The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review

BMC Primary Care, Journal Year: 2023, Volume and Issue: 24(1)

Published: Feb. 6, 2023

Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients represent challenge for general practitioners (GPs). Integration of pharmacists within practice (herein 'pharmacist integration') may improve medications management patient outcomes. This systematic review assessed the effectiveness costs pharmacist integration.

Language: Английский

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Independent and combined associations of handgrip strength and walking speed with cognitive function in older adults: evidence from a national cross-sectional study

Aging & Mental Health, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 8

Published: June 4, 2024

Objectives Although there have been studies on the association of handgrip strength or walking speed alone with cognitive abilities, few determined combined associations and function. Therefore we aimed to explore independent function in Chinese older adults using a nationally representative sample.

Language: Английский

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Current and evolving treatment strategies for the Alzheimer disease continuum

The American Journal of Managed Care, Journal Year: 2020, Volume and Issue: 26(Suppl 8), P. S167 - S176

Published: Aug. 1, 2020

Alzheimer disease (AD) is the sixth leading cause of death and most common etiology for dementia.It causes a significant burden to public health system, patients afflicted with it, their caregivers.Continuing professional education will increase competency on AD, including importance early detection, patient caregiver education, role new therapeutic targets treatment AD.Application knowledge improve clinical decision making, quality life among caregivers, optimize medication therapy, outcomes, decrease costs associated AD. Statement Educational NeedAlzheimer requires multispecialty approach diagnosis treatment.The estimated cost includes direct medical, indirect, social care costs.Early can both diagnosis, current emerging therapies, societal economic help managed professionals provide timely appropriate patients. ObjectivesUpon completion this activity, participants should be able to:• Explore impact as it relates progression, value comorbidities, effect caregivers.• Analyze data pharmacologic disease.• Examine therapy management drug utilization reviews controlling improving outcomes disease. Accreditation StatementPharmacy Times Continuing Education™ accredited by Council Pharmacy Education (ACPE) provider continuing pharmacy education.This activity approved 2.5 contact hours (0.25 CEU) under ACPE universal number 0290-0000-20-207-H01-P.

Language: Английский

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Effects of Hospital-Based Comprehensive Medication Reviews Including Postdischarge Follow-up on Older Patients’ Use of Health Care

JAMA Network Open, Journal Year: 2021, Volume and Issue: 4(4), P. e216303 - e216303

Published: April 30, 2021

Suboptimal use of medications is a leading cause health care-related harm. Medication reviews improve medication use, but evidence the possible benefit inpatient review for hard clinical outcomes after discharge scarce.To study effects hospital-based comprehensive (CMRs), including postdischarge follow-up older patients' care resources, compared with only and usual care.The Reviews Bridging Healthcare trial cluster randomized crossover that was conducted in 8 wards multiprofessional teams at 4 hospitals Sweden from February 6, 2017, to October 19, 2018, 12 months completed December 2019. The prespecified protocol. Outcome assessors were blinded treatment allocation. In total, 2644 patients aged 65 years or who had been admitted 1 least day included. Data modified intention-to-treat population analyzed 10, 2019, September 9, 2020.Each ward participated 6 consecutive 8-week periods. provide 3 treatments during each period: CMR, CMR plus follow-up, without pharmacist.The primary outcome measure incidence unplanned hospital visits (admissions emergency department visits) within months. Secondary included medication-related admissions, clinicians, time first visit, mortality, costs care.Of participants, 7 withdrew inclusion, leaving 2637 analysis (1357 female [51.5%]; median age, 81 [interquartile range, 74-87] years; number medications, 9 5-13]). analysis, 922 received 823 892 care. crude rate 1.77 per patient-year total population. did not differ between intervention groups (adjusted ratio, 1.04 [95% CI, 0.89-1.22] 1.15 0.98-1.34] follow-up). However, associated an increased 1.29; 95% 1.05-1.59) There no differences regarding other secondary outcomes.In this hospitalized patients, decrease visits. findings do support performance CMRs as trial. Alternative forms aim should be considered subjected trials.ClinicalTrials.gov Identifier: NCT02986425.

Language: Английский

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Separate and combined associations of obesity and handgrip strength with cognitive function in older adults: A national cross-sectional study in China

Journal of Sports Sciences, Journal Year: 2024, Volume and Issue: 42(2), P. 109 - 115

Published: Jan. 17, 2024

This study examined the separate and combined associations of obesity handgrip strength with cognitive function in older adults. In total 4,839 adults were included this cross-sectional study, their body mass index (BMI) measured. Cognitive was evaluated using Telephone Interview for Status. Three individual categories created BMI (normal weight: 18.5≤ < 24.0 kg/m2 overweight: 24.0≤ 28.0 obesity: ≥ (low, normal, high tertiles), then these pooled together. Logistic regression analyses used to examine function. Results indicated that overweight had a lower rate than normal weight There an inverse association between Participants likelihood compared those strength. The findings suggested or associated odds decline. Moreover, concurrence additive effect on

Language: Английский

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Sharing of relevant medication information through discharge summaries in an acute setting – perspectives from hospital-based physicians, general practitioners and clinical pharmacists

