Symptoms of older orthopedic and rheumatic patients : A telephone survey about symptoms, symptom communication, treatment and further support after hospital discharge.

BACKGROUND: In older multimorbid orthopedic and rheumatic patients, data on symptoms besides pain or reduced mobility are rarely published. OBJECTIVE: We investigated patients' perspectives on their symptoms after hospital discharge. MATERIAL AND METHODS: Orthopedic and rheumatic patients aged over 70 years were asked via telephone interviews about (i) their symptoms, (ii) communication, (iii) treatment, and (iv) support. RESULTS: (i) The 60 participants (35 women and 25 men) reported a median of 6 (min-max: 1-14) different symptoms, of which 86% (356 of 415) had existed before hospitalization, (ii) patients did not communicate 28% (117) of symptoms to either healthcare professionals, family or friends and (iii) 52 (87%) patients desired improvement. Of the 280 most impairing symptoms, 19% (52) were not treated at all. (iv) Almost all patients (59; 98%) considered it easy to obtain support. CONCLUSION: Remarkably, many symptoms were not communicated or treated despite the patients having been hospitalized.

Assessment of Patients' Views on Drug Benefits and Risks: An Interview Study with Cardiovascular Patients.

Better and balanced information strategies supporting cardiovascular patients' adherence are required. Cardiovascular drugs have outstanding morbidity and mortality benefits. This can be counteracted by patients' perceptions of risks. Drug information should help the patient but not fuel unwarranted fears. We performed a cross-sectional survey of patients admitted to a cardiology ward. We evaluated (i) the patients' general benefit-risk estimation of their pharmacotherapy; (ii) views on benefits; (iii) views on risks; and (iv) information sources. Additionally, we assessed aspects of anxiety and depression with the Patient Health Questionnaire-4 (PHQ-4). (i) 67 patients (66%) rated expected drug benefits higher than potential risks. (ii) 72% of benefits motivated the patients to take their medication as prescribed. Patients more frequently mentioned surrogate markers as benefits than clinical benefits (p < 0.001). (iii) 56% of risks mentioned were perceived as bothersome and 35% as concerning. Risks were more often perceived as bothersome and concerning by patients with higher PHQ-4 scores (p=0.016). (iv) Physicians were the most frequent information source of benefits (92% of patients) and risks (45%), and pharmacy staff for 27% and 14%, respectively. Laymen or media served as sources of information on benefits in 39%, for risks in 40%, and package leaflets in 26% and 36%. 42% of the patients would like to receive more information on benefits versus 27% on risks. Our results suggest that knowledge of benefits motivates patients to take their drugs as prescribed. There is already good information on surrogate markers for process control with active patient involvement. However, a lack of knowledge still exists in relation to clinical benefits. Regarding risks, it has been shown that patients with higher PHQ-4 scores are more likely to be bothered or concerned. Both emphases on clinical benefits and individualization depending on PHQ-4 scores may be valuable resources for patient counseling to support adherence.

[Antibiotics Stewardship Team Recommendations - An Analysis under Routine Conditions in a University Hospital]. / Empfehlungen des Antibiotic-Stewardship Teams ­ eine Analyse unter Routinebedingungen eines Universitätsklinikums.

AIM: To evaluate recommendations of an antibiotic stewardship (ABS) team during routine weekly visits and to analyse their implementation and reasons for non-implementation by the ward physicians. METHODS: Multiprofessional ABS Rounds (members: infectiology, microbiology, pharmacy and hospital epidemiology) were accompanied by an observer in nine intensive and peripheral wards of a university hospital (1451 beds) for eight weeks. The recommendations of the ABS team were prospectively analysed, and when these were not implemented, ward physicians in charge were asked to give reasons for non-implementation. RESULTS: A total of 262 patients were visited in the course of 359 ABS visits. A median of four physicians and one pharmacist (Q25/Q75: 4/6) participated in the ABS rounds. In 177/359 (49%) of visits, at least one recommendation for anti-infective therapy was given; the total number of recommendations made was 210. The most frequent (38%, 80/210) recommendations were related to the prescribed therapy duration. The more different the professional groups participating in the ABS rounds, the larger was the number of recommendations given (p=0.016; odds ratio=1.018 (1.003-1.033)). 62/210 (30%) of the ABS recommendations were not implemented by the ward physicians in charge. The most frequent reason (32%: 20/62) for this was the deliberate decision by the physicians to deviate from the recommended therapy. CONCLUSIONS: The high recommendation rate of 50% demonstrates the need for optimizing therapy by the ABS teams in routine practice. The larger the number of different specialists participating in single visits, the larger was the number of recommendations. Reasons for the lack of implementations need to be critically examined by both the ABS team and the ward physicians in charge.

