Medication reviews in primary care in Sweden: importance of clinical pharmacists’ recommendations on drug-related problems

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• 作者：Sara Modig ; Lydia Holmdahl ; Åsa Bondesson
• 关键词：Clinical significance ; DRP ; Drug ; related problem ; Medication review ; Primary care ; Sweden
• 刊名：Pharmacy World Science
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：38
• 期：1
• 页码：41-45
• 全文大小：345 KB
• 参考文献：1.Hovstadius B, Hovstadius K, Astrand B, Petersson G. Increasing polypharmacy—an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol. 2010;10:16.PubMed PubMedCentral CrossRef
  2.Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug–drug interactions: population database analysis 1995–2010. BMC Med. 2015;13:74.PubMed PubMedCentral CrossRef
  3.Turnheim K. Drug therapy in the elderly. Exp Gerontol. 2004;39(11–12):1731–8.PubMed CrossRef
  4.Seymour RM, Routledge PA. Important drug–drug interactions in the elderly. Drugs Aging. 1998;12(6):485–94.PubMed CrossRef
  5.Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. Dicp. 1990;24(11):1093–7.PubMed
  6.Fryckstedt J, Asker-Hagelberg C. Drug-related problems common in the emergency department of internal medicine. The cause of admission in almost every third patient according to quality follow-up. Lakartidningen. 2008;105(12–13):894–8.PubMed
  7.Mjorndal T, Boman MD, Hagg S, Backstrom M, Wiholm BE, Wahlin A, Dahlqvist R. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf. 2002;11(1):65–72.PubMed CrossRef
  8.Paul E, End-Rodrigues T, Thylen P, Bergman U. Adverse drug reactions a common cause of hospitalization of the elderly. A clinical retrospective study. Lakartidningen. 2008;105(35):2338–42.PubMed
  9.Patel P, Zed PJ. Drug-related visits to the emergency department: how big is the problem? Pharmacotherapy. 2002;22(7):915–23.PubMed CrossRef
  10.Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.PubMed CrossRef
  11.Hellstrom LM, Bondesson A, Hoglund P, Midlov P, Holmdahl L, Rickhag E, Eriksson T. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol. 2011;67(7):741–52.PubMed CrossRef
  12.Milos V, Rekman E, Bondesson A, Eriksson T, Jakobsson U, Westerlund T, Midlov P. Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study. Drugs Aging. 2013;30(4):235–46.PubMed CrossRef
  13.Bondesson A, Holmdahl L, Midlov P, Hoglund P, Andersson E, Eriksson T. Acceptance and importance of clinical pharmacists’ LIMM-based recommendations. Int J Clin Pharm. 2012;34(2):272–6.PubMed CrossRef
  14.Hedström M, Lidström B, Hulter Åsberg K. PHASE-20: a new instrument for assessment of possible therapeutic drug-related symptoms among elderly in nursing homes. Nord J Nurs Res Clin Stud. 2009;4:9–14.CrossRef
  15.Indicators for evaluation of the quality of drug use by elderly. Stockholm: The National Board of Health and Welfare; 2003, updated 2010. Report No.: 2010-6-29.
  16.Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: The McGraw-Hill Companies Inc; 1998. ISBN 978-0070120464.
  17.Hatoum HT, Hutchinson RA, Witte KW, Newby GP. Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction. Drug Intell Clin Pharm. 1988;22(3):252–9.PubMed
  18.Perera PN, Guy MC, Sweaney AM, Boesen KP. Evaluation of prescriber responses to pharmacist recommendations communicated by fax in a medication therapy management program (MTMP). J Manag Care Pharm. 2011;17(5):345–54.PubMed
  19.Kwint HF, Faber A, Gussekloo J, Bouvy ML. Effects of medication review on drug-related problems in patients using automated drug-dispensing systems: a pragmatic randomized controlled study. Drugs Aging. 2011;28(4):305–14.PubMed CrossRef
  20.Vinks TH, Egberts TC, de Lange TM, de Koning FH. Pharmacist-based medication review reduces potential drug-related problems in the elderly: the SMOG controlled trial. Drugs Aging. 2009;26(2):123–33.PubMed CrossRef
  21.Hilmer SN, Gnjidic D, Le Couteur DG. Thinking through the medication list—appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician. 2012;41(12):924–8.PubMed
  22.Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol. 2004;57(2):121–6.PubMed PubMedCentral CrossRef
  
• 作者单位：Sara Modig (1) (2)
  Lydia Holmdahl (3)
  Åsa Bondesson (1) (4)
  
  1. Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden
  2. Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Malmö, Sweden
  3. Department of Medicine, Lund University Hospital, Lund, Sweden
  4. Department of Laboratory Medicine/Clinical Pharmacology, Lund University, Lund, Sweden
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Internal Medicine
  Pharmacy
  
• 出版者：Springer Netherlands
• ISSN：2210-7711

文摘

Background One way of preventing and solving drug-related problems in frail elderly is to perform team-based medication reviews. Objective To evaluate the quality of the clinical pharmacy service to primary care using structured medication reviews, focusing on the clinical significance of the recommendations made by clinical pharmacists. Setting A random sample of 150 patients (out of 1541) who received structured team based medication reviews. The patients lived at a geriatric nursing home or were ≥65 years and lived in ordinary housing with medication-related community help. Method Based on information on symptoms, kidney function, blood pressure, diagnoses and the medication list, a pharmacist identified possible drug-related problems and supplied recommendations for the general practitioner to act on. Two independent physicians retrospectively ranked the clinical significance of the recommendations according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Main outcome measure The clinical significance of the recommendations. Results In total 349 drug-related problems were identified, leading to recommendations. The vast majority of the recommendations (96 %) were judged to have significance 3 or higher and more than the half were judged to have significance 4 or higher. Conclusion The high proportion of clinically significant recommendations provided by pharmacists when performing team-based medication reviews suggest that these clinical pharmacy services have potential to increase prescribing quality. As such, the medication reviews have the potential for contributing to a better and safer drug therapy for elderly patients. Keywords Clinical significance DRP Drug-related problem Medication review Primary care Sweden