Database: EMBASE Classic+EMBASE <1947 to 2011 February 15>, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1948 to Present> Search Strategy: -------------------------------------------------------------------------------- 1 medication review.ti,ab. (587) 2 remove duplicates from 1 (380) 3 1 not 2 (207) 4 from 1 keep 1-5,9-11,13-14,19,21,25,32-41,43,50,53-55,62-67,76-77,79-80,82-85,88-94,96,98-102,104-108,110,114-115,117-119,121-122,124-125,128,130-132,136,142-143,145,147-149,151,156,160-162,164,171-174,177,184-185,196,198-199,201-202,214,216,219,222-223,225-228,239,241,246-248,250-254,257-262,266,273-281,284,286-288,290,294-295,297-300,303-306,311,314-315,320-322,328,331-334,343,351,353,359-471,474-587 (390) 5 from 4 keep 1-30 (30) 6 from 4 keep 165-215 (51) *************************** <1> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21214918 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Leendertse AJ AU - de Koning FH AU - Goudswaard AN AU - Jonkhoff AR AU - van den Bogert SC AU - de Gier HJ AU - Egberts TC AU - van den Bemt PM FA - Leendertse, Anne J FA - de Koning, Fred H P FA - Goudswaard, Alex N FA - Jonkhoff, Andries R FA - van den Bogert, Sander C A FA - de Gier, Han J FA - Egberts, Toine C G FA - van den Bemt, Patricia M L A IN - Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands. TI - Preventing hospital admissions by reviewing medication (PHARM) in primary care: design of the cluster randomised, controlled, multi-centre PHARM-study. SO - BMC Health Services Research. 11(1):4, 2011. AS - BMC Health Serv Res. 11(1):4, 2011. NJ - BMC health services research PI - Journal available in: Electronic Citation processed from: Internet JC - 101088677 OI - Source: NLM. PMC3024925 SB - IM CP - England AB - BACKGROUND: Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published randomised controlled trials on pharmacotherapy reviews showed no or little effect on morbidity and mortality. Therefore we designed the PHARM (Preventing Hospital Admissions by Reviewing Medication)-study with the objective to study the effect of the total pharmaceutical care process on medication related hospital admissions and on adverse drug events, survival and quality of life. METHODS/DESIGN: The PHARM-study is designed as a cluster randomised, controlled, multi-centre study in an integrated primary care setting. Patients with a high risk of a medication related hospital admission are included in the study with randomisation at GP (general practitioner) level. We aim to include 14200 patients, 7100 in each arm, from at least 142 pharmacy practices.The intervention consists of a patient-centred, structured, pharmaceutical care process. This process consists of several steps, is continuous and occurs over multiple encounters of patients and clinicians. The steps of this pharmaceutical care process are a pharmaceutical anamnesis, a review of the patient's pharmacotherapy, the formulation and execution of a pharmaceutical care plan combined with the monitoring and follow up evaluation of the care plan and pharmacotherapy. The patient's own pharmacist and GP carry out the intervention. The control group receives usual care.The primary outcome of the study is the frequency of hospital admissions related to medication within the study period of 12 months of each patient. The secondary outcomes are survival, quality of life, adverse drug events and severe adverse drug events. The outcomes will be analysed by using mixed-effects Cox models. DISCUSSION: The PHARM-study is one of the largest controlled trials to study the effectiveness of the total pharmaceutical care process. The study should therefore provide evidence as to whether such a pharmaceutical care process should be implemented in the primary care setting. TRIAL REGISTRATION: Trial number: NTR 2647. ES - 1472-6963 IL - 1472-6963 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20110107 DP - 2011 DC - 20110124 YR - 2011 UP - 20110214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21214918 <2> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21303466 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Data-Review AU - Parsons C AU - Alldred D AU - Daiello L AU - Hughes C FA - Parsons, Carole FA - Alldred, David FA - Daiello, Lori FA - Hughes, Carmel IN - Lecturer, School of Pharmacy, Queen's University Belfast, Belfast, UK Lecturer, School of Healthcare, Leeds University, Leeds, UK Assistant Professor, Department of Neurology, Brown University, Providence, RI, USA Professor, School of Pharmacy, Queen's University Belfast, Belfast, UK. TI - Prescribing for older people in nursing homes: strategies to improve prescribing and medicines use in nursing homes. SO - International Journal of Older People Nursing. 6(1):55-62, 2011 Mar. AS - Int J Older People Nurs. 6(1):55-62, 2011 Mar. NJ - International journal of older people nursing PI - Journal available in: Print Citation processed from: Internet JC - 101267281 SB - IM, N CP - England AB - parsons c., alldred d., daiello l. & hughes c. (2011)Prescribing for older people in nursing homes: strategies to improve prescribing and medicines use in nursing homes. International Journal of Older People Nursing6, 55-62 doi: 10.1111/j.1748-3743.2010.00263.x Interventions to improve prescribing in the nursing home environment are many and varied. The critical literature review presented in Paper 1 (Parsons et al., 2011, International Journal of Older People Nursing6, 45-54) in this series discussed the main issues repeatedly identified as problematic, and this paper summarises the main approaches which have been used to attempt to improve prescribing. These include national legislation which demands documented justification for the prescribing of medicines, medication review, approaches to reducing medication errors, improving communication across care boundaries and assessment teams and alternative service models. It is difficult to make global recommendations as some of these approaches are country specific or have been delivered in different ways, involving different professionals. However, a series of prompt questions have been provided which may assist nursing home staff in deciding whether prescribing is optimal in a resident or if an intervention is required which may lead to an overall improvement in outcomes. Copyright 2011 Blackwell Publishing Ltd. ES - 1748-3743 IL - 1748-3735 DO - http://dx.doi.org/10.1111/j.1748-3743.2010.00263.x PT - Journal Article LG - English DP - 2011 Mar DC - 20110209 YR - 2011 UP - 20110210 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21303466 <3> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20825538 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Nishtala PS AU - McLachlan AJ AU - Bell JS AU - Chen TF FA - Nishtala, Prasad S FA - McLachlan, Andrew J FA - Bell, J Simon FA - Chen, Timothy F IN - Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia. prasadn@pharm.usyd.edu.au TI - A retrospective study of drug-related problems in Australian aged care homes: medication reviews involving pharmacists and general practitioners. SO - Journal of Evaluation in Clinical Practice. 17(1):97-103, 2011 Feb. AS - J Eval Clin Pract. 17(1):97-103, 2011 Feb. NJ - Journal of evaluation in clinical practice PI - Journal available in: Print-Electronic Citation processed from: Internet JC - cwd, 9609066 SB - IM CP - England AB - BACKGROUND: Drug-related problems (DRPs) in Australian aged care homes have been studied previously. However, little is known about the acceptance and implementation of pharmacists' recommendations by general practitioners (GPs) to resolve DRPs. OBJECTIVES: The primary objective of this study was to investigate the number and nature of DRPs identified by accredited clinical pharmacists. The secondary objective was to study the GP acceptance and implementation of pharmacist recommendations to resolve DRPs. METHODS: This was a retrospective study of 500 randomly selected, de-identified medication reviews performed by 10 accredited clinical pharmacists over 6 months across 62 aged care homes. The DRPs identified by pharmacists were subsequently classified by the drugs involved, types of problem (indication, effectiveness and safety) and medical diagnoses of the patient. GP written feedback on the medication review reports determined implementation of pharmacists' recommendations to resolve the DRPs. RESULTS: A total of 1433 DRPs were identified in 480 of the 500 residents. Potential DRPs were frequently classified as risk of adverse drug reactions, need for additional monitoring and inappropriate choice of a drug. Alimentary, cardiovascular, central nervous system and respiratory drugs were most frequently implicated, accounting for more than 75% of the DRPs. GPs' acceptance and implementation of pharmacists recommendations were 72.5% (95% CI; 70.2, 74.8) and 58.1% (95% CI; 55.5, 60.6), respectively. CONCLUSIONS: Over 96% of the residents had potential DRPs identified by pharmacists. GP acceptance of pharmacists' recommendations was independent of the drug category, but not independent of the disease category. Copyright 2010 Blackwell Publishing Ltd. ES - 1365-2753 IL - 1356-1294 DO - http://dx.doi.org/10.1111/j.1365-2753.2010.01374.x PT - Journal Article LG - English EP - 20100902 DP - 2011 Feb DC - 20110119 YR - 2011 UP - 20110209 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20825538 <4> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20722881 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Castelino RL AU - Bajorek BV AU - Chen TF FA - Castelino, Ronald L FA - Bajorek, Beata V FA - Chen, Timothy F IN - Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia. ronald.castelino@sydney.edu.au TI - Are interventions recommended by pharmacists during Home Medicines Review evidence-based?. SO - Journal of Evaluation in Clinical Practice. 17(1):104-10, 2011 Feb. AS - J Eval Clin Pract. 17(1):104-10, 2011 Feb. NJ - Journal of evaluation in clinical practice PI - Journal available in: Print-Electronic Citation processed from: Internet JC - cwd, 9609066 SB - IM CP - England AB - INTRODUCTION: Over the past decade medication review services have been implemented in many countries, including Australia, UK and USA. Although, the attitudes and barriers to the implementation of evidence-based medicine have been investigated, the extent to which medication review recommendations are evidence-based is not known. OBJECTIVE: To determine (1) the extent to which pharmacist's recommendations during medication review services were consistent with the evidence-based guides at the time of the review; and (2) the nature and extent of drug-related problems (DRPs) and the actions recommended by pharmacists to resolve DRPs. METHOD: A retrospective review of Home Medicines Review cases performed on 224 community-dwelling older people (65 years or older). The chi-squared test for categorical variables was used to compare the proportion of recommendations that were evidence-based and recommendations for which no evidence could be identified in the most common Australian information sources. DRPs and the actions recommended to resolve the DRPs were classified according to previously employed criteria. RESULTS: Pharmacists made a total of 1114 therapeutic recommendations to general practitioners, of which 964 required supporting pharmacotherapeutic evidence. The majority (94%) of the pharmacists' recommendations were in accordance with the evidence-based guides, as compared with the recommendations for which no evidence could be identified (P < 0.001). Pharmacists reported that 98% of the patients had at least one problem with use of their medication detected. CONCLUSION: The majority of the actions recommended by pharmacists during the medication review process were consistent with the literature embedded in key Australian information sources. Medication management in older people is complex and challenging, as highlighted by the DRPs identified in 98% of our patients. A suitably trained pharmacist, with full access to the patient, medical record and supporting resources, can help to improve the quality use of medicines in this at-risk population. Copyright 2010 Blackwell Publishing Ltd. ES - 1365-2753 IL - 1356-1294 DO - http://dx.doi.org/10.1111/j.1365-2753.2010.01375.x PT - Journal Article LG - English EP - 20100815 DP - 2011 Feb DC - 20110119 YR - 2011 UP - 20110209 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20722881 <5> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21294317 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - De Wulf I AU - Depuydt C AU - Develter M AU - De Waele L AU - Leyssens A AU - Pierreux T AU - Vansteenkiste D AU - Vermaelen K AU - Vermeir S AU - Foulon V FA - De Wulf, I FA - Depuydt, C FA - Develter, M FA - De Waele, L FA - Leyssens, A FA - Pierreux, T FA - Vansteenkiste, D FA - Vermaelen, K FA - Vermeir, S FA - Foulon, V IN - Service Projets Scientifiques, CDSP-CWOA, APB. dewulf.isabelle@mail.apb.be TI - [Medication review in the elderly by the community pharmacist: a pilot study]. [French] OT - Revue des medicaments chez la personne agee polymediquee par le pharmacien d'officine: une etude pilote. SO - Journal de Pharmacie de Belgique. (4):110-7, 2010 Dec. AS - J Pharm Belg. (4):110-7, 2010 Dec. NJ - Journal de pharmacie de Belgique PI - Journal available in: Print Citation processed from: Print JC - jnb, 0375351 SB - IM CP - Belgium IS - 0047-2166 IL - 0047-2166 PT - Journal Article LG - French DP - 2010 Dec DC - 20110204 YR - 2010 UP - 20110208 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21294317 <6> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21108651 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Roughead EE AU - Barratt JD AU - Ramsay E AU - Pratt N AU - Ryan P AU - Peck R AU - Killer G AU - Gilbert AL FA - Roughead, E E FA - Barratt, J D FA - Ramsay, E FA - Pratt, N FA - Ryan, P FA - Peck, R FA - Killer, G FA - Gilbert, A L IN - Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, Australia. libby.roughead@unisa.edu.au TI - Collaborative home medicines review delays time to next hospitalization for warfarin associated bleeding in Australian war veterans. SO - Journal of Clinical Pharmacy & Therapeutics. 36(1):27-32, 2011 Feb. AS - J Clin Pharm Ther. 36(1):27-32, 2011 Feb. NJ - Journal of clinical pharmacy and therapeutics PI - Journal available in: Print Citation processed from: Internet JC - hpi, 8704308 SB - IM CP - England AB - WHAT IS KNOWN AND BACKGROUND: Unintended bleeds are a common complication of warfarin therapy. We aimed to determine the impact of general practitioner-pharmacist collaborative medication reviews in the practice setting on hospitalization-associated bleeds in patients on warfarin. METHOD: We undertook a retrospective cohort study using administrative claims data for the ambulatory veteran and war widow population, Australia. Participants were veterans, war widows and their dependents aged 65 years and over dispensed warfarin. The exposed groups were those exposed to a general practitioner (GP)-pharmacist collaborative home medication review. The service includes GP referral, a home visit by an accredited pharmacist to identify medication-related problems, a pharmacist report with follow-up undertaken by the GP. The outcome measure was time to next hospitalization for bleeding. RESULTS: There were 816 veterans exposed to a home medicines review and 16,320 unexposed patients, with an average age of 81.5 years, and six to seven co-morbidities. Adjusted results showed a 79% reduction in likelihood of hospitalization for bleeding between 2 and 6 months (HR, 0.21 95% CI, 0.05-0.87) amongst those who had received a home medicines reviewed compared to the unexposed patients. No effect was seen in the time period from review to 2 months, nor in the time period 6 to 12 months post a review. WHAT IS NEW AND CONCLUSION: Medicines review in the practice setting delays time to next hospitalization for bleeding in those treated with warfarin in the period 2 to 6 months after the review, but is not sustained over time. Six monthly medication reviews may be required for patients on warfarin who are considered at high risk of bleeding. Copyright 2010 The Authors. JCPT Copyright 2010 Blackwell Publishing Ltd. ES - 1365-2710 IL - 0269-4727 DO - http://dx.doi.org/10.1111/j.1365-2710.2009.01149.x PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English DP - 2011 Feb DC - 20110104 YR - 2011 UP - 20110121 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21108651 <7> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20823125 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Fiss T AU - Dreier A AU - Meinke C AU - van den Berg N AU - Ritter CA AU - Hoffmann W FA - Fiss, Thomas FA - Dreier, Adina FA - Meinke, Claudia FA - van den Berg, Neeltje FA - Ritter, Christoph Alexander FA - Hoffmann, Wolfgang IN - Department of Epidemiology of Health Care and Community Health, Ernst Moritz Arndt University of Greifswald, Ellernholzstr, Germany. thomas.fiss@uni-greifswald.de TI - Frequency of inappropriate drugs in primary care: analysis of a sample of immobile patients who received periodic home visits. SO - Age & Ageing. 40(1):66-73, 2011 Jan. AS - Age Ageing. 40(1):66-73, 2011 Jan. NJ - Age and ageing PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 0375655, 2xr SB - IM CP - England AB - BACKGROUND: drug intake is associated with the risk of drug-related problems (DRPs), e.g. the intake of PIM. OBJECTIVE: the proportion of potentially inappropriate medication (PIM) taken by elderly people was analysed. DESIGN: community-based, prospective cohort study. SETTING: ambulatory health-care sector in a German rural area. SUBJECTS: seven hundred and forty-four patients with age >65 years and regular intake of drugs. METHODS: comprehensive home medication review (HMR) provided by specially qualified assistants of GP practices using electronic case reporting forms (eCRFs), and GP's diagnoses were extracted from patients' health records. Updated Beers' list of Fick et al. was used to detect PIM for patients >65 years and drug-condition interaction. RESULTS: a total of 18% (n= 134) of the patients received 163 inappropriate drugs. Out of these drugs, most prevalent PIM were benzodiazepine derivates (n= 45). Out of all drugs, 25 drug-condition interactions were identified. The intake of PIM was slightly associated with self-reported falls (: 0.1074; P= 0.0244). Multivariate logistic regression showed significant results for the number of taken substances (OR = 1.176; 95% CI 1.121-1.234, P< 0.001). CONCLUSIONS: a high proportion of patients taking PIM in a community-based setting were investigated. Statistical associations with self-reported falls were found. Confounding may influence data. Further research to investigate findings is needed. ES - 1468-2834 IL - 0002-0729 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100907 DP - 2011 Jan DC - 20101214 YR - 2011 UP - 20101227 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20823125 <8> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21166297 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Cowie MR FA - Cowie, Martin R IN - Imperial College London, Royal Brompton Hospital. TI - Improving the management of chronic heart failure. SO - Practitioner. 254(1734):29-32, 3, 2010 Nov. AS - Practitioner. 