Published: Jan. 10, 2025

Background Poor-quality discharge summaries, particularly regarding medication information, can lead to adverse drug events, readmissions or even death. Therefore, effective communication across sectors is crucial, especially for multimorbid elderly patients, who are at high risk due polypharmacy and complex needs. While pharmacists’ recommendations improve quality, they also add the information flow. This focus group interview study aims explore healthcare professionals’ perceptions of current exchange in summaries between an emergency hospital department general practice tailor from a clinical pharmacist after review ensuring safer transition patients Denmark. Methods A semi-structured was conducted with nine professionals primary secondary sector. Data were synthesized independently by two researchers using thematic analysis. Results In total, included participants (four hospital-based physicians (including pharmacologist), three practitioners (GPs), pharmacists). We identified themes each including sub-themes analysis: Theme 1) Challenges usability implementability content summaries concentrated on key lack updated lists. 2) Different practices affect management which time constraints, color coding interpretation load, theme 3) How pharmacist-led reviews focusing compliance, evidence-based directed outpatient clinics. Conclusion highlights new knowledge crucial tailoring pharmacist: there need concise focused changes, reasons these polypharmacy, compliance requiring GP review. Improving requires standardized routines, shared format understanding, innovative technology ensure that GPs easily find, comprehend, act information. Moreover, outpatients perceived challenging needs further exploration.

Language: Английский

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Prevalence and Risk Factors for Drug-Related Problems in People With Dementia Living in the Community: A Systematic Review and Meta-Analysis

Journal of the American Medical Directors Association, Journal Year: 2022, Volume and Issue: 23(6), P. 980 - 991.e10

Published: March 8, 2022

Language: Английский

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How Do Pharmacists Practice in Aged Care? A Narrative Review of Models from Australia, England, and the United States of America

International Journal of Environmental Research and Public Health, Journal Year: 2021, Volume and Issue: 18(23), P. 12773 - 12773

Published: Dec. 3, 2021

Medication management in residential aged care facilities (RACFs) is complex and often sub-optimal. Pharmacist practice models services have emerged internationally to address medication-related issues RACFs. This narrative review aimed explore pharmacist Australia, England the USA, identify key activities characteristics within each model. A search strategy using terms was performed peer-reviewed databases, as well grey literature. Additionally, experts from selected countries were consulted obtain further information about their respective countries. Thirty-six documents met inclusion criteria included review. Four major identified formed focus of review: (1) NHS’s Medicine Optimisation Care Homes (MOCH) program England; (2) Australian model utilising visiting accredited pharmacists; (3) Centers for Medicare Medicaid (CMS) pharmacy long-term USA; (4) Therapy Management (MTM) USA. reviews all models, but had distinct relation comprehensiveness, who eligible, how frequently residents receive medication activity. There heterogeneity types facility-level offered by pharmacists, research needed determine effectiveness these improving quality use medicines setting. found that some pharmacists a limited level collaboration with other healthcare professionals, emphasising need trial innovative integrated increased achieve holistic patient-centred approach management.

Language: Английский

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Implementation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© into home medicines review: a protocol for a cluster-randomised clinical trial in older adults

BMC Geriatrics, Journal Year: 2020, Volume and Issue: 20(1)

Published: Feb. 12, 2020

Abstract Background Older people living in the community have a high prevalence of polypharmacy and are vulnerable to adverse drug events. Home Medicines Review (HMR) is collaborative medication review service involving general practitioners (GPs), accredited clinical pharmacists (ACPs) patients, which aims prevent medication-related problems. This study evaluate implementation Computerised Clinical Decision Support System (CCDSS) called G-MEDSS© (Goal-directed Medication Electronic System) HMRs deprescribe anticholinergic sedative medications, assess effect deprescribing on outcomes. Methods consists 2 stages: Stage I – two-arm parallel-group cluster-randomised trial, II process evaluation CCDSS intervention HMR. Community-dwelling older adults with without dementia who referred for HMR by their GP recruited ACPs will be included this study. G-MEDSS designed provide decision support healthcare when completing review, tailor care meet patients’ goals preferences. The contains three tools: Goals Care Management Tool, Drug Burden Index (DBI) Calculator©, revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. produces patient-specific reports, as part communication patient’s GP, reports patient (or carer). randomised arm use create referring carer) submitting report. comparison usual (without G-MEDSS). Outcomes primary outcome reduction DBI exposure 3 months after ± between groups. secondary outcomes include changes (physical cognitive function, falls, institutionalisation, visits, adherence mortality) 3-months Discussion expected add evidence that combination supporting can improve prescribing adults. Trial registration trial was registered Australian New Zealand Trials Registry ACTRN12617000895381 19th June 2017.

Language: Английский

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Trajectories of care of community-dwelling people living with dementia: a multidimensional state sequence analysis

BMC Geriatrics, Journal Year: 2023, Volume and Issue: 23(1)

Published: April 27, 2023

Abstract Background The type and level of healthcare services required to address the needs persons living with dementia fluctuate over disease progression. Thus, their trajectories care (the sequence use time) may vary significantly. We aimed (1) propose a typology among community-dwelling people dementia; (2) describe compare characteristics according respective trajectories; (3) evaluate association between membership, socioeconomic factors, self-perceived health. Methods This is an observational study using data innovative Care Trajectories -Enriched Data (TorSaDE) cohort, linkage five waves Canadian Community Health Survey (CCHS), health administrative from Quebec provincial health-insurance board. analyzed 690 who participated in at least one cycle CCHS date last completion index date). were defined as sequences two years preceding date, following information: 1) Type units consulted (Hospitalization, Emergency department, Outpatient clinic, Primary clinic); 2) professionals (Geriatrician/psychiatrist/neurologist, Other specialists, Family physician). Results Three distinct types dementia: low ( n = 377; 54.6%); high primary 154; 22.3%); 3) overall 159; 23.0%). Group 3 membership was associated urban areas, poorer perceived status higher comorbidity. Conclusion Further understanding how subgroups patients time could help highlight fragility areas allocation resources implement best practices, especially context resource shortage.

Language: Английский

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