESULTS: Forty-five patients 6 to 41 years old participated in the study. The skills most often performed independently were preparing nebulizer treatments (85%) and telling someone if they feel their medicines are causing a problem (89%). Skills least often performed were carrying a medication list (82%) and bringing a medication list to appointments (76%). In respondents 21 years of age and older, less than 75% of respondents were involved with obtaining financial resources, maintaining equipment, carrying a medication list, or rinsing their mouth after using inhaled medicines. Participants were able to provide drug name, dose, and frequency of use for pancreatic enzymes and azithromycin 37% and 24% of the time, respectively. CONCLUSIONS: In the population surveyed, many medication-related skills had not been acquired by early adulthood. Assessing and providing education for medication-related self-care skills at all ages are needed.
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Nicosia, Francesca M., Malena J. Spar, Marilyn Stebbins, Rebecca L. Sudore, Christine S. Ritchie, Kirby P. Lee, Kevin Rodondi, and Michael A. Steinman. "What Is a Medication-Related Problem? A Qualitative Study of Older Adults and Primary Care Clinicians." Journal of General Internal Medicine 35, no. 3 (November 1, 2019): 724–31. http://dx.doi.org/10.1007/s11606-019-05463-z.
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Erlen, Judith A., Susan M. Sereika, Ran Sun, Lisa K. Tamres, Fengyan Tang, and Jennifer H. Lingler. "Outcomes of a Problem-Solving Medication Management Intervention for Informal Caregivers." Western Journal of Nursing Research 41, no. 11 (February 7, 2019): 1642–57. http://dx.doi.org/10.1177/0193945919825844.
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Older adults with memory loss often require assistance from caregivers to manage their medications. This study examined the efficacy of a problem-solving-based intervention focused on caregiver medication management, problem solving, self-efficacy, and daily hassles. Caregiver health-related quality of life (HRQoL) and patient health care utilization were secondary outcomes. Totally, 83 patients (age 79.9±8.8 years) and their informal caregivers (age 66.9±12 years, female 69.9%, White 85.5%) were randomized; data collection occurred at baseline, 8, 16, and 24 weeks. Linear mixed modeling showed significant decreases in medication deficiencies which were sustained over time. No significant changes in caregiver problem solving, daily hassles, or patient health care utilization occurred between groups or over time. In addition, caregiver self-efficacy and mental HRQoL decreased in both groups. Physical HRQoL decreased in the intervention group, yet increased in the usual care group. Future research should investigate these outcomes in larger and more diverse samples.
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Abhishek S and Jayadevkumar. "Need of Pharmacist on Medication Management for Elderly Patients Residing In Rural Area: A Review." International Journal of Research in Pharmaceutical Sciences 11, no. 3 (July 3, 2020): 2809–14. http://dx.doi.org/10.26452/ijrps.v11i3.2355.
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Medication management services are area oriented towards patient safety, medication appropriateness, effect of drug and adherence with the help of pharmacist and other healthcare providers to improve the health outcomes. In older aged population chronic non communicable diseases like hypertension, diabetes, COPD etc. are common and this leading to Polypharmacy and medication inappropriateness. Polypharmacy is further results to drug interaction with drug, food and body fluids and increase drug related problems. These medication problem leads to decreased level of medication adherence. Pharmacist plays an important role in minimizing drug related mortality and morbidity. As per the 2010 data out of 57 million deaths, chronic non communicable diseases like cardiovascular disease, COPD, cancer, Diabetes mellitus contributes more for mortality that is 36 million (63%). In these more than three quarters of deaths occurred in elderly patients. . As per the survey conducted by govt. of India in 2017 shows 5% of population are above 65 years and estimated that by the time of 2050 India holds 20% of population are above 65years. These numbers provide evidence of the chronic shortage of trained healthcare professionals such as physicians, dentists, nurses, pharmacists due to the poor economic situation in India. The evolution of the role of the pharmacist, with the rapid development of pharmacy practice and pharmaceutical care, points to the significance of the responsibilities of a pharmacist in ensuring medication use for patients is safe, effective, and rational. Significant accomplishments will be achieved in rural areas relation to the development of strategies to improve medication use and enhance the positive health outcomes in the elderly population.