254(1734):29-32, 3, 2010 Nov. NJ - The Practitioner PI - Journal available in: Print Citation processed from: Print JC - phq, 0404245 SB - IM CP - England AB - NICE has updated its guideline on heart failure. The principal changes from the 2003 guideline include more directive advice on how to improve the quality and timeliness of diagnosis. There is greater encouragement to use beta-blockers, more emphasis on rehabilitation, and better access to specialist advice--particularly at the time of diagnosis, admission to hospital, and where symptoms do not respond to first-line therapy with diuretics, ACE inhibitors and beta-blockers. A full history should be taken and clinical examination carried out. Patients with a past history of MI, or those with a high plasma BNP, should be referred to be seen within two weeks for echocardiography and specialist opinion. The specialist should determine: whether heart failure is present; its likely aetiology; precipitating factors; type of cardiac dysfunction; correctable causes; relevant comorbidity, and prognosis. Those with no history of MI but an elevated plasma BNP should be referred to be seen within six weeks for such assessment. Older adults, and patients with peripheral vascular disease, erectile dysfunction, diabetes mellitus, interstitial pulmonary disease and COPD without reversibility should be considered for beta-blocker therapy. A start low, go slow approach is recommended, with clinical review after each titration. Monitoring should include a clinical assessment, medication review, and a check of renal function as a minimum. Such a review should take place at least six monthly but may have to be much more frequent if there is a change in drug prescription or clinical status. Patients with stable heart failure should be offered a supervised group exercise-based rehabilitation programme designed for such patients. This should include a psychological and educational component, and could be incorporated within an existing cardiac rehabilitation programme. IS - 0032-6518 IL - 0032-6518 PT - Journal Article LG - English DP - 2010 Nov DC - 20101220 YR - 2010 UP - 20101221 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=21166297 <9> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20584702 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - van Doormaal JE AU - Rommers MK AU - Kosterink JG AU - Teepe-Twiss IM AU - Haaijer-Ruskamp FM AU - Mol PG FA - van Doormaal, Jasperien E FA - Rommers, Mirjam K FA - Kosterink, Jos G W FA - Teepe-Twiss, Irene M FA - Haaijer-Ruskamp, Flora M FA - Mol, Peter G M IN - Department of Hospital and Clinical Pharmacy, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. j.v.doormaal@mzh.nl TI - Comparison of methods for identifying patients at risk of medication-related harm. SO - Quality & Safety in Health Care. 19(6):e26, 2010 Dec. AS - Qual Saf Health Care. 19(6):e26, 2010 Dec. NJ - Quality & safety in health care PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 101136980 SB - H CP - England AB - BACKGROUND: With the introduction of Computerised Physician Order Entry (CPOE) in routine hospital care, a great deal of effort has been put into refining Clinical Decision Support Systems (CDSS) to identify patients at risk of preventable medication-related harm. OBJECTIVES: This study compared a CPOE with basic CDSS and 16 clinical rules with a manual pharmacist medication review to detect overdose and drug-drug interactions that actually required a change in medication. METHODS: The study involved the review of 313 patients admitted over 5 months at an internal medicine ward where a change in medication as a result of dosing of therapeutic errors was detected by a manual medication review by a trained pharmacist. Subsequently, all these patients' medication orders (MOs) were entered into the authors' CPOE with basic CDSS. Medication orders with a safety alert indicating overdose and drug-drug interactions generated by the authors' CPOE with basic CDSS were compared with the same type of medication errors identified through manual review. The positive predictive value (PPV), sensitivity and specificity compared with manual review were determined. Second, a set of 16 clinical rules was applied to the patient and prescribing data. The overlap between the clinical rules and manual review was determined by comparing patients triggered by the clinical rule with patients with a corresponding error in the manual medication review. RESULTS: Manual medication review identified 57 medication errors involving overdose and 143 therapeutic errors of which 46 were drug-drug interactions. The CPOE with basic CDDS generated 297 safety alerts involving overdose (PPV 0.06, sensitivity 0.32, specificity 0.92) and 365 safety alerts involving drug-drug interactions (PPV 0.12, sensitivity 0.96, specificity 0.91). The clinical rules generated 313 safety alerts identifying 39% of all the overdoses and therapeutic errors found in the manual review at which they were targeted. In 23% of the alerts generated by a clinical rule, the patients actually required a change of medication as indicated by the manual review. When CPOE with basic CDSS and the rules were combined, 66% of the overdoses and therapeutic errors were identified. CONCLUSIONS: The authors' CPOE with basic CDSS and the clinical rules are useful early strategies for preventing medication-related harm. They could be a first step towards more advanced decision support. These computerised systems will be even more useful in daily practice, once they are further fine-tuned to decrease the number of alerts that need no clinical action. ES - 1475-3901 IL - 1475-3898 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100627 DP - 2010 Dec DC - 20101203 YR - 2010 UP - 20101221 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20584702 <10> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20842477 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Data-Review AU - Clark AM AU - Davidson P AU - Currie K AU - Karimi M AU - Duncan AS AU - Thompson DR FA - Clark, Alexander M FA - Davidson, Patricia FA - Currie, Kay FA - Karimi, Mehri FA - Duncan, Amanda S FA - Thompson, David R IN - Faculty of Nursing, Level 3 CSB, University of Alberta, Edmonton, AB, Canada, T6R 2R6, alex.clark@ualberta.ca. TI - Understanding and promoting effective self-care during heart failure. SO - Current Treatment Options in Cardiovascular Medicine. 12(1):1-9, 2010 Jan. AS - Curr Treat Options Cardiovasc Med. 12(1):1-9, 2010 Jan. NJ - Current treatment options in cardiovascular medicine PI - Journal available in: Print Citation processed from: Internet JC - 9815942 CP - United States AB - OPINION STATEMENT: Heart failure (HF) self-care relates to the decisions made outside clinical settings by the individual with HF to maintain life, healthy functioning, and well-being. The people who help patients most (ie, caregivers/family members) should be involved in care, and general principles of health behavior change should be used to guide support. Medicines should be prescribed with once-daily dosing, with pharmacists providing medication review and support. Pill boxes should be provided and patients' health literacy levels assessed. Psychosocial interventions for smoking cessation should be undertaken. Regular aerobic exercise may benefit patients with mild to moderate HF and some with severe but stable HF; therefore, referral to cardiac rehabilitation should be considered. Exercise regimen must take into account patient-related factors, including functional status, comorbid conditions, and patient preferences. Intake of salt, alcohol, and fluid should be restricted, although these steps are supported by limited evidence. Patients should be educated on appropriate sources of help. They should seek help immediately for persistent chest pain, palpitations, syncope, breathlessness at rest, or a weight increase of >= 2 lb. Depression, if present, should be addressed with antidepressants (sertraline and citalopram), cognitive behavioral therapy, and regular exercise. HF disease management programs should be offered if available. ES - 1534-3189 IL - 1092-8464 PT - Journal Article LG - English DP - 2010 Jan DC - 20100915 YR - 2010 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20842477 <11> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20840451 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Ross S AU - Loke YK FA - Ross, Sarah FA - Loke, Yoon K IN - Division of Medical and Dental Education, University of Aberdeen, Aberdeen and School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. s.ross@abdn.ac.uk TI - Development of learning outcomes for an undergraduate prescribing curriculum (British Pharmacological Society prescribing initiative). [Review] SO - British Journal of Clinical Pharmacology. 70(4):604-8, 2010 Oct. AS - Br J Clin Pharmacol. 70(4):604-8, 2010 Oct. NJ - British journal of clinical pharmacology PI - Journal available in: Print Citation processed from: Internet JC - au9, 7503323 OI - Source: NLM. PMC2950995 [Available on 10/01/11] SB - IM CP - England AB - AIMS: The question of whether new medical graduates are adequately prepared for the challenge of prescribing has been raised. Although broad outcomes for prescribing competency have been agreed, clarity is needed on the detailed outcomes expected of new graduates. This study aimed to create a consensus on the required competencies for new graduates in the area of prescribing. METHODS: We used a modified Delphi approach based on the findings of a systematic review of educational interventions for improved prescribing. Panellists were asked to rank the importance of a list of 53 possible learning outcomes and to add any additional outcomes felt to be missing. RESULTS: Of the 48 experts who were invited to participate, 28 agreed (58%). Forty-five learning outcomes were included from the original list of 53. A further nine outcomes were suggested by panellists, of which five were included. The wording of three outcomes was changed in line with suggestions from the panellists. Many of the agreed outcomes relate to improving patient safety through medication review, checking appropriateness of the drug for the patient, recognizing the prescriber's limitations and seeking advice when needed. Enhanced communication with the patient and healthcare team, better documentation in the notes and discharge letters were key areas featured in this Delphi exercise. DISCUSSION: This study has identified 50 learning outcomes for teaching prescribing. These build on the existing British Pharmacological Society document by focusing specifically on prescribing, with greater emphasis on avoiding medication errors and better communication. Copyright 2010 The Authors. British Journal of Clinical Pharmacology Copyright 2010 The British Pharmacological Society. ES - 1365-2125 IL - 0306-5251 DO - http://dx.doi.org/10.1111/j.1365-2125.2009.03581.x PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review LG - English DP - 2010 Oct DC - 20100915 YR - 2010 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20840451 <12> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20230611 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - In-Process AU - Ahmad A AU - Hugtenburg J AU - Welschen LM AU - Dekker JM AU - Nijpels G FA - Ahmad, Abeer FA - Hugtenburg, Jacqueline FA - Welschen, Laura M C FA - Dekker, Jacqueline M FA - Nijpels, Giel IN - Department of Clinical Pharmacology and Pharmacy, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. a.ahmad@vumc.nl TI - Effect of medication review and cognitive behaviour treatment by community pharmacists of patients discharged from the hospital on drug related problems and compliance: design of a randomized controlled trial. SO - BMC Public Health. 10:133, 2010. AS - BMC Public Health. 10:133, 2010. NJ - BMC public health PI - Journal available in: Electronic Citation processed from: Internet JC - 100968562 OI - Source: NLM. PMC2850341 SB - IM CP - England AB - BACKGROUND: Drug related problems (DRPs) are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases. Examples of drug related problems are contra-indications, interactions, adverse drug reactions and inefficacy of treatment. Causes of these problems include prescription errors and non-compliance with treatment. The aim of this study is to examine the effect of medication review and cognitive behaviour therapy of discharged patients by community pharmacists to minimize the occurrence of drug related problems. METHODS/DESIGN: A randomized controlled trial will be performed. Community pharmacists will be randomized into a control group and an intervention group. 342 Patients, aged over 60 years, discharged from general and academic hospitals, using five or more prescription drugs for their chronic disease will be asked by their pharmacy to participate in the study. Patients randomized to the control group will receive usual care according to the Dutch Pharmacy Standard. The medication of patients randomised to the intervention group will be reviewed by the community pharmacist with use of the national guidelines for the treatment of diseases, when patients are discharged from the hospital. The Pharmaceutical Care network Europe Registration form will be used to record drug related problems. Trained pharmacy technicians will counsel patients at home at baseline and at 1,3,6,9 and 12 months, using Cognitive Behaviour Treatment according to the Theory of Planned Behaviour. The patient's attitude towards medication and patient's adherence will be subject of the cognitive behaviour treatment. The counselling methods that will be used are motivational interviewing and problem solving treatment. Patients adherence towards drug use will be determined with use of the Medication Adherence Report Scale Questionnaire. There will be a follow-up of 12 months.The two primary outcome measures are the difference in occurrence of DRPs between intervention and control group and adherence with drug use. Secondary endpoints are attitude towards drug use, incidence of Re-hospitalisations related to medicines, functional status of the patient, quality of life and the cost-effectiveness of this intervention. DISCUSSION: Combining both medication review and Cognitive Behaviour Treatment may decrease DRPs and may result in more compliance with drug use among patients discharged from the hospital and using 5 or more chronic drugs. TRIAL REGISTRATION: Dutch Trial Register NTR1194. ES - 1471-2458 IL - 1471-2458 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't LG - English EP - 20100315 DP - 2010 DC - 20100407 YR - 2010 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=20230611 <13> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 16553492 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Tobias DE FA - Tobias, Dianne E IN - Tobias Consulting Services, Davis, CA, USA. TI - Medication-related problems in nursing homes. Commentary: Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. SO - Consultant Pharmacist. 19(7):629-30, 2004 Jul. AS - Consult Pharm. 19(7):629-30, 2004 Jul. NJ - The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists PI - Journal available in: Print Citation processed from: Print JC - 9013983 CP - United States IS - 0888-5109 IL - 0888-5109 PT - Journal Article LG - English DP - 2004 Jul DC - 20060323 YR - 2004 ED - 20070612 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=16553492 <14> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 15885009 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Graffen M AU - Kennedy D AU - Simpson M FA - Graffen, M FA - Kennedy, D FA - Simpson, M IN - Riverina Division of General Practice, Wagga Wagga, New South Wales, Australia. m.graffen @swsahs.nsw.gov.au TI - Quality use of medicines in the rural ambulant elderly: a pilot study. SO - Rural & Remote Health. 4(3):184, 2004 Jul-Sep. AS - RURAL REMOTE HEALTH. 4(3):184, 2004 Jul-Sep. NJ - Rural and remote health PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 101174860 CP - Australia AB - INTRODUCTION: Australia has a rapidly ageing population, especially in rural areas, and strategies to address medicines and the elderly are particularly relevant. The aims of this 18 month study, therefore, were to: (1) determine the influence of a medication review on the quality of life of elderly ambulatory patients managed by a general practitioner; and (2) assess the impact of the medication review process on health outcomes such as medication-related hospital admissions in ambulant elderly patients actively managed by their GP. METHODS: The study was conducted within the area serviced by the rural Riverina Division of General Practice, New South Wales, Australia. Patients were identified by clinical audit, and recruited to the study if they met the inclusion criteria of being: older than 65 years, ambulant, living independently and on five or more medications. The study sample consisted of 402 participants (156 men, 38.8%; 246 women, 61.2%). Fifty-eight participants withdrew from the study for a variety of reasons. A two-group (intervention, control) pre- and post-intervention randomized study design was utilized. Quality of life was assessed using SF-36. The medication history and clinical details of the 202 study participants were reviewed by the project pharmacist and their GP. Medication changes were suggested to patients by their GP and follow-up SF36 and review of hospitalisation episodes were conducted after 6 months. RESULTS: 3382 medications were identified as being taken, an average of 8.4 medications per patient. After the initial medication review, the study pharmacist suggested an alteration in dose, form or frequency for 687 medications in the intervention group. The GPs recommended an alteration in 243 of patient medications. Of the entire study population (n = 402), only two participants' admission to hospital was specifically attributed to medication-related issues. There were no significant differences between the quality of life assessments for the combined groups; however, the intervention group recorded significantly higher scores in two of the nine dimensions measured: vitality (p 0.009) and mental health (p 0.0001), at the post-intervention assessment. CONCLUSION: While the intervention did not reduce hospitalisation episodes and only led to a modest improvement in quality of life, the development of a mutually acceptable form of face-to-face pharmacist/GP medication review, identification of potentially serious adverse drug reactions, identification of previously unreported complementary medicine use, and enhanced GP awareness of the risks of polypharmacy were positive outcomes of the study. ES - 1445-6354 IL - 1445-6354 PT - Journal Article LG - English EP - 20040917 DP - 2004 Jul-Sep DC - 20050511 YR - 2004 ED - 20050524 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=15885009 <15> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 16563057 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - PubMed-not-MEDLINE AU - Rhoads M AU - Thai A FA - Rhoads, Mark FA - Thai, Amy IN - Danny's SunScript Pharmacy, Tuscon, Arizona 85712, USA. mark.rhoads@sunh.com TI - Physician acceptance rate of pharmacist recommendations to reduce use of potentially inappropriate medications in the assisted living setting. SO - Consultant Pharmacist. 18(3):241-7, 2003 Mar. AS - Consult Pharm. 