Intake of aspirin prior to metamizole does not completely prevent high on treatment platelet reactivity.

PURPOSE: Metamizole can sterically inhibit aspirin (ASA) from binding to cyclooxygenase 1 (COX1). It is recommended that ASA should be taken 30 min prior to metamizole to maintain the irreversible inhibition of arachidonic acid (AA)-induced platelet aggregation. We aimed to analyse the inhibitory effect of ASA and metamizole on AA-induced platelet aggregation over the course of the day. METHODS: We analysed hospitalized patients who ingested ASA at least 30 min prior to metamizole (recommended dosing group, n = 15), metamizole prior or simultaneously with ASA (not recommended dosing group, n = 16) and patients with unknown or mixed intake (mixed dosing group, n = 5). AA-induced light transmission (LTA) and impedance aggregometry (IA) were measured before, 1-2 and 5-6 h after the intake of ASA ± metamizole. RESULTS: Maximum AA-induced LTA prior to the intake of ASA was significantly lower and the rate of high on treatment platelet reactivity (HTPR) higher in the recommended compared with the not recommended dosing group (19.6% vs. 46.9%, p = 0.011 and 4/15 vs. 12/16 patients, p = 0.017). There was no difference when IA was used. Maximum AA-induced LTA after the intake of ASA ± metamizole was lower in patients in the not recommended but not in the recommended dosing group. All patients with HTPR in the recommended dosing group had regular inhibition of AA-induced LTA after discontinuation of metamizole. CONCLUSION: Co-medication of ASA and metamizole significantly influences platelet inhibition with variations during the day and can cause HTPR in patients taking ASA prior to metamizole or simultaneously.

Fall-risk-increasing adverse reactions-is there value in easily accessible drug information? A case-control study.

PURPOSE: The individual fall risk of a patient is often multifactorial. Polymedication contributes to an additional risk of fall-risk-increasing adverse reactions (FRIARs). Previous studies have not sufficiently investigated the complexity facing prescribers when balancing the therapeutic benefits of individual drugs against their potential fall risk. METHODS: An expert panel identified drugs with FRIARs based on the Summary of Product Characteristics (SmPC). These FRIARs and other parameters (such as the total number of drugs, dosage, dose adjustments, and drug changes) were then analyzed for their impact on falls in a case-control study using logistic regression. RESULTS: During a 1-year period, 112 (1%) of 11,481 hospital patients experienced at least one fall event. Complete data was available for evaluation from 87 of them (case group). We matched these patients to another 87 patients who had no fall events (control group). FRIAR drugs were more frequently prescribed in the case group (4.26 (Q25-Q75, 3.75-4.78) per patient; p = 0.033) than in the control group (3.48 (2.97-3.99)). Drugs with FRIARs (ß = 0.137; p = 0.035) and the total number of FRIARs (ß = 0.033; p = 0.031) increased the fall risk. The total number of drugs, dosage, dose adjustments, and drug changes showed no influence. CONCLUSIONS: FRIARs were associated with a higher number of falls. To consider FRIARs offers a chance to address the complexity of the individual medication. This data can support future computerized physician order entries with clinical decision support.

The impact of evidence from clinical trials on counselling for over-the-counter drugs: A national survey of pharmaceutical staff in German pharmacies.