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Mongaret, Céline, Léa Aubert, Amélie Lestrille, Victorine Albaut, Pierre Kreit, Emmanuelle Herlem, Natacha Noel, et al. "The Role of Community Pharmacists in the Detection of Clinically Relevant Drug-Related Problems in Chronic Kidney Disease Patients." Pharmacy 8, no. 2 (May 22, 2020): 89. http://dx.doi.org/10.3390/pharmacy8020089.
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Community pharmacists (CPs) have traditionally had limited access to patients’ estimated glomerular filtration rate (eGFR) during the medication-dispensing process. The increasing access to shared electronic health records is making eGFR available, but the skills needed to detect and manage clinically relevant drug-related problems (DRPs) are poorly documented. The primary objective of this study was to investigate the role of CPs in the medication-dispensation process for elderly patients with renal impairment. A total of 70 CPs participated in this 6 month study. Community pharmacists asked all patients ≥65 years to bring their laboratory test values for the next medication-dispensing process. Drug-related problem detection rates were compared between CPs (prospective period) and expert pharmacists (retrospectively). The clinical relevance of each DRP was assessed by nephrologists and general practitioners using an appropriate tool. Community pharmacists recruited n = 442 patients with eGFR < 60 mL/min/1.73 m2 and detected n = 99 DRPs, whereas expert pharmacists detected n = 184 DRPs. The most frequently detected DRPs were dosage problems and contraindications. According to assessment by clinicians, CPs and expert pharmacists identified 54.0% and 84.7% of clinically relevant DRPs, respectively. This study suggests a positive impact of the systematic availability of eGFR to CPs on the detection of several DRPs with clinical relevance.
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Sakalauskaitė, Dovilė, and Viktorija Kielė. "Medication Administration Errors and Contributing Factors at Nurses Workplace: Literature Review." Slauga. Mokslas ir praktika 2, no. 10 (298) (October 29, 2021): 1–10. http://dx.doi.org/10.47458/slauga.2021.2.18.
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Abstract. Medication errors are a serious problem that can be a threat to health and patient safety and can lead to mistrust of the health system and the work of professionals. Medication administration errors occur at any stage of patient care and can be related to a variety of influencing factors [1].
This literature review identifies the main medication administration errors, which are grouped into medication administration and incorrect documentation of administered medication groups. Along with medication administration errors, the main reasons why nurses make errors in medication administration are identified.
The study focuses on medication administration errors and their determinants in nurses' work.
The aim of the literature review was to analyze medication errors and their determinants in nurses' work.
Methods: an exploratory review was conducted to analyze medication administration errors and their determinants in nurses' work. The methodology considered five main stages that contributed to a focused analysis of the selected studies.
Results of the literature review. It was found that medication errors are influenced by the work environment, which is full of extraneous sounds, other members of the medical team, and conversations unrelated to the administration of medicines. The human factor is also a factor in medication administration errors related to the medication, its dose, or the wrong administration time. Medication administration errors are inevitable, no matter how advanced the patient's care and nursing techniques.
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Pouls, Bart PH, Charlotte L. Bekker, Sandra van Dulmen, Johanna E. Vriezekolk, and Bart JF van den Bemt. "A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping." JMIR Serious Games 10, no. 1 (February 18, 2022): e31570. http://dx.doi.org/10.2196/31570.
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Background Patients’ implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was “after the intervention, participants have a more positive attitude toward antirheumatic drugs.” Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions.
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Puumalainen, Emmi, Marja Airaksinen, Sanni E. Jalava, Timothy F. Chen, and Maarit Dimitrow. "Comparison of drug-related problem risk assessment tools for older adults: a systematic review." European Journal of Clinical Pharmacology 76, no. 3 (December 10, 2019): 337–48. http://dx.doi.org/10.1007/s00228-019-02796-w.
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Abstract Purpose This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (≥ 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. Methods The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool’s content, development methods, and validation assessment. Results The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks; (2) pharmacotherapy-related risks; and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted (n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency (n = 3) and inter-rater reliability (n = 2). Conclusions The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.