18(3):241-7, 2003 Mar. NJ - The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists PI - Journal available in: Print Citation processed from: Print JC - 9013983 CP - United States AB - OBJECTIVE: To reduce the number of potentially inappropriate medication orders, based on the Beers' criteria, for an elderly population residing in assisted living facilities through consultant pharmacist medication review, interventions, and recommendations DESIGN: Prospective case series of consultant pharmacist recommendations. PATIENTS: Census of 456 residents of assisted living facilities who received a new or refill medication order during the preceding two months. INTERVENTIONS: Potentially inappropriate medications for the elderly were identified and recommendation letters faxed to the physician for consideration. MAIN OUTCOME MEASURES: Demographic characteristics, prevalence data for medications ordered and considered potentially inappropriate based on the Beers' criteria, and physician acceptance and return rate of recommendations. RESULTS: The data demonstrated that 31.6% of the residents in this study were receiving one or more routine or p.r.n. medications orders considered potentially inappropriate based on the Beers' criteria. The majority (82.9%) of the residents were female, and the average age of the residents was 85.4 +/- 7.34 SD years (range, 66-102 years). A total of 205 routine and p.r.n. medication orders were identified as potentially inappropriate. Of these orders, 16.7% were discontinued and 2.5% were changed to lower dosage regimens. The overall return rate of all recommendations faxed to physicians was 88.7%. CONCLUSIONS: Potentially inappropriate medications, according to the Beers' criteria for use in the elderly, are ordered at a high rate for residents of assisted living facilities. Though not mandated in all states, screening of these orders by a consultant pharmacist, with recommendations for alternative pharmacotherapy of less risk, would be appropriate. Physicians do address the recommendations in the majority of cases, but the physician acceptance rate of those recommendations is much lower. Consultant pharmacists have the opportunity to educate physicians of the risks of using medications considered potentially inappropriate for geriatric patients. Further studies are needed to determine barriers to physician acceptance of these recommendations. IS - 0888-5109 IL - 0888-5109 PT - Journal Article LG - English DP - 2003 Mar DC - 20060327 YR - 2003 ED - 20060425 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=prem&AN=16563057 <16> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20724395 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Boockvar KS AU - Livote EE AU - Goldstein N AU - Nebeker JR AU - Siu A AU - Fried T FA - Boockvar, K S FA - Livote, E E FA - Goldstein, N FA - Nebeker, J R FA - Siu, A FA - Fried, T IN - Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA. kenneth.boockvar@mssm.edu TI - Electronic health records and adverse drug events after patient transfer. SO - Quality & Safety in Health Care. 19(5):e16, 2010 Oct. AS - Qual Saf Health Care. 19(5):e16, 2010 Oct. NJ - Quality & safety in health care PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 101136980 OI - Source: NLM. NIHMS150670 [Available on 10/01/11] OI - Source: NLM. PMC2965207 [Available on 10/01/11] SB - H CP - England MH - Aged MH - Aged, 80 and over MH - Cohort Studies MH - Connecticut/ep [Epidemiology] MH - *Drug Toxicity/ep [Epidemiology] MH - *Electronic Health Records MH - Female MH - Hospitals MH - Humans MH - Male MH - Medical Audit MH - Middle Aged MH - New York/ep [Epidemiology] MH - Nursing Homes MH - *Patient Transfer AB - BACKGROUND: Our objective was to examine the frequencies of medication error and adverse drug events (ADEs) at the time of patient transfer in a system with an electronic health record (EHR) as compared with a system without an EHR. It was hypothesised that the frequencies of these events would be lower in the EHR system because of better information exchange across sites of care. METHODS: 469 patients transferred between seven nursing homes and three hospitals in New York and Connecticut between 1999 and 2005 were followed retrospectively. Two groups of patients were compared: US Veterans Affairs (VA) patients, with an EHR, and non-VA patients, without an EHR, on the following measures: (1) medication prescribing discrepancies at nursing home/hospital transfer, (2) high-risk medication discrepancies and (3) ADEs caused by medication discrepancies according to structured medical record review by pairs of physician and pharmacist raters. RESULTS: The overall incidence of ADE caused by medication discrepancies was 0.20 per hospitalisation episode. After controlling for demographic and clinical covariates, there were no significant differences between VA and non-VA groups in medication discrepancies (mean difference 0.02; 95% CI -0.81 to 0.85), high-risk medication discrepancies (-0.18; 95%CI -0.22 to 0.58) or occurrence of an ADE caused by a medication discrepancy (OR 0.96; 95% CI 0.18 to 5.01). CONCLUSIONS: There was no difference, with and without an EHR, in the occurrence of medication discrepancies or ADEs caused by medication discrepancies at the time of transfer between sites of care. Reducing such problems may require specialised computer tools to facilitate medication review. ES - 1475-3901 IL - 1475-3898 PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. NO - 5K23AG025933-04 (United States NIA NIH HHS) LG - English EP - 20100819 DP - 2010 Oct DC - 20101027 YR - 2010 ED - 20110204 UP - 20110207 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20724395 <17> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20582472 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Ellitt GR AU - Engblom E AU - Aslani P AU - Westerlund T AU - Chen TF FA - Ellitt, Glena R FA - Engblom, Ellinor FA - Aslani, Parisa FA - Westerlund, Tommy FA - Chen, Timothy F IN - Faculty of Pharmacy A15, The University of Sydney, Sydney, NSW, 2006, Australia. TI - Drug related problems after discharge from an Australian teaching hospital. SO - Pharmacy World & Science. 32(5):622-30, 2010 Oct. AS - Pharm World Sci. 32(5):622-30, 2010 Oct. NJ - Pharmacy world & science : PWS PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bo7, 9307352 SB - IM CP - Netherlands MH - Adult MH - Aged MH - Aged, 80 and over MH - Australia MH - Community Pharmacy Services/og [Organization & Administration] MH - Continuity of Patient Care/og [Organization & Administration] MH - Directive Counseling/og [Organization & Administration] MH - Drug Interactions MH - *Drug Utilization Review/sn [Statistics & Numerical Data] MH - Female MH - Hospitals, Teaching MH - Humans MH - Male MH - *Medication Reconciliation/sn [Statistics & Numerical Data] MH - Medication Therapy Management/og [Organization & Administration] MH - Middle Aged MH - *Patient Discharge MH - *Pharmaceutical Preparations/ae [Adverse Effects] MH - Pharmacists MH - Retrospective Studies AB - OBJECTIVE: To reconcile patients' medicines and to classify drug related problems identified during medication review conducted after discharge from hospital. SETTING: Patients were discharged from the cardiology unit of Westmead Hospital after recruitment into the Westmead Medicines Project which ran from 2004 to 2007. METHOD: This retrospective study involved an analysis of drugs, diseases and drug related problems in medication review reports available for 76 out of 85 patients who received a Home Medicines Review (HMR). Data sources for medication reconciliation and analyses also included hospital discharge summaries (n = 70) and GP referrals for HMR (n = 44). Comprehensive clinical profiles were constructed for the 76 subjects whose drug related problems were identified, coded, and then classified from their HMR reports. MAIN OUTCOME MEASURES: Number, type, distribution and international classification of drugs, diseases and drug-related problems. RESULTS: Patients were prescribed drugs for a broad range of cardiovascular, circulatory, endocrine, respiratory and digestive system diseases. Mean number of drugs per patient in discharge summaries: 8.7 +/- SD 3.3 (range 3-19); in GP referrals: 8.9 +/- SD 4.3 (range 2-23); and in HMR reports: 10.8 +/- SD 4.0 (range 3-24). Mean number of diseases per patient in discharge summaries: 4.1 +/- SD 2.9 (range 1-11); and in HMR reports: 4.7 +/- SD 2.6 (range 1-12). A total of 398 drug related problems were identified for 71 (93.3%) patients with mean 5.6 +/- SD 4.3 problems (range 1-21). The most frequently recorded problems were the patients' uncertainty about drug aim: n = 128 (32.0%); potential interactions n = 89 (22.4%); and adverse reactions n = 60 (15.1%). CONCLUSION: This study showed that patients recently discharged from a tertiary care hospital had a significant number of drug related problems. Classification of drugs and diseases revealed a broad range of non-cardiovascular medicines and conditions in the patients from an acute care cardiology unit. We found that home medicines review provided continuity of care and an opportunity for medication reconciliation which revealed marked differences in number of drugs, between hospital discharge and medicines review. The patients' uncertainly about their drugs and their diverse range of co-morbidities indicated the need for timely counselling by pharmacists in the community. RN - 0 (Pharmaceutical Preparations) ES - 1573-739X IL - 0928-1231 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100626 DP - 2010 Oct DC - 20101005 YR - 2010 ED - 20110127 UP - 20110128 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20582472 <18> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21165854 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hignett S FA - Hignett, Sue IN - Dept. of Ergonomics (Human Sciences), Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK. S.M.Hignett@lboro.ac.uk TI - Technology and building design: initiatives to reduce inpatient falls among the elderly. SO - Herd. 3(4):93-105, 2010. AS - HERD. 3(4):93-105, 2010. NJ - HERD PI - Journal available in: Print Citation processed from: Print JC - 101537529 SB - IM CP - United States MH - *Accidental Falls/pc [Prevention & Control] MH - Aged MH - *Environment, Controlled MH - *Equipment Design MH - *Frail Elderly MH - *Hospital Design and Construction MH - Humans MH - *Safety Management/mt [Methods] AB - This paper offers a narrative exploration of interventions for inpatient falls among the elderly with respect to the design of technology (equipment and furniture) and buildings. Most of the contributory risk factors for inpatient falls among the elderly were identified in the 1950s, but incident and injury rates remain relatively unchanged in the 2000s. Interventions have predominantly focused on staff and organizational changes, for example monitoring (observation) and communication, possibly in response to increased patient privacy (isolation) in single rooms. The clinical response has been to modify the patient by means of medication review, continence management, and impact protectors. This paper considers whether technology and building design have helped or hindered the newly admitted frail and/or confused elderly patient at risk of falling, assuming the provision of good nursing and medical practice (e.g., observation, treatment, and care). IS - 1937-5867 IL - 1937-5867 PT - Journal Article LG - English DP - 2010 DC - 20101217 YR - 2010 ED - 20110121 UP - 20110124 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=21165854 <19> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20798808 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Basheti IA AU - Ryan G AU - Woulfe J AU - Bartimote-Aufflick K FA - Basheti, Iman A FA - Ryan, Greg FA - Woulfe, Jim FA - Bartimote-Aufflick, Kathryn IN - Faculty of Pharmacy, Private University of Applied Sciences, Amman, Jordan. ibasheti@usyd.edu.au TI - Anonymous peer assessment of medication management reviews. SO - American Journal of Pharmaceutical Education. 74(5), 2010 Jun 15. AS - Am J Pharm Educ. 74(5), 2010 Jun 15. NJ - American journal of pharmaceutical education PI - Journal available in: Print Citation processed from: Internet JC - 0372650, 3r9 OI - Source: NLM. PMC2907842 SB - IM CP - United States MH - *Education, Pharmacy/mt [Methods] MH - *Educational Measurement/mt [Methods] MH - Humans MH - *Medication Therapy Management/ed [Education] MH - *Peer Group AB - OBJECTIVES: To investigate whether pharmacy students' anonymous peer assessment of a medication management review (MMR) was constructive, consistent with the feedback provided by an expert tutor, and enhanced the students' learning experience. DESIGN: Fourth-year undergraduate pharmacy students were randomly and anonymously assigned to a partner and participated in an online peer assessment of their partner's MMR. ASSESSMENT: An independent expert graded a randomly selected sample of the MMR's using a schedule developed for the study. A second expert evaluated the quality of the peer and expert feedback. Students also completed a questionnaire and participated in a focus group interview. Student peers gave significantly higher marks than an expert for the same MMR; however, no significant difference between the quality of written feedback between the students and expert was detected. The majority of students agreed that this activity was a useful learning experience. CONCLUSIONS: Anonymous peer assessment is an effective means of providing additional constructive feedback on student performance on the medication review process. Exposure to other students' work and the giving and receiving of peer feedback were perceived as valuable by students. ES - 1553-6467 IL - 0002-9459 DI - 77 PT - Evaluation Studies PT - Journal Article LG - English DP - 2010 Jun 15 DC - 20100827 YR - 2010 ED - 20110120 UP - 20110121 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20798808 <20> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20934616 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Becker C AU - Rapp K FA - Becker, Clemens FA - Rapp, Kilian IN - Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376 Stuttgart, Germany. clemens.becker@rbk.de TI - Fall prevention in nursing homes. [Review] SO - Clinics in Geriatric Medicine. 26(4):693-704, 2010 Nov. AS - Clin Geriatr Med. 26(4):693-704, 2010 Nov. NJ - Clinics in geriatric medicine PI - Journal available in: Print Citation processed from: Internet JC - cln, 8603766 SB - IM CP - United States MH - *Accident Prevention MH - *Accidental Falls/pc [Prevention & Control] MH - Aged MH - Environment Design MH - Exercise MH - Fractures, Bone MH - *Homes for the Aged MH - Humans MH - Long-Term Care MH - *Nursing Homes MH - Risk Factors MH - *Risk Management MH - Vitamin D/ad [Administration & Dosage] AB - The incidence of falls and fall-related injuries such as hip fractures remains high in nursing homes (NHs) across the world. Randomized controlled trials have shown that interventions that combine multiple components such as progressive exercise, medication review, and improvements in the person-environment fit and delivered by multidisciplinary teams can effectively reduce the number of falls and fallers. Vitamin D supplementation in adequate dosage is another effective method to reduce the burden of injuries in NHs. Single interventions such as exercise alone or insufficient organizational support are reasons for failure or even harmful consequences. Large-scale efforts are needed and justified to translate these findings into meaningful results. Copyright Copyright 2010 Elsevier Inc. All rights reserved. RN - 1406-16-2 (Vitamin D) ES - 1557-8623 IL - 0749-0690 PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review LG - English DP - 2010 Nov DC - 20101011 YR - 2010 ED - 20110114 UP - 20110117 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20934616 <21> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19705320 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Farrell B AU - Pottie K AU - Woodend K AU - Yao V AU - Dolovich L AU - Kennie N AU - Sellors C FA - Farrell, B FA - Pottie, K FA - Woodend, K FA - Yao, V FA - Dolovich, L FA - Kennie, N FA - Sellors, C IN - Elisabeth Bruyere Research Institute, CT Lamont Primary Health Care Centre, Ottawa, Ontario, Canada K1N 5C8. bfarrell@bruyere.org TI - Shifts in expectations: evaluating physicians' perceptions as pharmacists become integrated into family practice. SO - Journal of Interprofessional Care. 24(1):80-9, 2010 Jan. AS - J Interprof Care. 24(1):80-9, 2010 Jan. NJ - Journal of interprofessional care PI - Journal available in: Print Citation processed from: Internet JC - 9205811 SB - IM CP - England MH - Adult MH - Analysis of Variance MH - *Attitude of Health Personnel MH - Data Collection MH - Educational Status MH - Female MH - Humans MH - *Interdisciplinary Communication MH - Male MH - Middle Aged MH - Ontario MH - *Pharmacists/og [Organization & Administration] MH - *Physicians/og [Organization & Administration] MH - *Prejudice MH - *Primary Health Care/og [Organization & Administration] MH - Program Development MH - Program Evaluation MH - Questionnaires MH - *Social Perception AB - The objective of this study was to measure how primary care family physicians perceived their own and pharmacists' contributions to medication processes as pharmacists become integrated into primary care group family practices. The 22- item Family Medicine Medication Use Processes Matrix was mailed to physicians in seven sites at the 3rd, 12th and 19th month of pharmacist integration. Paired sample t-tests for the third month results were conducted to compare perceptions between pharmacist and physician contributions. One way repeated measure ANOVA test was conducted to determine significant changes over time. Physicians initially perceived their own contributions to be significantly higher than pharmacists in three subscales: Diagnosis & Prescribing, Monitoring and Administration/Documentation and their own contributions to be significantly lower than the pharmacists in the Education subscale. Over time, physicians perceived increases in the pharmacists' contribution to the Diagnosis & Prescribing, Monitoring and Medication Review subscales and decreases in their own contribution to the Diagnosis & Prescribing and Education subscales. Changes in family physicians' perceptions of pharmacists' contribution demonstrate an initial underestimate of pharmacists' role in primary care family practice and a gradual recognition of expertise and competence. This may have led to increased comfort in sharing aspects of contribution to medication use processes. ES - 1469-9567 IL - 1356-1820 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English DP - 2010 Jan DC - 20100105 YR - 2010 ED - 20110106 UP - 20110107 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19705320 <22> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20653678 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Roughead EE AU - Kalisch LM AU - Barratt JD AU - Gilbert AL FA - Roughead, Elizabeth E FA - Kalisch, Lisa M FA - Barratt, John D FA - Gilbert, Andrew L IN - Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, Australia. TI - Prevalence of potentially hazardous drug interactions amongst Australian veterans. SO - British Journal of Clinical Pharmacology. 70(2):252-7, 2010 Aug. AS - Br J Clin Pharmacol. 