WHAT IS KNOWN AND OBJECTIVE: Evidence from clinical trials should form the foundation of healthcare advice. Comparatively little has been investigated about the implementation of evidence in over-the-counter (OTC) counselling in community pharmacies. The objective of this study was to explore the current impact of clinical trials on OTC counselling from the perspective of pharmaceutical staff. METHODS: Pharmaceutical staff in German community pharmacies were invited to participate in a nationwide cross-sectional survey using SoSci Survey. Within the questionnaire, the following items were queried: (i) attitudes towards influencing factors on OTC drug recommendation, (ii) practical procedure of OTC drug recommendations, (iii) experiences and challenges in handling clinical trials, and (iv) current and desired continuing education on self-medication. Multiple logistic regression was employed to identify predictors for OTC recommendations based on clinical trials in routine. RESULTS AND DISCUSSION: In total, 1068 participants completed the survey. (i) Clinical trial data were rated as 'very important' for drug recommendations by 33% and as 'rather important' by 50%. (ii) 8% reported that they base their recommendations on clinical trial data 'in almost all consultations', 40% 'in most consultations'. (iii) 69% faced difficulties in including clinical trial data into their counselling. (iv) 7% read original clinical trials at least once a month. Predictors for routine OTC recommendations based on clinical trials were as follows: male gender, university degree, clinical trials considered to be important for recommendations, inclusion of clinical trials in counselling assessed as easy, higher frequency of reading specialized literature per year, increasing number of working pharmacists in the pharmacy, and more casual than regular customers in the pharmacy. WHAT IS NEW AND CONCLUSION: Most of the pharmaceutical staff recognize the importance of clinical studies for self-medication advice. Based on self-report, however, clinical trial data are not taken routinely into account in practice. Only a minor proportion of staff routinely deal with studies. Therefore, appropriate instruments are required to make knowledge from clinical trials available in community pharmacies.

A prospective intervention study to identify drug-related emergency department visits comparing a standard care group and a pharmaceutical care group.

BACKGROUND AND IMPORTANCE: Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions. OBJECTIVE: The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support. DESIGN/SETTING/PARTICIPANTS: This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related. OUTCOME MEASURES AND ANALYSIS: The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated. MAIN RESULTS: A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25-Q75) 63.5-83.5] and took 7 [(Q25-Q75) 5-8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25-Q75) 66-83] and number of drugs taken was 9 [(Q25-Q75) 5.25-11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35-5.38). An intervention on the patient's pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group. CONCLUSION: In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.

Patients' perspective on their drug therapy after bariatric surgery: A quantitative, cross-sectional interview study.

Drug therapy in patients who have undergone bariatric surgery is challenging. We aimed to investigate the patients' perspective on their drug therapy. This should allow deriving tailored measures to better support patients and their healthcare professionals with drug therapy after bariatric surgery. We conducted a quantitative telephone-based interview study with patients who have undergone bariatric surgery. The interview consisted of assessments in three parts: (i) current drug therapy: prescription, administration and adherence, (ii) changes after bariatric surgery and (iii) adverse events. (i) The 105 enrolled patients were taking a median of 10 (range: 3-30) drugs. In 1017 of 1080 drugs (94%), expectations in drug effectiveness were (rather) met. Of the 105 patients, 27% reported difficulties in drug administration, 44% forgot to take their drugs at least one time and 20% reported deviations from the prescription. (ii) Sixteen percent of the patients observed changes in drug effectiveness or tolerability-additionally to therapy adjustment by physicians. (iii) Seventy-four percent recognised at least one adverse event right before and/or after bariatric surgery, most frequently in gastrointestinal disorders. Patients who have undergone bariatric surgery have to deal with many difficulties in drug handling and adverse events. Our study emphasises the need for better and more individual support for patients with their drug therapy after bariatric surgery and, therefore, suggests a multidisciplinary approach that includes pharmacists. The stronger involvement of the patients' perspective seems to be a valuable source in research and practice.

Overcoming Barriers in Nurse-Pharmacist Collaborations on Wards - Qualitative Expert Interviews with Nurses and Pharmacists.