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Mohammed, Mesud, Bodena Bayissa, Mestawet Getachew, and Fuad Adem. "Drug-related problems and determinants among elective surgical patients: A prospective observational study." SAGE Open Medicine 10 (January 2022): 205031212211224. http://dx.doi.org/10.1177/20503121221122438.
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Objectives: The aim of this study was to assess drug-related problems and determinants among elective surgical patients admitted to Jimma University Medical Center. Methods: A hospital-based prospective observational study was conducted at Jimma University Medical Center, from April 10 to July 10, 2018. Data were collected through patients’ interview and physicians’ medication orders and charts review using pre-tested questionnaire and data abstraction formats. Drug-related problems were assessed for each patient using drug-related problem classification tool. Data were analyzed using Statistical Package for Social Science for windows; version 21.0. The predictors of drug-related problems were determined by multivariable logistic regression analysis. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results: Of the total 141 participants, 98 (69.5%) of them had at least one drug-related problem during their hospital stay. A total of 152 drug-related problems were identified among 141 elective surgical patients. The most common identified drug-related problems were indication-related problems (39%) followed by effectiveness-related problems (21%) and safety-related problems (21%). The presence of complication (adjusted odds ratio = 2.90, 95% confidence interval (1.302, 3.460)), American Society of Anesthesiologists Physical Status ⩾ 2 (adjusted odds ratio = 6.01, 95% confidence interval (1.0011, 9.500)), and postoperative antibiotics (adjusted odds ratio = 6.027, 95% confidence interval (1.594, 22.792)) were independent predictors of drug-related problems. Conclusion: The prevalence of drug-related problems is high among elective surgical patients. The indication-related problems were the most common category of drug-related problem identified among elective surgical patients. The presence of complication, American Society of Anesthesiologists Physical Status ⩾ 2, and postoperative antibiotics were the independent predictors of drug-related problems.
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Probosiwi, Neni, Tsamrotul Ilmi, Nur Fahma Laili, Henni Wati, Lintang Bismantara B.G.PS, Anggeria Nimas Saputri, and Desna Talia Saputri. "Analisis Faktor yang Berhubungan dengan Medication Error Pasien Rawat Inap di Klinik X Kediri." Jurnal Ilmiah Universitas Batanghari Jambi 21, no. 3 (October 11, 2021): 1123. http://dx.doi.org/10.33087/jiubj.v21i3.1605.
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Medicaction error is an important problem in the health sector that can increase mortality, increase the duration of hospitalization, and increase the cost of treatment. Identifying the risk factors for medication errors is an important first step in preventing medication errors. This study aimed to identify the relationship between patient characteristics and medication errors in inpatients at clinic x. The study was conducted qualitatively with a cross-sectional design with recorded data. The study was conducted using clinical record data from July to December. The study sample consisted of 196 patients who met the inclusion criteria with a consecutive sampling technique. Analysis of the relationship between variables was carried out by chi-square analysis with a significance value of 5% (0.05). The results showed that inpatients at clinic x experienced medication errors of 17.86% which consisted of prescribing errors of 2.55% and administrative errors of 15.31%. Patient gender was not significantly associated with medication errors (p> 0.05). Patient age was significantly associated with medication errors (p<0.001). The number of drugs was significantly associated with medication errors (p<0.001). Length of stay was not significantly associated with medication errors (p < 0.05). Drug class was significantly related to medication error. The conclusion is that the patient's age, the number of drugs received by the patient and the class of drugs are factors related to the incidence of medication errors. The patient aspect also contributes to the risk factor for medication errors so that it can be considered in preventing medication errors in health practice by health workers.
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Liu, Victoria C., Insaf Mohammad, Bibban B. Deol, Ann Balarezo, Lili Deng, and Candice L. Garwood. "Post-discharge Medication Reconciliation: Reduction in Readmissions in a Geriatric Primary Care Clinic." Journal of Aging and Health 31, no. 10 (August 30, 2018): 1790–805. http://dx.doi.org/10.1177/0898264318795571.