70(2):252-7, 2010 Aug. NJ - British journal of clinical pharmacology PI - Journal available in: Print Citation processed from: Internet JC - au9, 7503323 OI - Source: NLM. PMC2911555 [Available on 08/01/11] SB - IM CP - England MH - Aged MH - Aged, 80 and over MH - Angiotensin-Converting Enzyme Inhibitors/ct [Contraindications] MH - Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use] MH - Anti-Inflammatory Agents, Non-Steroidal/ct [Contraindications] MH - Anti-Inflammatory Agents, Non-Steroidal/tu [Therapeutic Use] MH - Anticoagulants/ct [Contraindications] MH - Anticoagulants/tu [Therapeutic Use] MH - Antifungal Agents/ct [Contraindications] MH - Antifungal Agents/tu [Therapeutic Use] MH - Antipsychotic Agents/ct [Contraindications] MH - Antipsychotic Agents/tu [Therapeutic Use] MH - Australia MH - Calcium Channel Blockers/ct [Contraindications] MH - Calcium Channel Blockers/tu [Therapeutic Use] MH - Cyclosporins/ct [Contraindications] MH - Cyclosporins/tu [Therapeutic Use] MH - *Drug Interactions MH - *Drug Therapy, Combination/ae [Adverse Effects] MH - Drug Utilization/sn [Statistics & Numerical Data] MH - Enzyme Inhibitors/ct [Contraindications] MH - Enzyme Inhibitors/tu [Therapeutic Use] MH - Female MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/ct [Contraindications] MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use] MH - Immunosuppressive Agents/ct [Contraindications] MH - Immunosuppressive Agents/tu [Therapeutic Use] MH - Male MH - Serotonin Uptake Inhibitors/ct [Contraindications] MH - Serotonin Uptake Inhibitors/tu [Therapeutic Use] MH - *Veterans AB - WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Up to 21% of adverse drug event related hospital admissions are due to drug interactions. Clinical significance of drug interactions varies. * Studies which only identified drug interactions of potentially major clinical significance found lower prevalence, of between 2 and 16%. * Prevalence of drug interactions defined 'potentially hazardous' has had limited study, with no publications identified for the Australian population. WHAT THIS STUDY ADDS * In the study population of 287 074, 1.5% of subjects were dispensed potentially hazardous interacting drug pairs. * However, limited to populations on specific medicines, it was found that for patients dispensed verapamil, methotrexate, amiodarone, lithium, warfarin, cyclosporin and itraconazole, potentially hazardous interactions occurred at a rate greater than 5%. * These patients should be the focus of medication review programmes to avoid potentially serious adverse drug events. BACKGROUND Up to 21% of adverse drug event-related hospital admissions are due to drug interactions. Clinical significance of drug interactions varies, and drug interactions defined 'potentially hazardous' are more likely to contribute to morbidity and mortality. AIM The aim of this study was to assess the prevalence of potentially hazardous drug interactions in an elderly Australian veteran population. METHODS This study assessed the prevalence of potentially hazardous drug interactions, where hazardous was defined in three or more international drug interaction references, using Repatriation Pharmaceutical Benefits Scheme pharmacy claims data. Analysis was limited to patients who received regular concurrent dispensings of potentially hazardous interacting medicines. RESULTS Of the 287 074 subjects included in the study, 1.5% were dispensed potentially hazardous interacting drug pairs. For patients dispensed cyclosporin, concomitant use of a statin was common (47%); as was statin use with those dispensed itraconazole (31%). Of those dispensed methotrexate, 24% also received a non-steroidal anti-inflammatory drug; of those on lithium, 18% also received an ACE inhibitor or angiotensin 2 receptor blocker; of those on warfarin, 7.2% and 5.9% were co-dispensed an non-steroidal anti-inflammatory drugs or antiplatelets respectively; for those on verapamil, 5.3% were co-dispensed a beta-blocker, while for those on amiodarone 6.2% were co-dispensed digoxin. CONCLUSIONS Overall prevalence of potentially serious drug interactions appears to be low in the Australian veteran population. However, patients taking cyclosporine, itraconazole, methotrexate, lithium, warfarin, verapamil and amiodarone appear to be most at risk and their medicine use should be regularly reviewed to prevent potentially hazardous drug interactions. RN - 0 (Angiotensin-Converting Enzyme Inhibitors) RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (Anticoagulants) RN - 0 (Antifungal Agents) RN - 0 (Antipsychotic Agents) RN - 0 (Calcium Channel Blockers) RN - 0 (Cyclosporins) RN - 0 (Enzyme Inhibitors) RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Immunosuppressive Agents) RN - 0 (Serotonin Uptake Inhibitors) ES - 1365-2125 IL - 0306-5251 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English DP - 2010 Aug DC - 20100726 YR - 2010 ED - 20110105 UP - 20110106 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20653678 <23> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21046863 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Walsh EK AU - Cussen K FA - Walsh, E K FA - Cussen, K IN - General Practice Training Unit, Waterford Regional Hospital, Dunmore Rd, Waterford. elbreathnach@hotmail.com TI - "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly. SO - Irish Medical Journal. 103(8):236-8, 2010 Sep. AS - Ir Med J. 103(8):236-8, 2010 Sep. NJ - Irish medical journal PI - Journal available in: Print Citation processed from: Print JC - gxd, 0430275 SB - IM CP - Ireland MH - Aged MH - Humans MH - *Medication Reconciliation MH - *Polypharmacy MH - Prospective Studies AB - Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction. IS - 0332-3102 IL - 0332-3102 PT - Journal Article PT - Randomized Controlled Trial LG - English DP - 2010 Sep DC - 20101104 YR - 2010 ED - 20101223 UP - 20101227 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=21046863 <24> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21069119 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bryant L AU - Coster G AU - McCormick R FA - Bryant, Linda FA - Coster, Gregor FA - McCormick, Ross IN - Department of General Practice and Primary Health Care, The University of Auckland, PB 92019 Auckland, New Zealand. linda@cpsl.biz TI - Community pharmacist perceptions of clinical medication reviews. SO - Journal of Primary Health Care. 2(3):234-42, 2010 Sep. AS - J Prim Health Care. 2(3):234-42, 2010 Sep. NJ - Journal of primary health care PI - Journal available in: Electronic Citation processed from: Print JC - 101524060 SB - IM CP - New Zealand MH - Adult MH - *Attitude of Health Personnel MH - *Community Pharmacy Services MH - Drug Utilization Review MH - Female MH - General Practitioners MH - Humans MH - *Interprofessional Relations MH - Interviews as Topic MH - Male MH - Middle Aged MH - *Pharmacists MH - *Professional Role AB - INTRODUCTION: Changes in delivery of health care services has led to pressure for community pharmacists to extend their traditional role and become more involved with patient-focussed services such as medication reviews, in collaboration with general practitioners (GPs). This has not been generally implemented into routine practice, and many barriers have been suggested that inhibit community pharmacists extending their role. These have often focussed on physical or functional barriers. This study explores possible attitudinal factors that prevent increased participation of community pharmacists in medication reviews undertaken in collaboration with GPs. METHODS: Twenty community pharmacist participants who participated in the General Practitioner-Pharmacist Collaboration (GPPC) study were interviewed. The GPPC study investigated the outcomes of community pharmacists undertaking a clinical medication review in collaboration with GPs, and the potential barriers. Semi-structured interviews were analysed using a general inductive thematic approach. FINDINGS: Emerging themes were that community pharmacists perceived that they were not mandated to undertake this role, it was not a legitimate role, particularly from the business perceptive, and pharmacists were concerned that they lacked the skills and confidence to provide this level of input. CONCLUSION: While there is concern that community pharmacists' skills are underutilised, there are probable attitudinal barriers inhibiting pharmacists from increasing their role in clinical medication reviews. Perceived legitimacy of the service was a dominant theme, which appeared to be related to issues in the business model. Further investigation should consider the use of a clinical pharmacist working within a general practice independent of a community pharmacy. IS - 1172-6164 IL - 1172-6156 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100901 DP - 2010 Sep DC - 20101111 YR - 2010 ED - 20101213 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=21069119 <25> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 21069118 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bryant L AU - Coster G AU - McCormick R FA - Bryant, Linda FA - Coster, Gregor FA - McCormick, Ross IN - Department of General Practice and Primary Health Care, The University of Auckland, PB 92019 Auckland, New Zealand. linda@cpsl.biz TI - General practitioner perceptions of clinical medication reviews undertaken by community pharmacists. SO - Journal of Primary Health Care. 2(3):225-33, 2010 Sep. AS - J Prim Health Care. 2(3):225-33, 2010 Sep. NJ - Journal of primary health care PI - Journal available in: Electronic Citation processed from: Print JC - 101524060 SB - IM CP - New Zealand MH - Adult MH - *Attitude of Health Personnel MH - *Community Pharmacy Services MH - *Drug Utilization Review MH - Female MH - *General Practitioners MH - Humans MH - *Interprofessional Relations MH - Interviews as Topic MH - Male MH - Middle Aged MH - *Professional Role AB - INTRODUCTION: Delivery of current health care services focuses on interdisciplinary teams and greater involvement of health care providers such as nurses and pharmacists. This requires a change in role perception and acceptance, usually with some resistance to changes. There are few studies investigating the perceptions of general practitioners (GPs) towards community pharmacists increasing their participation in roles such as clinical medication reviews. There is an expectation that these roles may be perceived as crossing a clinical boundary between the work of the GP and that of a pharmacist. METHODS: Thirty-eight GPs who participated in the General Practitioner-Pharmacists Collaboration (GPPC) study in New Zealand were interviewed at the study conclusion. The GPPC study investigated outcomes of a community pharmacist undertaking a clinical medication review in collaboration with a GP, and potential barriers. The GPs were exposed to one of 20 study pharmacists. The semi-structured interviews were recorded and transcribed verbatim then analysed using a general inductive thematic approach. FINDINGS: The GP balanced two themes, patient outcomes and resource utilisation, which determined the over-arching theme, value. This concept was a continuum, depending on the balance. Factors influencing the theme of patient outcomes included the clinical versus theoretical nature of the pharmacist recommendations. Factors influencing resource utilisation for general practice were primarily time and funding. CONCLUSION: GPs attributed different values to community pharmacists undertaking clinical medication reviews, but this value usually balanced the quality and usefulness of the pharmacist's recommendations with the efficiency of the system in terms of workload and funding. IS - 1172-6164 IL - 1172-6156 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100901 DP - 2010 Sep DC - 20101111 YR - 2010 ED - 20101213 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=21069118 <26> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20866163 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Linton A AU - Bacon TA AU - Trice S AU - Devine J AU - Cottrell L AU - McGinnis TJ AU - McAllister EB FA - Linton, Andrea FA - Bacon, Thomas A FA - Trice, Shana FA - Devine, Joshua FA - Cottrell, Linda FA - McGinnis, Thomas J FA - McAllister, Everett B IN - Department of Defense Pharmacy Outcomes Research Team, Falls Church, Virginia, USA. andrea.linton@wowway.com TI - Results from a mailed promotion of medication reviews among Department of Defense beneficiaries receiving 10 or more chronic medications. SO - Journal of Managed Care Pharmacy. 16(8):578-92, 2010 Oct. AS - J Manage Care Pharm. 16(8):578-92, 2010 Oct. NJ - Journal of managed care pharmacy : JMCP PI - Journal available in: Print Citation processed from: Print JC - 9605854 SB - IM CP - United States MH - Age Factors MH - Aged MH - Catchment Area (Health) MH - Data Interpretation, Statistical MH - Drug Prescriptions MH - *Drug Therapy/mt [Methods] MH - Female MH - Humans MH - Individualized Medicine MH - Male MH - Medical Records MH - *Medication Therapy Management MH - Middle Aged MH - Military Personnel MH - North Carolina MH - Outcome Assessment (Health Care) MH - Patient Acceptance of Health Care MH - *Patient Education as Topic/mt [Methods] MH - Pharmacists MH - Polypharmacy MH - Postal Service MH - Sex Factors MH - United States MH - United States Department of Defense AB - BACKGROUND: Like many payers, the Department of Defense (DoD) has limited ability to work directly with prescribers to ensure appropriate medication use. Many older beneficiaries are prescribed multiple maintenance medications, placing them at higher risk for adverse drug interactions, contraindicated medication use, and other polypharmacy-related problems. Medication reviews may mitigate these risks, but the optimal venue for medication therapy management is unclear. OBJECTIVES: To (a) determine if beneficiaries will respond to a mailed request from the DoD to pursue a medication review; (b) identify medication review location and outcomes from the patient perspective; and (c) assess the statistical significance of changes in the number of prescription medications overall and for key categories, including maintenance medications and contraindicated medications, relative to a propensity-matched comparison group. METHODS: A total of 4,000 TRICARE beneficiaries aged 55 years or older, residing in North Carolina, who obtained 10 or more maintenance medications (defined by a unique combination of drug, strength, and dosage form) during the 90-day baseline period from May 3, 2008, to July 31, 2008, were mailed letters requesting their participation in the study. Consenting subjects received a personalized medication list to review with their physicians or pharmacists and a survey form to complete after the review. Survey results were compared by location of medication review (i.e., physician's office, pharmacy, or both). Changes from the 90-day baseline to 90-day post-intervention period were calculated for prescription utilization measures (total drug count, maintenance drug count, count of Beers list medications, and count of contraindicated drug combinations) for the subsample of subjects who completed the survey (n = 373) and for subjects who received the initial consent letter (n = 3,856) versus a propensity-matched comparison sample drawn from neighboring states. Variables included in the propensity score were gender, age group, military rank, catchment status indicating proximity to military pharmacies, enrollment status, number of pharmacy settings used, and each of 30 binary disease indicators. RESULTS: A total of 1,469 subjects responded to the consent letter (response rate = 38.1%); 606 subjects consented to participate (consent rate = 15.7%); and 373 subjects returned a completed survey (completion rate = 9.7%). Among those who completed the survey, 190 (50.9%) received reviews in a physician's office; 103 (27.6%) received reviews in a pharmacy; 60 (16.1%) received reviews in both locations; and 20 (5.4%) reported a different location or no location. 61 survey respondents (16.4%) indicated that they were told to stop a medication, and 77 (20.6%) reported a dosage change. Medication changes occurred significantly more frequently for reviews performed at a physician's office compared with other review locations. Therapeutic classes most frequently stopped or adjusted for dosage were antidiabetics, diuretics, antilipidemics, renin-angiotensin aldosterone system inhibitors, anticoagulants, nonsteroidal anti-inflammatory drugs, and beta-adrenergic blocking agents. 85% of respondents reported that the medication review was worth doing. In the assessments of changes in prescription utilization from the baseline to post-intervention periods, no significant by-group differences were noted among those who completed the study relative to their matched comparison subjects. In the comparison of subjects who received the initial consent letter with their matched counterparts, small but statistically significant differences were observed for several prescription utilization measures, including changes in use of high-risk Beers list medications (P = 0.033); use of electrolytic, caloric, and water balance medications (P = 0.038); and use of hypertension medications (P = 0.028). The magnitude of the decrease observed among comparison subjects, however, exceeded that observed among the case subjects. CONCLUSIONS: Response was poor to a mailing that promoted a beneficiary- initiated medication review. The absence of significant changes following the medication review suggests several possibilities: a mailed intervention is ineffective in promoting medication review; medication regimens for study subjects are already optimized to the extent obtainable through a routine medication review; or the study sample size was too small to detect relevant changes. Most drug regimen changes were dosage adjustments for current medications or substitutions within the same therapeutic class. The extent to which comprehensive assessment of a patient's medication regimen, including nonprescription and herbal agents, was performed is unclear. More intensive interventions may be required to ensure that medication regimens are being actively managed among those who use a large number of prescription medications. IS - 1083-4087 IL - 1083-4087 PT - Journal Article LG - English DP - 2010 Oct DC - 20100927 YR - 2010 ED - 20101210 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20866163 <27> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20727511 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - St Peter WL FA - St Peter, Wendy L IN - University of Minnesota, Minneapolis, USA. WStPeter@cdrg.org TI - Improving medication safety in chronic kidney disease patients on dialysis through medication reconciliation. [Review] SO - Advances in Chronic Kidney Disease. 17(5):413-9, 2010 Sep. AS - Adv Chronic Kidney Dis. 17(5):413-9, 2010 Sep. NJ - Advances in chronic kidney disease PI - Journal available in: Print Citation processed from: Internet JC - 101209214 SB - IM CP - United States MH - Comorbidity MH - Health Records, Personal MH - Humans MH - Kidney Failure, Chronic/ec [Economics] MH - Kidney Failure, Chronic/ep [Epidemiology] MH - *Kidney Failure, Chronic/th [Therapy] MH - Medication Systems, Hospital/og [Organization & Administration] MH - Patient Care Management/og [Organization & Administration] MH - *Patient Care Management MH - Pharmaceutical Services/og [Organization & Administration] MH - Polypharmacy MH - Renal Dialysis/ec [Economics] MH - *Renal Dialysis AB - Patients with chronic kidney disease on dialysis are prescribed an average of 10 to 12 medications. Most hemodialysis patients encounter health care professionals 3 times a week, and peritoneal dialysis patients at least once a quarter; however, medication-related problems continue to be present in large numbers. A significant proportion of medication-related problems in hospitalized dialysis patients have been attributed to a medical information gap that occurs during transitions between healthcare settings. Information regarding the effect of medication reconciliation on the rates of medication-related errors and outcomes of dialysis patients is sparse. Information from hospital-based medication reconciliation programs suggests that dedicated multidisciplinary medication reconciliation teams using electronic or paper-based medication reconciliation tools can work to reduce medication errors and rates of rehospitalization. The dialysis center staff has intimate knowledge of patient medical histories, comorbid conditions, and dialysis-related medications; dialysis center practitioners are known to often prescribe other routine medications for patients undergoing dialysis. Therefore, the dialysis center is the most logical place for carrying out medication reconciliation. Data necessary for medication review and reconciliation, and data on the dialysis team's role in reconciling information after care transitions, have been outlined. Reducing medication errors through a systematic multidisciplinary approach may ultimately reduce hospitalization rates. Adequately powered trials are necessary to demonstrate that medication reconciliation can improve dialysis patient outcomes and cost. 