Development and Application of Comprehensive Medication Review Procedure to Community-Dwelling Elderly
Year: 2012
Type: dissertation
Abstract: Populations in Western countries are ageing. At the same time, use of medications is increasing among older people. Age-related changes in the body make the elderly vulnerable to adverse drug events. Thus, ensuring medication safety among this patient group is a growing health care concern. The aim of this study was to examine the Finnish collaborative Comprehensive Medication Review (CMR) model as a means to improve the appropriateness of pharmacotherapy among community-dwelling elderly. The specific aims were 1) to determine the prevalence of potentially inappropriate medication use according to the Beers 2003 criteria among Finnish non-institutionalized population aged ≥65 years; 2) to describe the development and assess participant satisfaction on the CMR accreditation training; 3) to describe the development of the CMR procedure and related documentation; and 4) to assess the drug-related problems (DRPs) pharmacists report to collaborating physicians during CMR and the resulting interventions among outpatients aged ≥65 years. The prevalence of potentially inappropriate drug use was studied by using the drug reimbursement register of the Social Insurance Institution covering the entire non-institutionalized population aged ≥65 years in 2007 (n=841 509, Study I). The development of the CMR procedure and accreditation training involved a review of literature and international medication review procedures, and pilot testing by 26 experienced pharmacists undergoing the CMR training in 2005 - 2006 (Studies II, III). Pharmacists satisfaction on the CMR training (n=38) and documentation (n=27) were assessed by surveys completed by CMR training participants in 2006 - 2007 (Studies II, III). The DRPs reported to the collaborating physicians were studied by a retrospective review of CMR case reports (n=121) by 26 community pharmacists attending the CMR training in 2006 - 2007 (Study IV). Approximately 15% of the non-institutionalized population aged ≥65 years used potentially inappropriate medications in 2007. The most worrying finding was the common use of benzodiazepines, particularly high-dose temazepam. The 1.5-year CMR accreditation training for practicing pharmacists combines distance learning and face-to-face learning. The participating pharmacists satisfaction with the training was high but several factors prevent them from conducting CMRs after the training. The collaborative CMR procedure involves access to clinical patient information, in-home patient interview, a case conference with the collaborating physician and standard documentation to support the process. The procedure covers four dimensions critical for safe and appropriate geriatric pharmacotherapy: Aging and Safety; Co-Morbidities; Polypharmacy; and Adherence. During CMR pharmacists reported to collaborating physicians an average of 6.5 DRPs/patient. Most common DRPs were inappropriate drug selection, especially involving psychotropics, and undertreatment. Also treatment of pain was often found to need improvement. Approximately half of the pharmacists recommendations led to medication changes, i.e., to an average of 3 changes/patient. The most common agreed change was to stop hypnotics or sedatives. The CMR procedure could be beneficial for improving pharmacotherapy among older outpatients as a large portion of DRPs identified by pharmacists led to medication changes. Actions to facilitate implementation of the model to Finnish health care system are needed. Also, further studies are needed to evaluate the effects of CMR on clinical, humanistic and economic outcomes.
Source: Työväentutkimus Vuosikirja
Author: Saija Leikola
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1515548434