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Objectives: This study aimed to evaluate hospital utilization and characterize interventions of pharmacist-led telephonic post-discharge medication reconciliation. Method: A retrospective analysis was conducted, including 833 index events in 586 geriatric patients receiving the intervention. Medicare claims were used to capture 30-day hospital utilization (admission to the emergency department, observation unit, or inpatient hospitalization) following discharge from any of these locations. Medication-related interventions were described. Results: Hospital utilization within 30 days after discharge from any location was greater for patients receiving usual care compared with the intervention (32.5% vs. 22.2%; odds ratio [OR] = 1.69, 95% confidence interval [CI] = [1.06, 2.68]). Inpatient admission within 30 days after discharge from any location was greater for those receiving usual care (14.7% vs. 6.4%; OR = 2.54, 95% CI = [1.18, 5.44]). At least one medication-related problem was identified and addressed in 89.8% of patients receiving the intervention. Discussion: A telephonic post-discharge medication reconciliation program can lead to reduction in hospital utilization in a geriatric population.
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Canning, Martin, Chui Han Lee, Richard Bolitho, and Erin Dunn. "Evaluation of the nature, severity, likelihood and preventability of medication-related hospital-acquired complications." Australian Health Review 44, no. 6 (2020): 935. http://dx.doi.org/10.1071/ah19215.
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ObjectivePricing for safety and quality was introduced into Australian hospitals using a defined list of hospital-acquired complications (HACs). Medication-related HACs include drug-related respiratory complications (DRRC), haemorrhagic disorder due to circulating anticoagulants (HDDCA) and hypoglycaemia. The aim of this study was to determine the probability, severity and preventability of medication-related HACs, common contributory medications and themes, and whether medication-related HACs are a suitable data source to inform risk associated with medicines use. MethodsMedical notes were reviewed retrospectively for all patients discharged from a tertiary referral metropolitan hospital between 1 July and 31 December 2018 who were flagged as experiencing a medication-related HAC. Naranjo, Hartwig’s and Schumock and Thornton tools were used to assess the probability, severity and preventability of medication-related HACs. ResultsOver the 6-month period, 88 patients experienced a medication-related HAC. An HAC was not identified in five (5.7%) patient charts. The most common HAC was hypoglycaemia (n=59; 67%), followed by HDDCA (n=23; 26%) and DRRC (n=6; 7%). Fifteen patients (17%) flagged with a hypoglycaemia HAC were not on a medicine associated with hypoglycaemia. Overall, 6% (n=4) of HACs were severe, 72% (n=49) were moderate and 22% (n=15) were mild. Where the HAC and causal medication(s) were identified (n=68), over half were probable (51.5%, n=35) and 44.1% (n=30) were possible causes of the adverse drug reaction; only two (2.9%) were definite causes. None of the DRRC HACs was preventable. Over half the HDDCA HACs (52.2%; n=12) and almost half the hypoglycaemia HACs (46.2%; n=18) were not preventable. Common themes included appropriate anticoagulant agent, dose and monitoring, as well as periprocedural hypoglycaemic management, which considers oral intake and comorbidities. ConclusionNot all patients who experience medication-related HACs were on causative medications. Of those who were, medications were probable causal agents in over 50% of cases. Only a small number of HACs were severe and under half of medication-related HACs were preventable. What is known about the topic?The relationship between pricing for safety and quality and improvements in patient outcomes has shown mixed results. Medication-related harm is a problem within Australia and system-wide changes should be considered to improve patient care. What does this paper add?This paper adds evidence to the use of medication-related HACs as a source of data to inform risk associated with medicines use and provides details on the preventability and severity of medication-related HACs and the likelihood that medicines contribute to these complications. What are the implications for practitioners?This paper provides clinicians and policy makers details on the utility of using medication-related HACs as a measure of risk associated with medicines use. It discusses merit in using HACs as a source for quality improvement, but recommends that definitions may need to be reviewed to enhance utility.
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Barcelo, Carla Fernandez, Elena Calvo-Cidoncha, and Laura Sampietro-colom. "PP151 VALIDATE Methodology On A Medication-Related Clinical Decision Support System: Holistic Assessment For Optimal Technology Adoption." International Journal of Technology Assessment in Health Care 38, S1 (December 2022): S89. http://dx.doi.org/10.1017/s026646232200263x.