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. ES - 1548-5609 IL - 1548-5595 PT - Journal Article PT - Review LG - English DP - 2010 Sep DC - 20100823 YR - 2010 ED - 20101130 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20727511 <28> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20526741 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Niquille A AU - Bugnon O FA - Niquille, Anne FA - Bugnon, Olivier IN - School of pharmaceutical sciences, University of Geneva, University of Lausanne, Community Pharmacy, Pharmacie de la PMU, 44 Rue du Bugnon, 1011 Lausanne, Switzerland. anne.niquille@hospvd.ch TI - Relationship between drug-related problems and health outcomes: a cross-sectional study among cardiovascular patients. SO - Pharmacy World & Science. 32(4):512-9, 2010 Aug. AS - Pharm World Sci. 32(4):512-9, 2010 Aug. NJ - Pharmacy world & science : PWS PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bo7, 9307352 SB - IM CP - Netherlands MH - Aged MH - *Cardiovascular Diseases/dt [Drug Therapy] MH - Community Pharmacy Services/ec [Economics] MH - *Community Pharmacy Services/og [Organization & Administration] MH - Cross-Sectional Studies MH - *Drug Costs MH - *Drug Utilization Review MH - Female MH - General Practitioners MH - Humans MH - Interprofessional Relations MH - Male MH - Medication Therapy Management/ec [Economics] MH - Middle Aged MH - Outcome Assessment (Health Care) MH - Outpatients MH - Pharmaceutical Preparations/ad [Administration & Dosage] MH - *Pharmaceutical Preparations/ae [Adverse Effects] MH - Pharmaceutical Preparations/ec [Economics] MH - *Pharmacists MH - Quality of Life MH - Switzerland AB - OBJECTIVE: To describe drug-related problems (DRPs) and expense problems (EPs) identified by a standardised community pharmacist-based medication review (MR) program among Swiss cardiovascular outpatients (56-75 years old) and to evaluate the need for collaborative pharmacy practice to achieve economic, clinical and humanistic outcomes. SETTING: A pilot population of 85 cardiovascular outpatients who were customers of 14 community pharmacies (members of the pharmacieplus virtual chain) and insured with Groupe Mutuel health insurance. METHOD: Cross-sectional study of a structured medication review program, conducted by 11 pharmacists in collaboration with 61 general practitioners (GPs), with patient interviews and access to medical data. MAIN OUTCOME MEASURE: Numbers and types of DRPs and EPs within the study population and odds ratios between them, as well as economic, clinical and humanistic outcomes. RESULTS: Of the included patients, 91% had at least one DRP or EP. The odds ratios indicated that not being exposed to DRPs was associated with a higher chance of reaching the clinical target (OR: 3.4; IC95%:1.1-10.5; P = 0.01), of having a better physical quality of life than the median (OR: 2.5; IC95%: 0.9-7.3; P = 0.05) and having lower total health care costs (OR: 3.2; IC95%:1.1-9.8; P = 0.02). CONCLUSIONS: This cross-sectional study shows that the control of cardiovascular risk factors, quality of life and healthcare costs are statistically related to the presence of DRPs detected by a community pharmacist-based MR program. RN - 0 (Pharmaceutical Preparations) ES - 1573-739X IL - 0928-1231 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100605 DP - 2010 Aug DC - 20100810 YR - 2010 ED - 20101122 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20526741 <29> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20059474 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lisby M AU - Thomsen A AU - Nielsen LP AU - Lyhne NM AU - Breum-Leer C AU - Fredberg U AU - Jorgensen H AU - Brock B FA - Lisby, Marianne FA - Thomsen, Anette FA - Nielsen, Lars Peter FA - Lyhne, Nina Munk FA - Breum-Leer, Charlotte FA - Fredberg, Ulrich FA - Jorgensen, Henny FA - Brock, Birgitte IN - Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus Sygehus, Aarhus, Denmark. ml@farm.au.dk TI - The effect of systematic medication review in elderly patients admitted to an acute ward of internal medicine. SO - Basic & Clinical Pharmacology & Toxicology. 106(5):422-7, 2010 May. AS - Basic Clin Pharmacol Toxicol. 106(5):422-7, 2010 May. NJ - Basic & clinical pharmacology & toxicology PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 101208422 SB - IM CP - Denmark MH - Aged MH - Denmark MH - Drug Interactions MH - Humans MH - Length of Stay MH - *Medication Errors/pc [Prevention & Control] MH - *Medication Therapy Management MH - Patient Care MH - Pharmacists MH - Pharmacology, Clinical MH - Physicians MH - Polypharmacy MH - Primary Health Care AB - Elderly patients are vulnerable to medication errors and adverse drug events due to increased morbidity, polypharmacy and inappropriate interactions. The objective of this study was to investigate whether systematic medication review and counselling performed by a clinical pharmacist and clinical pharmacologist would reduce length of in-hospital stay in elderly patients admitted to an acute ward of internal medicine. A randomized, controlled study of 100 patients aged 70 years or older was conducted in an acute ward of internal medicine in Denmark. Intervention arm: a clinical pharmacist conducted systematic medication reviews after an experienced medical physician had prescribed the patients' medication. Information was collected from medical charts, interview with the patients and database registrations of drug purchase. Subsequently, medication histories were conferred with a clinical pharmacologist and advisory notes recommending medication changes were completed. Physicians were not obliged to comply with the recommendations. Control arm: medication was reviewed by usual routine in the ward. Primary end-point was length of in-hospital stay. In addition, readmissions, mortality, contact to primary healthcare and quality of life were measured at 3-month follow-up. In the intervention arm, the mean length of in-hospital stay was 239.9 hr (95% CI: 190.2-289.6) and in the control arm: 238.6 hr (95% CI: 137.6-339.6), which was neither a statistical significant nor a clinically relevant difference. Moreover, no differences were observed for any of the secondary end-points. Systematic medication review and medication counselling did not show any effect on in-hospital length of stay in elderly patients when admitted to an acute ward of internal medicine. ES - 1742-7843 IL - 1742-7835 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't LG - English EP - 20100103 DP - 2010 May DC - 20100607 YR - 2010 ED - 20101122 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20059474 <30> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19826745 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Gisev N AU - Bell JS AU - O'Reilly CL AU - Rosen A AU - Chen TF FA - Gisev, Natasa FA - Bell, J Simon FA - O'Reilly, Claire L FA - Rosen, Alan FA - Chen, Timothy F IN - Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia. TI - An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. SO - Social Psychiatry & Psychiatric Epidemiology. 45(11):1071-9, 2010 Nov. AS - Soc Psychiatry Psychiatr Epidemiol. 45(11):1071-9, 2010 Nov. NJ - Social psychiatry and psychiatric epidemiology PI - Journal available in: Print-Electronic Citation processed from: Internet JC - uvp, 8804358 SB - IM CP - Germany MH - Australia MH - Community Mental Health Centers/st [Standards] MH - *Community Mental Health Centers/sn [Statistics & Numerical Data] MH - Community Pharmacy Services/og [Organization & Administration] MH - *Community Pharmacy Services/st [Standards] MH - Drug Utilization Review/mt [Methods] MH - *Drug Utilization Review/sn [Statistics & Numerical Data] MH - Expert Testimony/mt [Methods] MH - Female MH - Humans MH - Male MH - Medication Therapy Management/og [Organization & Administration] MH - Medication Therapy Management/st [Standards] MH - Medication Therapy Management/sn [Statistics & Numerical Data] MH - *Mental Disorders/dt [Drug Therapy] MH - Middle Aged MH - Pharmacists/px [Psychology] MH - *Pharmacists/sn [Statistics & Numerical Data] MH - Psychotropic Drugs/ae [Adverse Effects] MH - *Psychotropic Drugs/tu [Therapeutic Use] AB - BACKGROUND: Few studies have investigated strategies to identify and resolve drug-related problems among clients of community mental health teams (CMHTs). OBJECTIVE: The objective of this study was to evaluate the clinical impact and appropriateness of comprehensive medication reviews for clients of CMHTs. METHODS: Trained pharmacists conducted interviews (30-45 min each) with clients of CMHTs to identify actual and potential drug-related problems. The pharmacists prepared medication review reports that detailed their findings and recommendations to optimize drug therapy. An expert panel comprising a psychiatrist, general medical practitioner, mental health pharmacist and medication review pharmacist evaluated reviews for 48 clients of 5 CMHTs. Panelists independently assessed review findings, review recommendations, likelihood of recommendation implementation and the overall expected clinical impact. RESULTS: Two hundred and nine medication review findings and 208 medication review recommendations were evaluated. Panelists agreed with 76% of findings and considered that 81% of recommendations were appropriate. Collectively, 69% of recommendations were considered likely to be implemented. Thirty-seven (77%) reviews were deemed potentially to have a positive clinical impact. The agreement between panelists was statistically significant (P < 0.01) for the assessment of the findings, recommendations and likelihood of recommendation implementation. CONCLUSIONS: Pharmacists' findings and recommendations to optimize drug therapy were considered appropriate and likely to result in improved clinical outcomes. Comprehensive medication reviews may be a valuable strategy to identify and resolve drug-related problems among clients of CMHTs. RN - 0 (Psychotropic Drugs) ES - 1433-9285 IL - 0933-7954 PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20091015 DP - 2010 Nov DC - 20101018 YR - 2010 ED - 20101101 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19826745 <31> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20624609 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Marcum ZA AU - Handler SM AU - Wright R AU - Hanlon JT FA - Marcum, Zachary A FA - Handler, Steven M FA - Wright, Rollin FA - Hanlon, Joseph T IN - Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. TI - Interventions to improve suboptimal prescribing in nursing homes: A narrative review. [Review] [41 refs] SO - American Journal of Geriatric Pharmacotherapy. 8(3):183-200, 2010 Jun. AS - Am J Geriatr Pharmacother. 8(3):183-200, 2010 Jun. NJ - The American journal of geriatric pharmacotherapy PI - Journal available in: Print Citation processed from: Internet JC - 101190325 OI - Source: NLM. NIHMS222132 OI - Source: NLM. PMC2925103 SB - IM CP - United States MH - Aged MH - Homes for the Aged/og [Organization & Administration] MH - Homes for the Aged/sn [Statistics & Numerical Data] MH - Humans MH - Intervention Studies MH - *Nursing Homes/og [Organization & Administration] MH - Nursing Homes/sn [Statistics & Numerical Data] MH - Pharmaceutical Preparations/ad [Administration & Dosage] MH - Pharmaceutical Preparations/ae [Adverse Effects] MH - *Physician's Practice Patterns/st [Standards] MH - *Quality Assurance, Health Care/mt [Methods] MH - Randomized Controlled Trials as Topic AB - BACKGROUND: Appropriate medication prescribing for nursing home residents remains a challenge. OBJECTIVE: The purpose of this study was to conduct a narrative review of the published literature describing randomized controlled trials that used interventions to improve suboptimal prescribing in nursing homes. METHODS: The PubMed, International Pharmaceutical Abstracts, and EMBASE databases were searched for articles published in the English language between January 1975 and December 2009, using the terms drug utilization, pharmaceutical services, aged, long-term care, nursing homes, prescribing, geriatrics, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors' files, book chapters, and recent review articles was also conducted. Abstracts and posters from meetings were not included in the search. Studies were included if they: (1) had a randomized controlled design; (2) had a process measure outcome for quality of prescribing or a distal outcome measure for medication-related adverse patient events; and (3) involved nursing home residents. RESULTS: Eighteen studies met the inclusion criteria for this review. Seven of those studies described educational approaches using various interventions (eg, outreach visits) and measured suboptimal prescribing in different manners (eg, adherence to guidelines). Two studies described computerized decision-support systems to measure the intervention's impact on adverse drug events (ADEs) and appropriate drug orders. Five studies described clinical pharmacist activities, most commonly involving a medication review, and used various measures of suboptimal prescribing, including a measure of medication appropriateness and the total number of medications prescribed. Two studies each described multidisciplinary and multifaceted approaches that included heterogeneous interventions and measures of prescribing. Most (15/18; 83.3%) of these studies reported statistically significant improvements in >or=1 aspect of suboptimal prescribing. Only 3 of the studies reported significant improvements in distal health outcomes, and only 3 measured ADEs or adverse drug reactions. CONCLUSIONs: Mixed results were reported for a variety of approaches used to improve suboptimal prescribing. However, the heterogeneity of the study interventions and the various measures of suboptimal prescribing used in these studies does not allow for an authoritative conclusion based on the currently available literature. Copyright 2010 Excerpta Medica Inc. All rights reserved. [References: 41] RN - 0 (Pharmaceutical Preparations) ES - 1876-7761 IL - 1876-7761 PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Research Support, U.S. Gov't, P.H.S. PT - Review NO - K07AG033174 (United States NIA NIH HHS) NO - K12 RR023267 (United States NCRR NIH HHS) NO - P30AG024827 (United States NIA NIH HHS) NO - R01 HS017695 (United States AHRQ HHS) NO - R01 NR010135 (United States NINR NIH HHS) NO - R01AG027017 (United States NIA NIH HHS) NO - R01AG034056 (United States NIA NIH HHS) NO - R34 MH082682 (United States NIMH NIH HHS) NO - T32 AG021885-07 (United States NIA NIH HHS) NO - T32AG021885 (United States NIA NIH HHS) LG - English DP - 2010 Jun DC - 20100713 YR - 2010 ED - 20100810 RD - 20100930 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20624609 <32> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20601348 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Guirguis K FA - Guirguis, Kyrillos IN - Outreach Medication Review (OMR) program, St. Vincent's Hospital, Fitzroy, Victoria, Australia. kyrillos.guirguis@svhm.org.au TI - The use of nonprescription medicines among elderly patients with chronic illness and their need for pharmacist interventions. SO - Consultant Pharmacist. 25(7):433-9, 2010 Jul. AS - Consult Pharm. 25(7):433-9, 2010 Jul. NJ - The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists PI - Journal available in: Print Citation processed from: Print JC - 9013983 SB - IM CP - United States MH - Aged MH - Aged, 80 and over MH - Chronic Disease MH - Cohort Studies MH - Complementary Therapies/ae [Adverse Effects] MH - *Complementary Therapies/mt [Methods] MH - Dose-Response Relationship, Drug MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Middle Aged MH - Nonprescription Drugs/ad [Administration & Dosage] MH - Nonprescription Drugs/ae [Adverse Effects] MH - *Nonprescription Drugs/tu [Therapeutic Use] MH - Patient Education as Topic/mt [Methods] MH - *Pharmaceutical Services/og [Organization & Administration] MH - *Pharmacists/og [Organization & Administration] MH - Professional Role MH - Retrospective Studies MH - Self Medication/ae [Adverse Effects] MH - Sex Factors AB - OBJECTIVE: The use of over-the-counter (OTC) products and complementary medicines (CM) often results in adverse events. Little is known about the type of pharmacist interventions needed by elderly patients to optimize their use of such products. This study examines the prevalence of OTC/CM products used among chronically ill elderly patients and the types of pharmacist interventions the patients need. Gender differences were also investigated. DESIGN: Retrospective cohort study. SETTING: Homes of 51 patients recruited from a major metropolitan hospital in Melbourne, Australia. PATIENTS: Fifty-one elderly patients with chronic illness referred to the Outreach Medication Review program. INTERVENTION: Pharmacists' interventions to optimize the use of OTC/CM products. MAIN OUTCOME MEASURES: Number of OTC/CM products used and the number and type of pharmacists' interventions. RESULTS: 80.4% of patients were using OTC products, while 21.6% used CM products. Many OTC products were not used at the right dose, requiring pharmacists to adjust the dose in 18.7% of cases. Other patients (18.8%) were unaware of dosing regimens, while about one-third of patients needed to be educated on managing the ailment that required their use of the OTC/CM product in the first place. Men showed a nonsignificant increase in their need for pharmacist interventions. CONCLUSION: Elderly patients in this study used OTC/CM products, often without a proper understanding of the management principles of their condition or the dosing regimens of the products they use. Men may need more pharmacist interventions in relation to their use of OTC/CM products. Pharmacists should offer comprehensive advice on managing presenting ailments and requests for OTC/CM products. RN - 0 (Nonprescription Drugs) IS - 0888-5109 IL - 0888-5109 PT - Journal Article LG - English DP - 2010 Jul DC - 20100705 YR - 2010 ED - 20100826 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20601348 <33> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20571102 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Laaksonen R AU - Duggan C AU - Bates I FA - Laaksonen, Raisa FA - Duggan, Catherine FA - Bates, Ian IN - Pharmacy Practice Group, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK. r.laaksonen@bath.ac.uk TI - Performance of community pharmacists in providing clinical medication reviews. SO - Annals of Pharmacotherapy. 44(7-8):1181-90, 2010 Jul-Aug. AS - Ann Pharmacother. 