Purpose: Interprofessional collaboration in healthcare is an essential element in promoting patient safety. However, little research is available on the collaboration between nurses and pharmacists. To optimize processes, mutual understanding is needed, which can be gained by examining the perspectives of those collaborating professional groups. We aimed to identify barriers to the interprofessional collaboration of nurses and pharmacists as well as preconditions and solution strategies to devise approaches for optimizing teamwork in inpatient settings. Methods: We recruited pairs of collaborating nurses and pharmacists from different hospitals in German-speaking countries and conducted qualitative expert interviews by phone with each of them individually. Transcribed interviews were assessed using qualitative content analysis. Results: We conducted 12 interviews each with the collaborating nurses and pharmacists. The most frequently mentioned barriers to optimal collaboration were "skepticism due to perception as controller" (reported mainly by pharmacists), "organizational implementation", and "limited (possibilities of) presence" (reported by both professional groups). A solution strategy proposed to overcome such barriers was "explaining added value". This added value was found in "clinical-pharmaceutical activities as complement by additional perspective" and "reducing workload in tasks distant from the patient". Conclusion: Nurses, pharmacists and hospital management should recognize the added value of intensifying their collaboration regarding patient-related services. A combination of logistical and clinical-pharmaceutical activities should be established at the level of drug application since interviewees endorsed collaboration. A stepwise process must be anticipated to address existing barriers, including some redefinition of professional roles.

Medication review in multi-morbid geriatric patients: A training program for pharmacy students in Germany.

INTRODUCTION: Medication reviews can reduce the geriatric risk of experiencing drug-related problems (DRPs), but medication review training programs in pharmacy education are infrequent and inconsistent. Data on education programs that practice DRP management skills and DRP prioritization should be collected as such training requires a tailored student evaluation at the DRP level. METHODS: A geriatric patient medication review training was developed and implemented for eighth-semester pharmacy students. Students' DRP management skills were evaluated using audiotaped, 15-min simulated patient scenarios before and after the training using a newly developed algorithm (score 1-9, adequate management defined ≥7). The scenarios included 17 DRPs, five of which were identified as a high priority. Students rated their DRP management and knowledge by self-assessment before and after the training and supplied feedback about the training. RESULTS: Student comprehension and handling of DRPs improved after the training. The median number of adequately managed DRPs increased from 4 to 7 (P = .001) and the median number of high-priority DRPs identified increased from 4 to 5 (P = .007). Students felt they improved their overall competency, DRP management, and knowledge, and 85% rated the training essential to their university education. CONCLUSIONS: This training provided students with an objective evaluation algorithm for complex patient simulations in elderly patients. The training improved students' DRP prioritization and management, providing a basic template for future geriatric medication review training programs.

What influences the information exchange during self-medication consultations in community pharmacies? A non-participant observation study.

BACKGROUND: Although pharmaceutical staff consider guideline-compliant information exchange during self-medication consultations as crucial, they have not fully integrated it into practice. It is unclear what prevents pharmaceutical staff from implementing their positive intentions into their actual everyday practice. To improve the information exchange during the current consultation practice, a deeper understanding of its implementation is needed. OBJECTIVES: The aim was to evaluate the factors influencing information exchange during self-medication consultations in German community pharmacies. METHODS: We performed a non-participant observation of real-life consultations with post-consultation interviews of pharmaceutical staff in 10 pharmacies. The information exchanged during self-medication consultations was evaluated via 7 guideline-recommended information parameters in 2 stages of information exchange: (a) 'information gathering' and (b) 'provision of information'. Directly after each observed consultation, pharmaceutical staff's opinion about the consultation, the customer's interest and their own performance was questioned. Factors associated with the observed extent of information exchange were analysed by Poisson regression analysis. RESULTS: In the 379 self-medication consultations with 46 pharmaceutical staff members, 454 different customer enquiries were addressed, and 483 medications were dispensed. In median, 2 predefined information parameters (First-/Third quartile: 1/4) were fulfilled during an enquiry and 2 parameters (First-/Third quartile: 1/3) were fulfilled for a dispensed medication. Pharmaceutical staff were satisfied with 85% of their consultations and perceived 76% of them as easy to handle. In both information stages, information exchange increased when 'customers were perceived to be interested in counselling' (p < 0.001) and decreased when customers had a 'specific medication request' (p < 0.001). CONCLUSIONS: Information exchange in pharmacies needs to be better integrated into daily practice. Strategies to encourage information exchange should also include pharmaceutical staffs' perception of their own counselling technique. Ongoing patient-centred trainings should facilitate strategies to engage uninterested customers or costumers with specific medication requests in consultations.