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IntroductionIn the past decade, health technology assessment (HTA) has narrowed its scope to analyses of mainly clinical and economic benefits. Technology challenges in the 21st century emphasize the need for holistic assessments to obtain accurate recommendations for decision-making, as in HTA’s foundations. Using the VALues In Doing Assessments of health TEchnologies (VALIDATE) methodology for complex technologies provides a deeper understanding of problems through analysis of stakeholders’ views, allowing for more comprehensive HTAs. This study aimed to assess a pharmaceutical clinical decision support system (CDSS) using VALIDATE.MethodsSemi-structured interviews with different stakeholders were conducted in the following domains: problem definition (medication error [ME] occurrence and prevention); judgement of solution (existing preventive methods and previous experiences of the CDSS); background theories (future impact and personal beliefs); and barriers to and facilitators of implementation. The following individuals were interviewed: medical informatic specialists (n=3), pharmacists (n=2), nurses (n=2), physicians (n=2), CDSS company representatives (n=1), electronic health record developer (n=1), and health consultancy firm representatives (n=1). Content analysis was used to integrate and analyze the data.ResultsThe multistakeholder interviews identified various barriers to the acceptance and implementation of a pharmaceutical CDSS that were different from those reported in the literature. These included: (i) occurrence of ME (no traceability of medication taken or poor patient medication empowerment); (ii) perception of current level of MEs (huge improvement from ten years ago); (iii) perception of technology as a tool to prevent ME (not enough if only implemented at one point of care); (iv) previous experiences with a CDSS (low rates of development of CDSSs are due to medication prescriptions being digitalized last in hospitals); (v) CDSS metrics (input data should be measured to control CDSS performance); and (vi) other barriers.ConclusionsIncluding facts and stakeholders’ values in problem definition and the scoping of health technologies is essential for the proper conduct of HTAs. Incorporating views from multiple stakeholders when scoping the assessment of health technologies brings additional values to literature findings, resulting in a more holistic evaluation. The lack of multistakeholder scoping can lead to inaccurate information and result in wrong decisions about if, when, and how to adopt a CDSS.
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Siddiqui, Mujtaba Hasan, Iqbal Akhtar Khan, Fauzia Moyeen, and Khawar Abbas Chaudhary. "Identifying Barriers to Therapeutic Adherence in Type 2-Diabetes: A Complex and Multidimensional Clinical Issue." Asploro Journal of Biomedical and Clinical Case Reports 2, no. 1 (June 5, 2019): 22–28. http://dx.doi.org/10.36502/2019/asjbccr.6149.
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The problem of therapeutic non-adherence is a serious issue adversely affecting the adequate control and management of Type2 Diabetes (T2D).This unwelcoming situation has been studied well on various spots on the globe, with diverse results. The present study, aimed at identifying the barriers to therapeutic adherence, was conducted on a set of proven cases of T2D, managed by primary healthcare providers. The adherence rate to medication alone was 42% while to medication plus lifestyle recommendations 27%. Whereas sub-optimal health literacy, complexity of prescription and socioeconomic aspects were the main determinants, lapse on the part of healthcare system cannot be underscored. The present qualitative study was a preliminary investigation on a small sample .The magnitude of the problem necessitates that a large scale multi-centre in-depth quantitative study in 5 dimensions (recommended by WHO): socio-economic factors, health care team and system related factors, condition related factors , therapy related factors and patient related factors, be done on priority basis. This would pave the way for planning a well-designed intervention programme.
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Baracaldo-Santamaría, Daniela, Maria José Trujillo-Moreno, Andrés M. Pérez-Acosta, John Edwin Feliciano-Alfonso, Carlos-Alberto Calderon-Ospina, and Franklin Soler. "Definition of self-medication: a scoping review." Therapeutic Advances in Drug Safety 13 (January 2022): 204209862211275. http://dx.doi.org/10.1177/20420986221127501.