44(7-8):1181-90, 2010 Jul-Aug. NJ - The Annals of pharmacotherapy PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bbx, 9203131 SB - IM CP - United States MH - Aged MH - *Community Pharmacy Services/og [Organization & Administration] MH - Cross-Sectional Studies MH - England MH - Female MH - Humans MH - Male MH - *Medication Therapy Management/og [Organization & Administration] MH - Patient Care Planning/og [Organization & Administration] MH - Pharmaceutical Preparations/ad [Administration & Dosage] MH - *Pharmaceutical Preparations/ae [Adverse Effects] MH - *Pharmacists/og [Organization & Administration] MH - Pharmacists/st [Standards] MH - Professional Role MH - Prospective Studies MH - Quality Assurance, Health Care AB - BACKGROUND: Drug-related problems (DRPs) may result in adverse drug reactions causing hospital admissions (5-17%); older patients in particular may experience such reactions during a hospital stay (6-17%). While community pharmacists can identify DRPs through clinical medication reviews, little is known about how well they perform in providing such reviews. OBJECTIVE: To assess trained community pharmacists' performance in writing care plans and referrals when providing clinical medication reviews to elderly patients as part of a patient outcome-focused Medicines Management project. METHODS: In the south of England, 43 community pharmacists were recruited from 80 local community pharmacies; 37 completed clinical pharmacy training to provide medication reviews for elderly patients who were receiving prescriptions for 4 or more medicines from local general practices. Eleven trained pharmacists withdrew and did not provide any reviews. As part of quality assurance, a clinical pharmacist reviewed all care plans and referrals written by the community pharmacists and, if required, amended referrals before they were sent to the patients' family physicians with recommendations. The referrals written by the community pharmacists were compared with those written by the clinical pharmacist and were deemed to be accurate or incomplete (the community pharmacists could provide verbal information to the physicians) if the observations of DRPs and suggestions to solve them were beneficial to patients. Incorrect or missing observations and suggestions were considered nonbeneficial to patients. RESULTS: The performance assessment was based on a sample of 244 referrals written by 20 community pharmacists. The clinical pharmacist identified 908 DRPs and suggested 1489 solutions; the community pharmacists beneficially identified 75% of these DRPs (1% were incorrectly identified and 24% were missed) and suggested 58% of the solutions (6% were incorrectly suggested and 36% were missed). CONCLUSIONS: The community pharmacists beneficially identified most DRPs and suggested many solutions. However, the assessment may underestimate the community pharmacists' abilities, as it relied on the records they kept and was based on a gold standard. While the pharmacists were self-selected, this study provides valuable insight into trained community pharmacists' clinical medication review performance. RN - 0 (Pharmaceutical Preparations) ES - 1542-6270 IL - 1060-0280 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20100622 DP - 2010 Jul-Aug DC - 20100701 YR - 2010 ED - 20101008 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20571102 <34> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20553537 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Westbury J AU - Beld K AU - Jackson S AU - Peterson G FA - Westbury, Juanita FA - Beld, Karin FA - Jackson, Shane FA - Peterson, Gregory IN - Unit for Medication Outcomes, Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia. juanita.westbury@utas.edu.au TI - Review of psychotropic medication in Tasmanian residential aged care facilities. SO - Australasian Journal on Ageing. 29(2):72-6, 2010 Jun. AS - Australas J Ageing. 29(2):72-6, 2010 Jun. NJ - Australasian journal on ageing PI - Journal available in: Print Citation processed from: Internet JC - 9808874 SB - IM CP - Australia MH - Drug Utilization MH - *Homes for the Aged/og [Organization & Administration] MH - Humans MH - *Nursing Homes/og [Organization & Administration] MH - *Psychotropic Drugs/ad [Administration & Dosage] MH - Tasmania AB - AIM: To examine psychotropic medication review practices in residential aged care facilities. METHODS: Psychotropic medicine use data were collected from residents from 40 residential aged care facilities throughout Tasmania. As an indication of review practices, the measure was repeated at 33 of the original facilities a year later. RESULTS: A total of 2389 residents' medication records were examined in 2006. Regular doses of antipsychotics and benzodiazepines were taken by 42% and 21% of residents, respectively. Medication data were available for 1307 of the residents in 2007. Over 60% were taking the same antipsychotic or benzodiazepine agent, at the same dose in 2007, as they were in 2006. Dosage reduction or cessation occurred in less than a quarter of the residents. CONCLUSION: The utilisation of psychotropic medication is high in Tasmanian residential aged care facilities. Attempts to reduce psychotropic doses happen infrequently. Further research is required to establish the barriers to appropriate psychotropic medication review in this setting. RN - 0 (Psychotropic Drugs) ES - 1741-6612 IL - 1440-6381 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English DP - 2010 Jun DC - 20100617 YR - 2010 ED - 20101001 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20553537 <35> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20524710 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Lampela P AU - Hartikainen S AU - Lavikainen P AU - Sulkava R AU - Huupponen R FA - Lampela, Pasi FA - Hartikainen, Sirpa FA - Lavikainen, Piia FA - Sulkava, Raimo FA - Huupponen, Risto IN - Department of Pharmacology and Toxicology, University of Kuopio, Kuopio, Finland. Pasi.Lampela@uku.fi TI - Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. SO - Drugs & Aging. 27(6):507-21, 2010 Jun 1. AS - Drugs Aging. 27(6):507-21, 2010 Jun 1. NJ - Drugs & aging PI - Journal available in: Print Citation processed from: Internet JC - bek, 9102074 SB - IM CP - New Zealand MH - Aged MH - Aged, 80 and over MH - Drug Interactions MH - Drug Prescriptions MH - *Drug Therapy MH - Drug Toxicity MH - *Drug Utilization Review/mt [Methods] MH - Finland MH - *Geriatric Assessment/mt [Methods] MH - Humans MH - Intervention Studies MH - Interviews as Topic MH - Medical Records MH - Outpatients MH - Polypharmacy AB - High drug consumption among the elderly and inappropriate prescribing practices increase the risk of adverse drug effects in this population. This risk may be decreased by conducting, for example, a medication review alone or as part of a comprehensive geriatric assessment (CGA); however, little is known about the fate of the changes in medication made as a result of the CGA or medication review. To study the performance of the CGA with regards to medication changes and to determine the persistence of these changes over a 1-year period. This study was a population-based intervention study. A random sample of 1000 elderly (age > or =75 years) was randomized either to a CGA group or to a control group. Home-dwelling patients from these groups (n = 331 and n = 313 for intervention and control groups, respectively) were analysed in this study. Study nurses collected information on medication at study entry and 1 year later in both groups; in the intervention group, study physicians assessed, and changed when appropriate, the medication at study entry. The medication changes and their persistence over 1 year were then evaluated. Medication changes were more frequent in the intervention group than in the control group. Regular medication was changed during follow-up in 277 (83.7%) and in 228 (72.8%) [odds ratio (OR) 1.9; 95% CI 1.3, 2.8] patients in the intervention and control groups, respectively. In the intervention group, study physicians were responsible for 35.4% of all new prescriptions and for 15.6% of all drug terminations. Changes took place particularly in the prescription of CNS drugs. About 58% of the drugs initiated by study physicians were still in use 1 year later, and 25.5% of those terminated by study physicians had been reintroduced. Drug intervention as part of a CGA can be used to rationalize the drug therapy of a patient. However, its effectiveness is subsequently partly counteracted by other physicians working in the healthcare system. IS - 1170-229X IL - 1170-229X DO - http://dx.doi.org/10.2165/11536650-000000000-00000 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't LG - English DP - 2010 Jun 1 DC - 20100607 YR - 2010 ED - 20100816 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20524710 <36> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20498733 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kuhn C AU - Powell PH AU - Sterrett JJ FA - Kuhn, Catherine FA - Powell, Patricia H FA - Sterrett, James J IN - South Carolina College of Pharmacy, Charleston, SC, USA. TI - Elective course on medication therapy management services. SO - American Journal of Pharmaceutical Education. 74(3):40, 2010 Apr 12. AS - Am J Pharm Educ. 74(3):40, 2010 Apr 12. NJ - American journal of pharmaceutical education PI - Journal available in: Print Citation processed from: Internet JC - 0372650, 3r9 OI - Source: NLM. PMC2865406 SB - IM CP - United States MH - Clinical Competence MH - *Directive Counseling/mt [Methods] MH - *Education, Pharmacy/mt [Methods] MH - Educational Measurement MH - Humans MH - *Medication Therapy Management/ed [Education] MH - *Students, Pharmacy/px [Psychology] AB - OBJECTIVES: To determine the impact of active-learning strategies in a medication therapy management (MTM) elective on pharmacy students' preparedness to participate in real-life MTM counseling sessions. DESIGN: The elective included active-learning assignments such as patient cases, group discussions, role playing, and use of actual patients to prepare students for MTM services. ASSESSMENT: A survey was administered before (week 11) and after (week 15) completing a face-to-face comprehensive medication review (CMR) to evaluate achievement of course objectives and students' preparedness to participate in MTM. In the pre-CMR survey, 66.7% of the students strongly agreed that the course prepared them to provide MTM services. In the post-CMR survey, 88.9% of the students strongly agreed (p = 0.046). CONCLUSION: The active-learning strategies used in the MTM elective course provided students with the skills necessary to participate in MTM counseling sessions. Face-to-face CMRs better prepared pharmacy students to provide MTM services. ES - 1553-6467 IL - 0002-9459 PT - Journal Article LG - English DP - 2010 Apr 12 DC - 20100525 YR - 2010 ED - 20100823 RD - 20100930 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20498733 <37> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19891619 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Salter C FA - Salter, Charlotte IN - School of Medicine, Health Policy and Practice, University of East Anglia, Norwich. c.salter@uea.ac.uk TI - Compliance and concordance during domiciliary medication review involving pharmacists and older people. SO - Sociology of Health & Illness. 32(1):21-36, 2010 Jan. AS - Sociol Health Illn. 32(1):21-36, 2010 Jan. NJ - Sociology of health & illness PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 8205036, 100554340, ut3 SB - IM CP - England MH - Adult MH - Age Factors MH - Aged, 80 and over MH - Anthropology, Cultural MH - Communication MH - *Community Pharmacy Services MH - Directive Counseling MH - Education MH - Female MH - Great Britain MH - Humans MH - Male MH - *Medication Adherence/sn [Statistics & Numerical Data] MH - Patient Education as Topic MH - Patient Satisfaction MH - *Pharmacists MH - *Professional Role MH - *Professional-Patient Relations MH - Qualitative Research AB - Medication review is an advanced service registered pharmacists can now offer patients in the UK. This in-depth study of pharmacist-older patient communication during domiciliary medication review encounters examines how the interactions are constructed by participants and the influence of the compliance paradigm on the interaction. Twenty-nine observed, taped and transcribed consultations were analysed using discourse analysis. Ethnographic-style interviews in the field with pharmacists, follow-up interviews with patients and feedback workshops with pharmacists allowed interpretations to be tested and strengthened. The findings presented here use discourse analysis to look at the task-driven nature of the medication review encounters. The analysis explores the interactional format of three over-lapping phases of the consultations: (i) introductions and agenda setting; (ii) screening and testing patients' ability to comply; and, (iii) investigating over-the-counter medicines. Analysis suggests that a dominant compliance paradigm encourages pharmacist-led encounters with patients failing to engage in the medication review process. Little evidence of two-way reciprocated discussion or concordance was evident. The strategic nature of the discourse of compliance heard in these medication review encounters and its effect on older patients are discussed. The paper concludes with a consideration of the implications for pharmacy practice and policy development. ES - 1467-9566 IL - 0141-9889 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't LG - English EP - 20091104 DP - 2010 Jan DC - 20100426 YR - 2010 ED - 20100817 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19891619 <38> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20173804 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Sankaran S AU - Kenealy T AU - Adair A AU - Adair V AU - Coster H AU - Whitehead N AU - Sheridan N AU - Parsons M AU - Marshall E AU - Bailey L AU - Price C AU - Crombie D AU - Rea H FA - Sankaran, Shankar FA - Kenealy, Tim FA - Adair, Allan FA - Adair, Vivienne FA - Coster, Heather FA - Whitehead, Noeline FA - Sheridan, Nicolette FA - Parsons, Matthew FA - Marshall, Elaine FA - Bailey, Leslie FA - Price, Catherine FA - Crombie, Dwayne FA - Rea, Harry IN - Counties Manukau District Heath Board, South Auckland, New Zealand. TI - A complex intervention to support 'rest home' care: a pilot study. CM - Comment in: N Z Med J. 2010 Jan 29;123(1308):13-5; PMID: 20173801 SO - New Zealand Medical Journal. 123(1308):41-53, 2010 Jan 29. AS - N Z Med J. 123(1308):41-53, 2010 Jan 29. NJ - The New Zealand medical journal PI - Journal available in: Electronic Citation processed from: Internet JC - obq, 0401067 SB - IM CP - New Zealand MH - Advance Care Planning MH - Aged MH - Aged, 80 and over MH - Community Health Services/mt [Methods] MH - Drug Utilization Review/mt [Methods] MH - Education, Nursing, Continuing/mt [Methods] MH - Geriatrics/mt [Methods] MH - *Health Care Reform/mt [Methods] MH - *Homes for the Aged/og [Organization & Administration] MH - Hotlines MH - Humans MH - New Zealand MH - Patient Admission/sn [Statistics & Numerical Data] MH - Patient Care Team MH - Pilot Projects MH - *Program Evaluation/mt [Methods] AB - AIMS: To describe an intervention supporting Aged Related Residential Care (ARRC) and to report an initial evaluation. METHODS: The intervention consisted of: medication review by a multidisciplinary team; education programmes for nurses; telephone advice 'hotlines' for nursing and medical staff; Advance Care Planning; and implementing existing community programmes for chronic care management and preventing acute hospital admissions. Semi-structured interviews were conducted with members of the multidisciplinary team, rest home nurses and caregivers. Quantitative data were collected on medication changes, hotline use, use of education opportunities and admissions to hospital. RESULTS: Medications were reduced by 21%. Staff noted improvements in the physical and mental state of residents. There was no significant reduction in hospital admissions. Nurses were unable to attend the education offered to them, but it was taken up and valued by caregivers. There was minimal uptake of formal acute and chronic care programmes and Advance Care Planning during the intervention. Hotlines were welcomed and used regularly by the nurses, but not the GP. CONCLUSIONS: The provision of high status specialist support on site was enthusiastically welcomed by ARRC staff. The interventions continue to evolve due to limited uptake or success of some components in the pilot. ES - 1175-8716 IL - 0028-8446 PT - Journal Article LG - English EP - 20100129 DP - 2010 Jan 29 DC - 20100222 YR - 2010 ED - 20100312 RD - 20101022 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20173804 <39> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20064272 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Williams AF AU - Manias E AU - Walker RG FA - Williams, Allison F FA - Manias, Elizabeth FA - Walker, Rowan G IN - Melbourne School of Health Sciences, The University of Melbourne, Level 5, 234 Queensberry Street, Carlton, Australia 3053. afw@unimelb.edu.au TI - The devil is in the detail - a multifactorial intervention to reduce blood pressure in co-existing diabetes and chronic kidney disease: a single blind, randomized controlled trial. SO - BMC Family Practice. 11:3, 2010. AS - BMC Fam Pract. 11:3, 2010. NJ - BMC family practice PI - Journal available in: Electronic Citation processed from: Internet JC - 100967792 OI - Source: NLM. PMC2817677 SB - IM CP - England MH - Adult MH - Comorbidity MH - *Diabetes Complications/dt [Drug Therapy] MH - *Disease Management MH - Female MH - Health Behavior MH - Humans MH - Hypertension/co [Complications] MH - *Hypertension/dt [Drug Therapy] MH - *Kidney Diseases/co [Complications] MH - Male MH - Outcome Assessment (Health Care) MH - Patient Care Team MH - *Patient Compliance MH - Self Care MH - Single-Blind Method AB - BACKGROUND: About 30-60% of individuals are non-adherent to their prescribed medications and this risk increases as the number of prescribed medications increases. This paper outlines the development of a consumer-centred Medicine Self-Management Intervention (MESMI), designed to improve blood pressure control and medication adherence in consumers with diabetes and chronic kidney disease recruited from specialist outpatients' clinics. METHODS: We developed a multifactorial intervention consisting of Self Blood Pressure Monitoring (SBPM), medication review, a twenty-minute interactive Digital Versatile Disc (DVD), and follow-up support telephone calls to help consumers improve their blood pressure control and take their medications as prescribed. The intervention is novel in that it has been developed from analysis of consumer and health professional views, and includes consumer video exemplars in the DVD. The primary outcome measure was a drop of 3-6 mmHg systolic blood pressure at three months after completion of the intervention. Secondary outcome measures included: assessment of medication adherence, medication self-efficacy and general wellbeing. Consumers' adherence to their prescribed medications was measured by manual pill count, self-report of medication adherence, and surrogate biochemical markers of disease control. DISCUSSION: The management of complex health problems is an increasing component of health care practice, and requires interventions that improve patient outcomes. We describe the preparatory work and baseline data of a single blind, randomized controlled trial involving consumers requiring cross-specialty care with a follow-up period extending to 12 months post-baseline. TRIAL REGISTRATION: The trial was registered with the Australian and New Zealand Clinical Trials Register (ACTRN12607000044426). ES - 1471-2296 IL - 1471-2296 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't LG - English EP - 20100112 DP - 2010 DC - 20100210 YR - 2010 ED - 20100408 RD - 20100927 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20064272 <40> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20012362 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Roten I AU - Marty S AU - Beney J FA - Roten, Isabelle FA - Marty, Stefan FA - Beney, Johnny IN - Pharmacie des Hopitaux du Nord Vaudois et de la Broye, Entremonts 11, 1400, Yverdon-les-Bains, Switzerland. isabelle.roten@phnvb.ch TI - Electronic screening of medical records to detect inpatients at risk of drug-related problems. SO - Pharmacy World & Science. 