Developing a Mobile Health Application to Communicate Adverse Drug Reactions - Preconditions, Assessment of Possible Functionalities and Barriers for Patients and Their General Practitioners.

Purpose: Mobile health (mHealth) applications offer structured and timely communication between patients and general practitioners (GPs) about adverse drug reactions (ADR). Preconditions, functionalities and barriers should be studied to ensure safe implementation. Methods: We performed a cross-sectional questionnaire survey addressing (i) preconditions, (ii) users' assessment of functionalities and (iii) barriers to mHealth managing ADR communication. Results: A total of 480 patients and 31 GPs completed the survey. (i) A total of 269 (56%) patients and 13 (42%) GPs were willing to use mHealth for ADR communication. Willingness was negatively correlated with age for both patients (r = -0.231; p < 0.001) and GPs (r = -0.558; p = 0.002). (ii) Most useful functionalities mentioned by patients (>60%) included "Rapid feedback on urgency of face-to-face consultations." GPs valued information on "Patient's difficulties in medication administration." (iii) In free-text answers, the barrier reported most frequently by patients was "preferred personal GP contact" (6%), whereas GPs claimed, "uncomplicated use with low expenditure of time and personnel" (19%). Conclusion: Older patients and GPs mainly show reservations about mHealth for ADR communication but recognize possible benefits. mHealth implementation should avoid a negative effect on GPs' time budgets; the primary goal should not be to reduce the number of GP-patient contacts but to optimize them.

Pharmacy Technicians' Perception About Symptoms and Concerns of Older Patients Visiting Pharmacies: A Cross-Sectional Study.

PURPOSE: Older patients are still not sufficiently integrated into multidisciplinary care concepts including geriatric and palliative care. They do, however, regularly visit pharmacies to fill prescriptions or to buy self-medication. Thus, they have frequent contact with pharmacy technicians (PTs), who are widely involved in counselling in Germany. However, it is not known whether geriatric symptoms are recognized by PTs and to what extent older patients use their pharmacy to address geriatric or palliative concerns. This study aimed to investigate PTs' impression of older patients' symptoms, geriatric and palliative concerns in consultations, as well as multidisciplinary collaboration. PATIENTS AND METHODS: We conducted a cross-sectional study in April-May 2019. Using a self-administered questionnaire, PTs were asked about (i) geriatric symptoms, (ii) geriatric and palliative concerns older patients expressed in routine consultations, (iii) supposed reasons for inadequate care, and (iv) PTs' desire for multidisciplinary cooperation. RESULTS: (i) The 5 most common symptoms the 339 participating PTs recognized in the community pharmacy were pain, insomnia, restricted mobility, eye disorders, and constipation. (ii) The three most frequently addressed non-drug-related geriatric palliative concerns were mental strain, loneliness, and mourning. (iii) As reasons for inadequate patient care, PTs predominantly mentioned patient-related reasons (299 of 518 reasons, 58%). (iv) 85% of the PTs desired closer cooperation with general practitioners, 84% with nursing services and 39% with palliative physicians. CONCLUSION: PTs frequently saw older patients visiting the pharmacy who suffer from a variety of symptoms. PTs were additionally confronted with diverse geriatric or palliative concerns. We deduce, first, a need for PT training in geriatric and palliative care. Second, multidisciplinary care concepts and research should include pharmacies because they seem to be a low-threshold contact to older patients, who might need access to adequate care.

Evidence-based self-medication: development and evaluation of a professional newsletter concept for community pharmacies.