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Self-medication (SM) is a global and growing phenomenon. It represents a public health problem due to antibiotic resistance, risk of adverse drug reactions, drug–drug interactions, disease masking, and increased morbidity. There is not a consensus on the definition of SM. The definitions found in different studies make it difficult to address this problem from a theoretical perspective and therefore find an adequate solution to this public health problem. The aim of this article is to search the medical literature to characterize the current understanding of SM in the medical community. We conducted a scoping review of definitions of SM by searching on PubMed – Medline, Embase, and LILACS using the following combination of keywords: ‘self-prescription’ or ‘self prescription’, ‘self-medication’ or ‘self medication’, or ‘automedication’ and ‘definition’ or ‘explanation’. The search was limited to articles containing the definition of SM, with no limit on language or year. Duplicate studies and those that did not mention the definition of SM were excluded from the final review. A total of 65 studies were included in the final selection. We found a vast heterogeneity in the definition of SM. Most articles based their definition of SM on the process of obtaining the drug, the nonparticipation of a specific health professional, the source of the medication, and the reason for SM. Other interesting concepts such as self-care, nonadherence to a prescription, reuse of stored drugs, and sharing and lending medicines were also considered forms of SM by other authors, however. This study highlights the need to reach a consensus regarding the definition of SM to adequately propose strategies to address this global health problem. This study shows the diverse concepts that need to be included in a future definition of SM. Plain Language Summary Definition of self-medication: a review with systematic methodology Self-medication (SM) is a global and growing phenomenon that represents a public health problem due to antibiotic resistance, risk of dangerous side effects, interactions between drugs, and disease masking. Currently, there is not a consensus on the definition of SM, which makes it difficult to address this problem and therefore find an adequate solution. Making a standard definition would allow the development of programs focused on addressing drug-related problems associated with self-medication behavior. The purpose of this article is to search the medical literature to define the current understanding of SM in the medical community. We included a total of 65 studies and found a great variance in the definition of SM. Most articles based their definition of SM on the process of obtaining the drug, the nonparticipation of a specific health professional, the source of the medication, and the reason for SM. Other interesting concepts such as self-care, not following a prescription, reuse of stored drugs, and sharing and lending medicines were also considered forms of SM by other authors, however. Furthermore, this study highlights that SM is a wider concept that goes beyond aiming to promote and restore health, as aesthetic and recreational purposes are also reasons for SM that can put individuals at risk and compromise the correct and safe use of medications.
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Galán Andrés, Maria Isabel, Valeriana Guijo Blanco, Inés Casado Verdejo, José Antonio Iglesias Guerra, and Daniel Fernández García. "Self-Medication of Drugs in Nursing Students from Castile and Leon (Spain)." International Journal of Environmental Research and Public Health 18, no. 4 (February 5, 2021): 1498. http://dx.doi.org/10.3390/ijerph18041498.
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To determine the prevalence of self-medication in nursing students and their related factors, a transversal, descriptive study was performed on a sample of 378 nursing students. A total of 73.8% of the sample declared having used off-prescription drugs during the last month (2.84;2.26–3.58). A total of 28.9% said they did this because they are familiar with the health problem and its pharmacological solution and 25% deemed that it was a mild health problem. Drugs most commonly used off-prescription were analgesics in 88.91% (3.63;2.74–4.80) of occasions. They were mainly recommended by the students’ family (1.31;1.03–1.65) on 58.12% of the cases. Students keep analgesics they take off-prescription in their home first aid kit (4.47;3.28–6.08; p < 0.001). Unlike other studies, 53.2% obtained off-prescription drugs from the home first aid kit (1.13;0.89–1.43; p < 0.001). In addition, they gave advice and recommend drugs they have taken to other people with similar symptoms (1.97;1.59–2.44). A total of 85.72% kept excess drugs after a treatment (6.00;4.50–7.99). Self-medication is related to the storage of unused medicines and giving advice on the use of drugs to other people, among other things. Self-medication of drugs among nursing students is high. Thus, it appears necessary to review the training on rational the use of drugs and responsible self-medication in the discipline’s curriculum.
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Ghaderi, Ebrahim, Kambiz Hassanzadeh, Khaled Rahmani, Ghobad Moradi, Nader Esmailnasab, Daem Roshani, and Arian Azadnia. "Prevalence of self-medication and its associated factors: a case study of Kurdistan province." International Journal of Human Rights in Healthcare 13, no. 3 (February 21, 2020): 249–58. http://dx.doi.org/10.1108/ijhrh-09-2019-0075.