32(1):103-7, 2010 Feb. AS - Pharm World Sci. 32(1):103-7, 2010 Feb. NJ - Pharmacy world & science : PWS PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bo7, 9307352 SB - IM CP - Netherlands MH - Drug Monitoring/mt [Methods] MH - Drug Therapy MH - *Drug Toxicity/pc [Prevention & Control] MH - Drug Utilization Review MH - *Electronic Health Records/sn [Statistics & Numerical Data] MH - Humans MH - Inpatients/sn [Statistics & Numerical Data] MH - Medical Records Systems, Computerized MH - Pharmacists MH - Pharmacy Service, Hospital MH - Risk Factors MH - Sensitivity and Specificity AB - OBJECTIVE: The objective of the study is to develop and validate a screening tool for clinical pharmacists (CPs), comprising electronic queries (EQs) structured to identify inpatients at risk of drug-related problems (DRPs) [1]. SETTING: Internal Medicine and Geriatric Units of the (multi-site) Hopital du Valais. METHOD: EQs, identifying patients with potential DRPs and/or those requiring a medication review were compared with a CP-conducted manual check of all electronic medical records (EMRs), during their standard activities. The queries were aimed at identifying patients receiving drugs such as cytochrome P450 inducers, inhibitors or high-risk medications, those with renal impairment, those on digoxin with low serum potassium, those with intravenous (i.v.) anti-infectives or i.v. acetaminophen for more than 3 days, and elderly patients with polymedication (>or=80 years and >10 drugs). MAIN OUTCOME MEASURE: Sensitivity and specificity of the screening tool. RESULTS: Five hundred and one patients seen by 4 CPs during 36 ward rounds were screened. The EQs identified 64.7% of the visited inpatients. The CPs detected at least one DRP in 64.9% of all patients. A sensitivity of 85.1% and a specificity of 60.4% were achieved. CONCLUSION: This tool allows for efficient and rapid screening of patients at risk of DRPs in preparation for the ward round. It helps CPs to prioritize their medication reviews and to optimize their workload. ES - 1573-739X IL - 0928-1231 PT - Journal Article PT - Validation Studies LG - English EP - 20091210 DP - 2010 Feb DC - 20100121 YR - 2010 ED - 20100413 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20012362 <41> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19823939 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Guirguis K FA - Guirguis, Kyrillos IN - Outreach Medication Review (OMR) Program, St. Vincent's Hospital, P.O. Box 2900, Fitzroy, VIC, 3065, Australia. kyrillos.guirguis@svhm.org.au TI - Medications collected for disposal by outreach pharmacists in Australia. SO - Pharmacy World & Science. 32(1):52-8, 2010 Feb. AS - Pharm World Sci. 32(1):52-8, 2010 Feb. NJ - Pharmacy world & science : PWS PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bo7, 9307352 SB - IM CP - Netherlands MH - Aged MH - Aged, 80 and over MH - Australia MH - *Community-Institutional Relations MH - Fees, Pharmaceutical/sn [Statistics & Numerical Data] MH - Financing, Government/ec [Economics] MH - Humans MH - Pharmaceutical Preparations/ec [Economics] MH - *Pharmaceutical Preparations MH - *Pharmacists MH - Pharmacy Service, Hospital MH - Poverty MH - Waste Products/ae [Adverse Effects] MH - Waste Products/ec [Economics] MH - *Waste Products AB - OBJECTIVE: To examine the types, quantities, and monetary value of drugs which are disposed of by patients of outreach pharmacists, and to describe the role of outreach pharmacists in promoting the safe disposal of drug waste and reducing medication cost. SETTING: An Outreach Medication Review service at a major public hospital in Melbourne, Australia. METHODS: Part of the service offered by outreach pharmacists in OMR at St Vincent's Hospital Melbourne is to collect the medications that have expired, or are no longer needed by patients. This audit looked at all the items collected over a period of 2 months, July and August of 2008. We recorded the types of medication groups and the number of items in each of these groups. An estimate of the value of this medicinal waste was also made. MAIN OUTCOME MEASURE: Measurable parameters were the number of medications collected in the various therapeutic groups, and an estimate of their monetary value. This served to provide an estimate of the total value of wasted medications. RESULTS: Medications collected fell into 11 therapeutic groups, with a total of 293 items collected. The largest number of medications belonged to the cardiovascular group. The number of patients seen was 40 patients, with each patient having an average of 7.3 items that are either expired or unnecessary. The estimated value of medicinal waste per patient is about AU$1308 annually. CONCLUSION: Outreach pharmacists are in a good position to collect unnecessary medications, and to educate patients on the prudent use of government subsidy of medications. The economic ramification of medication disposal is significant, in terms of the cost of medications that end up not being used. Cardiovascular medications are the main group that end up being wasted, and is among the most expensive to subsidize. Further studies are needed to examine ways of minimising medication waste and reducing the cost of such wastage. RN - 0 (Pharmaceutical Preparations) RN - 0 (Waste Products) ES - 1573-739X IL - 0928-1231 PT - Journal Article LG - English EP - 20091013 DP - 2010 Feb DC - 20100121 YR - 2010 ED - 20100413 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19823939 <42> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19995493 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - RESPECT trial team FA - RESPECT trial team IR - Richmond S IR - Morton V IR - Cross B IR - Wong IC IR - Russell I IR - Philips Z IR - Miles J IR - Hilton A IR - Hill G IR - Farrin A IR - Coulton S IR - Chrystyn H IR - Campton P TI - Effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. SO - British Journal of General Practice. 60(570):e10-9, 2010 Jan. AS - Br J Gen Pract. 60(570):e10-9, 2010 Jan. NJ - The British journal of general practice : the journal of the Royal College of General Practitioners PI - Journal available in: Print Citation processed from: Internet JC - 9005323, ark OI - Source: NLM. PMC2801801 [Available on 01/01/11] SB - IM CP - England MH - Aged MH - Aged, 80 and over MH - *Community Pharmacy Services MH - Drug Prescriptions MH - *Drug Therapy/st [Standards] MH - *Family Practice MH - Female MH - Great Britain MH - Health Services for the Aged/og [Organization & Administration] MH - *Health Services for the Aged/st [Standards] MH - Humans MH - Interprofessional Relations MH - Male MH - Patient Care Planning/og [Organization & Administration] MH - *Patient Care Planning/st [Standards] MH - *Quality of Life AB - BACKGROUND: The pharmaceutical care approach serves as a model for medication review, involving collaboration between GPs, pharmacists, patients, and carers. Its use is advocated with older patients who are typically prescribed several drugs. However, it has yet to be thoroughly evaluated. AIM: To estimate the effectiveness of pharmaceutical care for older people, shared between GPs and community pharmacists in the UK, relative to usual care. DESIGN OF STUDY: Multiple interrupted time-series design in five primary care trusts which implemented pharmaceutical care at 2-month intervals in random order. Patients acted as their own controls, and were followed over 3 years including their 12 months' participation in pharmaceutical care. SETTING: In 2002, 760 patients, aged > or =75 years, were recruited from 24 general practices in East and North Yorkshire. Sixty-two community pharmacies also took part. A total of 551 participants completed the study. METHOD: Pharmaceutical care was undertaken by community pharmacists who interviewed patients, developed and implemented pharmaceutical care plans together with patients' GPs, and thereafter undertook monthly medication reviews. Pharmacists and GPs attended training before the intervention. Outcome measures were the UK Medication Appropriateness Index, the Short Form-36 Health Survey (SF-36), and serious adverse events. RESULTS: The intervention did not lead to any statistically significant change in the appropriateness of prescribing or health outcomes. Although the mental component of the SF-36 decreased as study participants become older, this trend was not affected by pharmaceutical care. CONCLUSION: The RESPECT model of pharmaceutical care (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) shared between community pharmacists and GPs did not significantly change the appropriateness of prescribing or quality of life in older patients. ES - 1478-5242 IL - 0960-1643 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't NO - G0001150 (United Kingdom Medical Research Council) LG - English DP - 2010 Jan DC - 20100106 YR - 2010 ED - 20100226 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19995493 <43> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20040164 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - RESPECT Trial Team FA - RESPECT Trial Team IR - Bojke C IR - Philips Z IR - Sculpher M IR - Campion P IR - Chrystyn H IR - Coulton S IR - Cross B IR - Morton V IR - Richmond S IR - Farrin A IR - Hill G IR - Hilton A IR - Russell I IR - Wong IC TI - Cost-effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. SO - British Journal of General Practice. 60(570):e20-7, 2010 Jan. AS - Br J Gen Pract. 60(570):e20-7, 2010 Jan. NJ - The British journal of general practice : the journal of the Royal College of General Practitioners PI - Journal available in: Print Citation processed from: Internet JC - 9005323, ark OI - Source: NLM. PMC2801802 [Available on 01/01/11] SB - IM CP - England MH - Aged MH - Aged, 80 and over MH - *Community Pharmacy Services/ec [Economics] MH - Community Pharmacy Services/og [Organization & Administration] MH - Cost-Benefit Analysis MH - *Drug Therapy/ec [Economics] MH - *Family Practice/ec [Economics] MH - Family Practice/og [Organization & Administration] MH - Female MH - Great Britain MH - *Health Services for the Aged/ec [Economics] MH - Health Services for the Aged/og [Organization & Administration] MH - Humans MH - Male MH - *Patient Care Planning/ec [Economics] MH - Patient Care Planning/og [Organization & Administration] MH - Prescription Drugs/ec [Economics] MH - Quality-Adjusted Life Years AB - BACKGROUND: Pharmaceutical care serves as a collaborative model for medication review. Its use is advocated for older patients, although its cost-effectiveness is unknown. Although the accompanying article on clinical effectiveness from the RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) trial finds no statistically significant impact on prescribing for older patients undergoing pharmaceutical care, economic evaluations are based on an estimation, rather than hypothesis testing. AIM: To evaluate the cost-effectiveness of pharmaceutical care for older people compared with usual care, according to National Institute for Health and Clinical Excellence (NICE) reference case standards. METHODS: An economic evaluation was undertaken in which NICE reference case standards were applied to data collected in the RESPECT trial. RESULTS: On average, pharmaceutical care is estimated to cost an incremental 10 000 UK pounds per additional quality-adjusted life year (QALY). If the NHS's cost-effectiveness threshold is between 20 000 and 30 000 UK pounds per extra QALY, then the results indicate that pharmaceutical care is cost-effective despite a lack of statistical significance to this effect. However, the statistical uncertainty surrounding the estimates implies that the probability that pharmaceutical care is not cost-effective lies between 0.22 and 0.19. Although results are not sensitive to assumptions about costs, they differ between subgroups: in patients aged >75 years pharmaceutical care appears more cost-effective for those who are younger or on fewer repeat medications. CONCLUSION: Although pharmaceutical care is estimated to be cost-effective in the UK, the results are uncertain and further research into its long-term benefits may be worthwhile. RN - 0 (Prescription Drugs) ES - 1478-5242 IL - 0960-1643 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't NO - G0001150 (United Kingdom Medical Research Council) LG - English DP - 2010 Jan DC - 20091230 YR - 2010 ED - 20100226 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20040164 <44> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19813063 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Tarn DM AU - Paterniti DA AU - Kravitz RL AU - Fein S AU - Wenger NS FA - Tarn, Derjung M FA - Paterniti, Debora A FA - Kravitz, Richard L FA - Fein, Stephanie FA - Wenger, Neil S IN - Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, USA. dtarn@mednet.ucla.edu TI - How do physicians conduct medication reviews?. SO - Journal of General Internal Medicine. 24(12):1296-302, 2009 Dec. AS - J Gen Intern Med. 24(12):1296-302, 2009 Dec. NJ - Journal of general internal medicine PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 8605834 OI - Source: NLM. PMC2787945 SB - IM CP - United States MH - Aged MH - Aged, 80 and over MH - Data Collection/mt [Methods] MH - Female MH - Humans MH - Male MH - *Medication Adherence MH - Office Visits MH - *Patient Education as Topic/mt [Methods] MH - Pharmaceutical Preparations/ae [Adverse Effects] MH - Pharmaceutical Preparations/ec [Economics] MH - *Pharmaceutical Preparations MH - *Physician-Patient Relations MH - *Physicians AB - BACKGROUND: Medication reviews are recommended annually for older patients. A medication review is a discussion of a patient's complete set of medications, but the actual content of a review is not well specified. The medical literature suggests that it is an exhaustive evaluation, but what physicians actually ask about their patients' medication regimens has been little studied. OBJECTIVE: To describe what physicians do when they review medications in the office setting. METHODS: Qualitative content analysis of audio-taped encounters between 100 patients aged 65 and older and 28 primary care physicians in two health care systems in Sacramento, California. RESULTS: Physicians use a combination of non-mutually exclusive strategies when reviewing chronic medications that include: (1) efforts to obtain a complete list of patient medications (36% of visits), (2) discussion of a topic related to the management of each of a patient's chronic medications (47% of visits), and (3) sequential discussion of the majority of a patient's medications without intervening discussion (45% of visits). Of 10 medication management topics that were discussed in medication reviews, a mean of 1.5 topics (SD = 1.7, range 0-7) were mentioned for each medication, with efficacy and directions being most common. Physicians conducted a sequential discussion that included discussion of each of a patient's medications in only 32% of visits. CONCLUSIONS: Comprehensive discussions about chronic medications are uncommon in routine practice. Practical conceptualization of what constitutes a physician-conducted medication review is needed. RN - 0 (Pharmaceutical Preparations) ES - 1525-1497 IL - 0884-8734 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural NO - 1K24MH072756-01 (United States NIMH NIH HHS) NO - 5K12AG001004 (United States NIA NIH HHS) NO - P30-AG028748 (United States NIA NIH HHS) LG - English EP - 20091008 DP - 2009 Dec DC - 20100121 YR - 2009 ED - 20100824 RD - 20100927 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19813063 <45> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 20052837 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Locca JF AU - Niquille A AU - Krahenbuhl JM AU - Figueiredo H AU - Bugnon O FA - Locca, Jean-Francois FA - Niquille, Anne FA - Krahenbuhl, Jean-Marc FA - Figueiredo, Hugo FA - Bugnon, Olivier IN - Unite de pharmacie communautaire, Section des sciences pharmaceutiques, Universite de Geneve, Pharmacie de la PMU, 1011 Lausanne. jean-francois.locca@hospvd.ch TI - [Physician-pharmacist collaboration: a way to improve the quality of drug prescribing]. [French] OT - Qualite de la prescription medicamenteuse: des progres grace a la collaboration medecins- pharmaciens. SO - Revue Medicale Suisse. 5(227):2382-4, 2386-7, 2009 Nov 25. AS - Rev Med Suisse. 5(227):2382-4, 2386-7, 2009 Nov 25. NJ - Revue medicale suisse PI - Journal available in: Print Citation processed from: Print JC - 101219148 SB - IM CP - Switzerland MH - *Cooperative Behavior MH - *Drug Prescriptions MH - Humans MH - Interprofessional Relations MH - *Pharmacists MH - *Physicians MH - Quality Assurance, Health Care AB - The medical prescription is the end-result of a structured process. It is, in effect, a medicolegal document that binds the physician who writes it as well as the pharmacist who delivers it, with a civil duty of care that is protected by penal sanction. Moreover, prescriptions carry important costs, and can be the source of errors, especially where there are breakdowns in the continuity of patient care. These features underline the importance of the act of "prescribing", and the need for ways to improve its quality through increased efficiency and safety. The Swiss experience of physicians-pharmacists Quality Circles for drug prescription in the community and in the nursing homes, represent with the medication review, one method of safeguarding quality prescribing. IS - 1660-9379 IL - 1660-9379 PT - English Abstract PT - Journal Article LG - French DP - 2009 Nov 25 DC - 20100107 YR - 2009 ED - 20100304 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20052837 <46> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19926560 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Kuhn CH AU - Casper KA AU - Green TR FA - Kuhn, Catherine H FA - Casper, Kristin A FA - Green, Tara R IN - College of Pharmacy, Ohio State University, Columbus, OH, USA. TI - Assessing Ohio grocery store patrons' perceptions of a comprehensive medication review. SO - Journal of the American Pharmacists Association: JAPhA. 49(6):787-91, 2009 Nov-Dec. AS - J Am Pharm Assoc (2003). 49(6):787-91, 2009 Nov-Dec. NJ - Journal of the American Pharmacists Association : JAPhA PI - Journal available in: Print Citation processed from: Internet JC - 101176252 SB - IM CP - United States MH - Adult MH - Aged MH - *Community Pharmacy Services MH - Counseling MH - *Drug Utilization Review MH - Female MH - Humans MH - Male MH - *Medication Therapy Management MH - Middle Aged MH - Ohio AB - OBJECTIVE: To assess grocery store patrons' perceptions of a comprehensive medication review (CMR) compared with traditional prescription medication counseling. DESIGN: Self-administered survey. SETTING: Eight central Ohio grocery stores during January through April 2007. PARTICIPANTS: Grocery store patrons. INTERVENTION: Survey events. MAIN OUTCOME MEASURES: Responses to survey items about CMRs and prescription medication counseling indicated (1) who study participants would expect to deliver each program, (2) where they would expect services to be offered, and (3) what they would expect to be included or discussed. RESULTS: Predefined response options were provided for each question. The majority of the 214 study participants associated physicians or pharmacists with a CMR. CMRs were thought to be provided in medical offices or pharmacies. Only 3 of 24 qualifiers were statistically significantly different when comparing CMRs and prescription medication counseling (inclusion of health and wellness screenings [55% vs. 43%, P = 0.015], discussion about any of the patients' medications being the same [45% vs. 56%, P = 0.026] and "other" [6% vs. 12%, P = 0.021]). CONCLUSION: Patients may not recognize pharmacists as primary providers of CMRs and may not see a clear distinction between a CMR and prescription medication counseling. More research is needed in this area to further solidify the results. Pharmacists need to market themselves as willing and capable individuals of providing CMRs. Additionally, pharmacists should highlight key differences between a CMR and prescription medication counseling so that patients understand the value of a CMR. ES - 1544-3450 IL - 1086-5802 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English DP - 2009 Nov-Dec DC - 20091120 YR - 2009 ED - 20100127 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19926560 <47> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19885077 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Leikola SN AU - Tuomainen L AU - Ovaskainen H AU - Peura S AU - Sevon-Vilkman N AU - Tanskanen P AU - Airaksinen MS FA - Leikola, Saija N S FA - Tuomainen, Lea FA - Ovaskainen, Harri FA - Peura, Sirpa FA - Sevon-Vilkman, Nina FA - Tanskanen, Paavo FA - Airaksinen, Marja S A IN - Faculty of Pharmacy, University of Helsinki, Finland. saija.leikola@iki.fi TI - Continuing education course to attain collaborative comprehensive medication review competencies. SO - American Journal of Pharmaceutical Education. 73(6):108, 2009 Oct 1. AS - Am J Pharm Educ. 73(6):108, 2009 Oct 1. NJ - American journal of pharmaceutical education PI - Journal available in: Print Citation processed from: Internet JC - 0372650, 3r9 OI - Source: NLM. PMC2769530 SB - IM CP - United States MH - Accreditation MH - *Clinical Competence MH - Computer-Assisted Instruction MH - Data Collection MH - *Drug Utilization Review MH - Education, Distance/mt [Methods] MH - *Education, Pharmacy, Continuing MH - Humans MH - *Pharmacists MH - *Problem-Based Learning/mt [Methods] MH - *Program Development MH - Teaching/mt [Methods] AB - OBJECTIVE: To implement a long-term continuing education course for pharmacy practitioners to acquire competency in and accreditation for conducting collaborative comprehensive medication reviews (CMRs). DESIGN: A 1(1/2)- year curriculum for practicing pharmacists that combined distance learning (using e-learning tools) and face-to-face learning was created. The training consisted of 5 modules: (1) Multidisciplinary Collaboration; (2) Clinical Pharmacy and Pharmacotherapy; (3) Rational Pharmacotherapy; (4) CMR Tools; and (5) Optional Studies. ASSESSMENT: The curriculum and participants' learning were evaluated using essays and learning diaries. At the end of the course, students submitted portfolios and completed an Internet-based survey instrument. Almost all respondents (92%) indicated their educational needs had been met by the course and 68% indicated they would conduct CMRs in their practice. The most important factors facilitating learning were working with peers and in small groups. Factors preventing learning were mostly related to time constraints. CONCLUSION: Comprehensive medication review competencies were established by a 1(1/2)- year continuing education curriculum that combined different teaching methods and experiential learning. Peer support was greatly appreciated as a facilitator of learning by course participants. ES - 1553-6467 IL - 0002-9459 PT - Journal Article LG - English DP - 2009 Oct 1 DC - 20091103 YR - 2009 ED - 20100108 RD - 20100927 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19885077 <48> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19649720 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Hugtenburg JG AU - Borgsteede SD AU - Beckeringh JJ FA - Hugtenburg, J G FA - Borgsteede, S D FA - Beckeringh, J J IN - Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands. JG.Hugtenburg@vumc.nl TI - Medication review and patient counselling at discharge from the hospital by community pharmacists. SO - Pharmacy World & Science. 31(6):630-7, 2009 Dec. AS - Pharm World Sci. 31(6):630-7, 2009 Dec. NJ - Pharmacy world & science : PWS PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bo7, 9307352 SB - IM CP - Netherlands MH - Aged MH - Aged, 80 and over MH - Community Pharmacy Services/ec [Economics] MH - *Community Pharmacy Services MH - Cost Savings MH - Cost-Benefit Analysis MH - Counseling/ec [Economics] MH - *Counseling MH - Drug Costs MH - Drug Prescriptions MH - Drug Utilization Review/ec [Economics] MH - *Drug Utilization Review MH - Female MH - House Calls MH - Humans MH - Male MH - Medication Adherence MH - Middle Aged MH - Mortality MH - Netherlands MH - *Patient Discharge MH - Patient Satisfaction MH - Pharmacists/ec [Economics] MH - *Pharmacists MH - Polypharmacy MH - Prescription Drugs/ae [Adverse Effects] MH - Prescription Drugs/ec [Economics] MH - *Prescription Drugs/tu [Therapeutic Use] MH - *Professional Role MH - Program Evaluation MH - Questionnaires MH - Time Factors AB - AIMS: In 2001, the Association of Amsterdam Community Pharmacists adopted a programme to improve the pharmaceutical care of patients who were discharged from hospital with five or more drug prescriptions. A comprehensive protocol for pharmaceutical care at discharge (IBOM-1) was developed. The aim of the study was to evaluate the initial IBOM protocol and to study the effects of the protocol on drug therapy and patient satisfaction as well as on drug use compliance and mortality. METHOD: A controlled intervention study involving 37 community pharmacies and 715 of their registered patients who were discharged from a hospital and using at least five prescribed drugs in the years 2001-2003. The intervention included an extensive medication review and drug counselling at the patient's home. MAIN OUTCOME MEASURE: Pharmacy intervention activities, changes in medication, discontinuation of drugs prescribed at discharge, mortality, time spent on the intervention activities, and medication cost savings were all evaluated. Patient satisfaction was measured by means of a questionnaire. RESULTS: 379 and 336 patients were enrolled in the intervention and control groups, respectively. The mean number of drugs per patient not dispensed, concomitantly dispensed, or of which the quantity was changed was higher in the intervention group than in the control group (0.70 +/- 1.74 vs. 0.40 +/- 1.43, 0.11 +/- 0.40 vs. 0.038 +/- 0.26, and 0.29 +/- 1.05 vs. 0.097 +/- 0.52, respectively). The mean number of drugs for which the dose or dosage form was changed was similar in both groups. Substitution of brand for generic or vice versa was greater in the intervention group. Changes resulting from a PAIS signal were similar in both groups. The mean number of drugs per patient for which contact was required with the physician or the Pharmacy Hospital Service Desk was higher in the intervention group (0.35 +/- 0.51 vs. 0.16 +/- 0.38). About 40% of home visits resulted in the clearing of redundant drug supplies. The IBOM-1 intervention did not influence discontinuation of drugs prescribed at discharge, nor did it influence mortality. Medication costs were slightly reduced. More patients of intervention pharmacies than of control pharmacies indicated that they were (very) satisfied with the drug counselling by their community pharmacist upon delivery of their discharge medication (87% vs. 50%; chi(2) < 0.001). CONCLUSIONS: Structured pharmaceutical care according to the IBOM-1 protocol led to more changes in drug therapy. Home visits resulted in the clearing of redundant home drug supplies. In addition, patients were highly satisfied with the counselling at discharge from hospital by their community pharmacist. Patient counselling at discharge from hospital by pharmacists, therefore, appears to be a meaningful pharmaceutical care activity. RN - 0 (Prescription Drugs) ES - 1573-739X IL - 0928-1231 PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20090801 DP - 2009 Dec DC - 20091023 YR - 2009 ED - 20100408 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19649720 <49> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19808372 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Roughead EE AU - Barratt JD AU - Ramsay E AU - Pratt N AU - Ryan P AU - Peck R AU - Killer G AU - Gilbert AL FA - Roughead, Elizabeth E FA - Barratt, John D FA - Ramsay, Emmae FA - Pratt, Nicole FA - Ryan, Philip FA - Peck, Robert FA - Killer, Graeme FA - Gilbert, Andrew L IN - Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, North Terrace, GPO Box 2471, Adelaide, South Australia 5001. libby.roughead@unisa.edu.au TI - The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohort study. SO - Circulation: Heart Failure. 2(5):424-8, 2009 Sep. AS - Circ. Heart fail.. 2(5):424-8, 2009 Sep. NJ - Circulation. Heart failure PI - Journal available in: Print-Electronic Citation processed from: Internet JC - 101479941 SB - IM CP - United States MH - *Adrenergic beta-Antagonists/tu [Therapeutic Use] MH - Aged MH - Aged, 80 and over MH - Australia MH - Bisoprolol/tu [Therapeutic Use] MH - Carbazoles/tu [Therapeutic Use] MH - *Community Pharmacy Services/sn [Statistics & Numerical Data] MH - *Cooperative Behavior MH - Databases as Topic MH - *Family Practice/sn [Statistics & Numerical Data] MH - Female MH - *Heart Failure/dt [Drug Therapy] MH - *Hospitalization/sn [Statistics & Numerical Data] MH - *House Calls/sn [Statistics & Numerical Data] MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Metoprolol/aa [Analogs & Derivatives] MH - Metoprolol/tu [Therapeutic Use] MH - Program Evaluation MH - Propanolamines/tu [Therapeutic Use] MH - Proportional Hazards Models MH - *Referral and Consultation/sn [Statistics & Numerical Data] MH - Retrospective Studies MH - Risk Assessment MH - Time Factors MH - Treatment Outcome MH - Veterans/sn [Statistics & Numerical Data] MH - Widowhood/sn [Statistics & Numerical Data] AB - BACKGROUND: Randomized controlled trials have demonstrated that collaborative medication reviews can improve outcomes for patients with heart failure. We aimed to determine whether these results translated into Australian practice, where collaborative reviews are nationally funded. METHODS AND RESULTS: This retrospective cohort study using administrative claims data included veterans 65 years and older receiving bisoprolol, carvedilol, or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure. We compared those exposed to a general practitioner-pharmacist collaborative home medication review with those who did not receive the service. The service includes physician referral, a home visit by an accredited pharmacist to identify medication-related problems, and a pharmacist report with follow-up undertaken by the physician. Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups. There were 273 veterans exposed to a home medicines review and 5444 unexposed patients. Average age in both groups was 81.6 years (no significant difference). The median number of comorbidities was 8 in the exposed group and 7 in the unexposed (P<0.0001). Unadjusted results showed a 37% reduction in rate of hospitalization for heart failure at any time (hazard ratio, 0.63; 95% CI, 0.44 to 0.89). Adjusted results showed a 45% reduction (hazard ratio, 0.55; 95% CI, 0.39 to 0.77) among those who had received a home medicines review compared with the unexposed patients. CONCLUSIONS: Medicines review in the practice setting is effective in delaying time to next hospitalization for heart failure in those treated with heart failure medicines. RN - 0 (Adrenergic beta-Antagonists) RN - 0 (Carbazoles) RN - 0 (Propanolamines) RN - 0 (metoprolol succinate) RN - 37350-58-6 (Metoprolol) RN - 66722-44-9 (Bisoprolol) RN - 72956-09-3 (carvedilol) ES - 1941-3297 IL - 1941-3289 PT - Journal Article PT - Research Support, Non-U.S. Gov't LG - English EP - 20090819 DP - 2009 Sep DC - 20091007 YR - 2009 ED - 20091027 RD - 20101118 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19808372 <50> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19737997 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Bayoumi I AU - Howard M AU - Holbrook AM AU - Schabort I FA - Bayoumi, Imaan FA - Howard, Michelle FA - Holbrook, Anne M FA - Schabort, Inge IN - Department of Family Medicine, McMaster University, Hamilton, ON, Canada. bayoumi@mcmaster.ca TI - Interventions to improve medication reconciliation in primary care. [Review] [20 refs] SO - Annals of Pharmacotherapy. 43(10):1667-75, 2009 Oct. AS - Ann Pharmacother. 43(10):1667-75, 2009 Oct. NJ - The Annals of pharmacotherapy PI - Journal available in: Print-Electronic Citation processed from: Internet JC - bbx, 9203131 SB - IM CP - United States MH - Adult MH - Ambulatory Care/mt [Methods] MH - Clinical Trials as Topic MH - Health Knowledge, Attitudes, Practice MH - Humans MH - *Medical History Taking/mt [Methods] MH - *Medication Errors/pc [Prevention & Control] MH - Patient Discharge MH - *Primary Health Care/mt [Methods] AB - OBJECTIVE: To systematically review all primary care intervention studies designed to implement medication reconciliation for effects on medication discrepancies, clinical outcomes, and patient knowledge of their medications. DATA SOURCES: We searched MEDLINE (1988-March 2008); Healthstar (1966-March 2008); CINAHL (1982-March 2008); EMBASE (1980-March 2008); Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Methodology Register, and Health Technology Assessments; and unpublished material. No language restrictions were applied. Search terms included medication reconciliation, medication errors, prescribing error, medication systems, adverse drug events, drug utilization review, medication list, medication record, and medications management. STUDY SELECTION AND DATA ABSTRACTION: Randomized controlled trials or before-and-after studies that examined the effect of various interventions on medication discrepancies either in ambulatory settings or at hospital discharge among community-dwelling adults were included. Two reviewers independently assessed studies to determine inclusion. Level of agreement between the reviewers was good, with unweighted Cohen's kappa of 0.71. Two of 3 independent reviewers abstracted data and evaluated validity from included studies. Disagreements between reviewers were resolved by consensus. DATA SYNTHESIS: Four trials met the inclusion criteria. Two before-and-after studies (n = 275) in ambulatory care examining systematic medication reconciliation at each visit produced conflicting results. One study showed a reduction in the proportion of medication discrepancies from 88.5% to 49.1% (OR 0.13; 95% CI 0.07 to 0.21); the other showed no benefit. One randomized controlled trial and one before-and-after study (n = 202) evaluated pharmacist medication review at hospital discharge. Neither showed a benefit. Heterogeneity precluded pooling of studies. All included studies had significant design flaws. CONCLUSIONS: There is no good quality evidence demonstrating the effectiveness of medication reconciliation in the primary care setting. Further research is needed. [References: 20] ES - 1542-6270 IL - 1060-0280 PT - Journal Article PT - Review LG - English EP - 20090908 DP - 2009 Oct DC - 20090928 YR - 2009 ED - 20091207 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19737997 <51> DB - Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) UI - 19766953 RO - From MEDLINE, a database of the U.S. National Library of Medicine. ST - MEDLINE AU - Nishtala PS AU - McLachlan AJ AU - Bell JS AU - Chen TF FA - Nishtala, Prasad S FA - McLachlan, Andrew J FA - Bell, J Simon FA - Chen, Timothy F IN - Faculty of Pharmacy, The University of Sydney, Sydney, Australia. prasadn@pharm.usyd.edu.au TI - Determinants of antidepressant medication prescribing in elderly residents of aged care homes in Australia: a retrospective study. SO - American Journal of Geriatric Pharmacotherapy. 7(4):210-9, 2009 Aug. AS - Am J Geriatr Pharmacother. 7(4):210-9, 2009 Aug. NJ - The American journal of geriatric pharmacotherapy PI - Journal available in: Print Citation processed from: Internet JC - 101190325 SB - IM CP - United States MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Analysis of Variance MH - *Antidepressive Agents/tu [Therapeutic Use] MH - Australia/ep [Epidemiology] MH - Drug Prescriptions/sn [Statistics & Numerical Data] MH - Female MH - *Homes for the Aged MH - Humans MH - Logistic Models MH - Male MH - Odds Ratio MH - Regression Analysis MH - Retrospective Studies MH - Sex Factors AB - BACKGROUND: Depression is underrecognized and poorly treated among older people living in aged care homes worldwide. Depression has been associated with higher rates of recurrence, disability, and death in older people. OBJECTIVES: The primary objective of this study was to assess the determinants of antidepressant medication prescribing among older people living in aged care homes in Australia. A further objective was to investigate the anti-depressant medications in common use, doses of antidepressants, and concurrent pharmacotherapy among people receiving antidepressants. METHODS: A random sample of 500 deidentified medication review reports was extracted from a database containing >165,000 Residential Medication Management Review reports. Residents' demographic and clinical characteristics, medical diagnoses, and prescribed medications were systematically extracted from these reports. Logistic regression models were used to determine factors associated with the prescribing of any antidepressant, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and "other" antidepressants (eg, mianserin, mirtazapine, venlafaxine). RESULTS: The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five percent were female. The prevalence of antidepressant prescribing among these aged care home residents was 33.0%. SSRIs were more commonly prescribed than TCAs, monoamine oxidase inhibitors, and other antidepressants. Antidepressants were more likely to be prescribed in people treated for dementia with mood disorder (odds ratio [OR] = 9.70; 95% CI, 5.26-17.88), depression (OR = 13.28; 95% CI, 6.44-27.36), and Parkinson's disease (OR = 3.56; 95% CI, 1.37-9.23). SSRI prescribing was associated with dementia with mood disorder (OR = 5.85; 95% CI, 3.19-10.72) and depression (OR = 6.44; 95% CI, 3.38-12.26). TCA prescribing was associated with depression (OR = 2.95; 95% CI, 1.18-7.35) and concurrent benzodiazepine use (OR = 2.43; 95% CI, 1.03-5.72). Other antidepressant prescribing was associated with dementia with mood disorder (OR = 6.53; 95% CI, 3.15-13.50) and depression (OR = 5.00; 95% CI, 2.23-11.19). CONCLUSIONS: There was preferential prescribing of SSRI antidepressants among these older aged care home residents with depression. Cognitive impairment alone was not significantly associated with antidepressant prescribing; however, these aged care home residents with dementia and mood disorders had an increased likelihood of being treated with antidepressants. The prescribing of TCAs was significantly associated with concurrent benzodiazepine use. RN - 0 (Antidepressive Agents) ES - 1876-7761 IL - 1876-7761 PT - Journal Article LG - English DP - 2009 Aug DC - 20090921 YR - 2009 ED - 20091117 UP - 20101214 XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=19766953