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Purpose Health is one of the most basic human rights. Self-medication not only results in many risks, complications and mortalities but also remains a massive economic burden on governments’ pharmaceutical budgets, insurance companies and the general population. The importance of self-medication as one of the worldwide health problems, this paper aims to investigate the extent of this problem and related factors in Sanandaj, Iran in 2018. Design/methodology/approach This cross-sectional, descriptive study was conducted on 838 people who referred to pharmacies in Sanandaj, Iran in 2018. The subjects were selected in 10 pharmacies, 84 in each, randomly. A self-constructed questionnaire was used to collect information about demographic features, prevalence and reasons for self-medication. The data was analyzed statistically by SPSS software. Findings The results show a high prevalence of self-medication, 73.70 per cent among people who referred to the pharmacies in Sanandaj during 2018. There was a significant correlation between self-medication and occupation, education level, age groups, chronic disease, smoking or reasons to refer to pharmacies (p < 0.05). Analgesics, antibiotics; non-steroid anti-inflammatory, cold and gastrointestinal medicines were the most commonly used medicines by the subjects. People with headache, cold, infection, stomach pain, toothache and dysmenorrhea were more likely to act self-medication than people with other complaints. Among people who do self-medication, (85.60 per cent) had already experienced satisfactory results after using medicines. Mild symptoms of the disease (74.11 per cent), availability of medicines (72.98 per cent) and easy access to medicine supplies in pharmacies (71.35 per cent) are other reasons for self-medication. Research limitations/implications In general, the study had some limitations. One of the limitations was related to the research period i.e. spring and summer. So, it is suggested to conduct studies in other seasons, too. Furthermore, as the time of self-medication was the past three months, there was a probability of recall bias. Originality/value The prevalence of self-medication in Sanandaj is high and alarming, implementing educational programs about this issue is extremely required. Health policymakers should take all necessary steps to tackle self-medication efficiently.
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Ekholm, Ola, Michael Davidsen, Christina Viskum Lytken Larsen, and Knud Juel. "A nationwide study of health-related quality of life, stress, pain or discomfort and the use of medicine among problem gamblers." Scandinavian Journal of Public Health 46, no. 5 (November 16, 2017): 514–21. http://dx.doi.org/10.1177/1403494817739501.
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Aim: The aim of this study was to investigate the associations between problem gambling and health-related quality of life, stress, pain or discomfort and the use of analgesics and sleeping pills. Methods: Data derives from the Danish Health and Morbidity Survey 2010. The survey was based on a random sample of 25,000 adult Danes (response rate: 61%), and data were collected via a self-administered questionnaire. The Lie/Bet Questionnaire was used as the screening instrument for problem gambling. Respondents were categorised as current, previous or non-problem gamblers. The questionnaire also included topics such as health-related quality of life (Short Form-12), perceived stress, pain and discomforts within the past two weeks, as well as the use of medication within the past two weeks. Results: Current problem gambling was strongly associated with negative outcomes such as poor mental health, high perception of stress, headache, fatigue and sleeping problems. Furthermore, previous problem gambling was generally associated with poorer health outcomes. Thus, current and previous problem gamblers had 2.36 times (95% confidence interval [CI] 1.44–3.87) and 1.66 times (95% CI 1.07–2.55) higher odds than non-problem gamblers of reporting fair or poor health, respectively. The data revealed no clear association between problem gambling and the use of analgesics. Conclusions: Both current and previous problem gambling were negatively associated with physical and mental-health problems. Health professionals should be alert to any signs of these complicating factors when planning the treatment of problem gamblers.
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Aleksiev, Dr Evgeniy. "Treatment of Medication-Related Osteonecrosis of the Jaw of a Patient with Immediate Implants." International Journal of Medical Science and Clinical Invention 8, no. 07 (July 5, 2021): 5514–20. http://dx.doi.org/10.18535/ijmsci/v8i07.01.
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Abstract: The aim of this paper is to present the case of a 73 year old man with immediate implants who was admitted to the Clinic of Maxillofacial Surgery for treatment of medication-related osteonecrosis of the upper right jaw. The problem occurred after the extraction of two teeth, without considering that the patient is undergoing chemotherapy with Xgeva. The patient was diagnosed with prostate cancer in 2013. In 2015 were found metastases on the bones. According to the particular characteristics of the patient he underwent surgery under general anesthesia. The innovation in our case is that we used a placement of a PRF membrane and plastic closure of the wound. This is a new and alternative treatment method and there were no postoperative complications or wound infections, which are usually common in the postoperative period for people with medication-related osteonecrosis of the jaws.
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Zulhaida, Andi, Rosdiana Rosdiana, and Veny Wilya. "FAKTOR-FAKTOR KEPATUHAN MENELAN OBAT PENDERITA TUBERCULOSIS DI PUSKESMAS SEULIMEUM ACEH BESAR." Jurnal Kesehatan Terpadu (Integrated Health Journal) 11, no. 1 (June 30, 2020): 34–40. http://dx.doi.org/10.32695/jkt.v11i1.48.
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Tuberculosis (Tb) still a major health problem in developing countries. The success of reducing Tb disease is influenced by compliance behavior and regularity in disease control. The study aims to identify factors related to medication adherence Tb patients. The study is cross sectional design. Data were collected using a questionnaire conducted in 2016. Determination of sample using a total population technique that is 36 Tb patients who consume OAT (Anti Tuberculosis Medication). The results of the study of 10 Tb patients having good Drug Consumption Supervisor (PMO) 76,9%, 14 Tb patients having good family roles 73,7% and 17 good transportation facilities 70.8% to the level of medication adherence was good. There is a relationship between PMO (p-value=0.014), transportation facilities (p-value=0.001), and family roles (p-value=0.001) with medication adherence Tb patients and there is no relationship between drug availability (p-value=0.281) with medication adherence Tb patients. Medication adherence Tb patients is associated with PMO, drug availability, transportation facilities, and family roles. Tb patients are expected to be consistent to take medication regularly and thoroughly.
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Ayele, Belete Achamyelew, Sofonyas Abebaw Tiruneh, Asnakew Achaw Ayele, Melaku Tadege Engidaw, Getachew Yideg Yitbarek, and Alemayehu Digssie Gebremariam. "Medication adherence and its associated factors among type 2 diabetic patients in Ethiopian General Hospital, 2019: Institutional based cross-sectional study." PLOS Global Public Health 2, no. 5 (May 10, 2022): e0000099. http://dx.doi.org/10.1371/journal.pgph.0000099.
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Introduction Globally, diabetes mellitus is becoming a major public health problem in developing countries. Diabetic medication has a major role in glycemic control. However, poor adherence to diabetes medication leads to increased morbidity and morbidity. This study aimed to determine diabetes medication adherence and its associated factors among type two diabetes (T2DM) patients from December 01, 2019 to December 31, 2019, at Debre Tabor General Hospital, Northwest Ethiopia. Methods An institutional-based cross-sectional survey was conducted with a sample of 422 T2DM at Debre Tabor General Hospital diabetic clinic, Ethiopia. The study was conducted from December 01-31/2019. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. The data were analyzed using STATA version 15.1 software. Logistic regressions were carried out to identify independent predictors for T2DM adherence. P-value less than 0.05 was used to declare statistical significance. Results A total of 408 T2DM patients were recruited for this study with a response rate of 96.7%. Overall, 58.33% (95% Confidence Interval (CI): 53.47–63.03) T2DM patients had good medication adherence.T2DM patients who were taking both oral and injectable anti-diabetic medications (Adjusted odds ratio (AOR) = 1.98, 95% CI: 1.16–3.39), got the prescribed anti-diabetic medication from the hospital (AOR = 0.51, 95% CI: 0.32–0.80), having own glucometer at home (AOR = 0.30, 95% CI: 0.16–0.54), and having good diabetes-related knowledge (AOR = 0.50, 95% CI: 0.27–0.90) were a significant determinant factors for anti-diabetic medication adherence. Conclusion Overall, more than half of T2DM patients had good medication adherence. Medication type, access to anti-diabetic medication, having own glucometer at home, diabetes-related knowledge were independent predictors of medication adherence. T2DM patients should have own glucometer at home and health promotion should provide about diabetic Mellitus for T2DM patients.