Background Providing evidence-based care is recognized as a key competence for all healthcare professionals. In order to support community pharmacists in evidence-based self-medication counseling, the umbrella organization of German pharmacists initiated the development of a nationwide concept. The key element of the concept was a professional newsletter that should help pharmacists incorporate research findings into their daily counseling practice. Objective To develop, implement and evaluate the professional newsletter concept. Setting German community pharmacies. Method Clinical pharmacists from a German university compiled and synthesized clinical trial data in a professional newsletter that would supply community pharmacists with evidence-based information on common over-the-counter medicines as well as instructions for searching and appraising scientific literature. The electronic newsletter was offered to interested community pharmacists free of charge, once or twice a month, after they signed up for a subscription. About one year after the publication of the first newsletter issue, the subscribers were invited to take part in an anonymous cross-sectional online survey. In all, 21 newsletter issues were published through the end of the survey period. Main outcome measure Perceived value of the professional newsletter with 10 predefined objectives. Results A total of 1975 persons subscribed to the professional newsletter. Of those, 150 persons working in community pharmacies completed the survey. Most of them perceived the synthesized information as 'useful' (81-95%). They attributed positive changes in knowledge (89%), skills (87-91%), awareness (85%), and motivation (67-77%) to the newsletter. However, almost half of them (43%) found it difficult to incorporate reading the newsletter in their everyday working life. Free-text feedback suggested that further modifications should be considered to facilitate a better integration of the newsletter into everyday pharmacy practice. Conclusion A nationwide provided professional newsletter can play a vital part in supporting pharmacists in evidence-based self-medication counseling. However, the practicability of such a newsletter needs to be further improved and the newsletter should be accompanied by additional measures.

Public's perspectives on guideline-recommended self-medication consultations in German community pharmacies.

The aim of this study was to assess the public's opinions and expectations of self-medication consultations in German community pharmacies with special emphasis on the acceptance of guideline-recommended consultation. In a cross-sectional study in the city centre of Leipzig, Germany, we conducted a questionnaire-based survey administered via an interview with passers-by from June to September 2018. The structured questionnaire contained questions assessing (I) previous experience with self-medication consultations, (II) possible reasons for declining self-medication consultations, (III) the attitude towards information gathering and (IV) expectations of self-medication consultations. (I) 92% of the 963 respondents stated they were generally satisfied with self-medication consultations in community pharmacies. Around one-fifth of all respondents claimed that they would like to be asked more health-related questions (22%) and receive more information on non-prescription drugs (20%). (II) Privacy issues (39%) and reluctance to talk about some medical conditions (43%) were the most frequent reasons for declining self-medication consultation. (III) Respondents understood the need for answering guideline-recommended questions (85-96%) and did not mind being asked these questions (70-96%). (IV) Most of the respondents expected to be counselled even if they did not ask for it directly (69%). Pharmacies were further expected to recommend the best drug, even if it was not what the customer initially intended to buy (87%). However, more than half of the respondents would consider counselling as unimportant if they knew exactly which medication they wanted to buy (56%) or if they had used the non-prescription drug before (70%). The majority also expected to receive guideline-recommended drug information (each item at least 52%). Thus, our study shows that respondents were mostly in line with the required standards of self-medication counselling guidelines. Customers expect high-quality counselling on self-medication. These findings support pharmaceutical staff's understanding of customers' barriers and expectations during self-medication consultations.

Are evidence-based criteria addressed during counseling on over-the-counter products? An observational study in community pharmacies.

OBJECTIVE: We examined whether evidence-based criteria were addressed during counseling on over-the-counter products (OTCs) in community pharmacies. METHODS: Consultations were observed in 10 community pharmacies. We analyzed communications about OTCs to determine if any information on three evidence-based criteria (outcome variables: scientific evidence such as clinical study results, pharmaceutical staff's experience, and customer's experience) was mentioned. Two groups of communications were compared with Pearson's chi-square and Fisher's exact test, as appropriate: The communications about OTCs recommended by the pharmaceutical staff vs. the communications about OTCs requested by customers. RESULTS: In 379 observed consultations, 300 OTCs were recommended by staff and 390 OTCs were requested by customers. The least included criterion was scientific evidence (in OTCs recommended by pharmaceutical staff - 1% vs. requested by customers - 0%), followed by pharmaceutical staff's experience (5% vs. 1%). The customer's experience was addressed more frequently (14% vs. 41%). Statistically significant differences between the two groups were found for all criteria (p < 0.05). CONCLUSION: Evidence-based criteria were rarely addressed during counseling on OTCs. PRACTICE IMPLICATIONS: Pharmaceutical staff should be encouraged to include the three evidence-based criteria more frequently. Additionally, customers should be encouraged to request such information from the staff in community pharmacies.

Considering additive effects of polypharmacy : Analysis of adverse events in geriatric patients in long-term care facilities.

BACKGROUND: Potential additive effects of polypharmacy are rarely considered in adverse events of geriatric patients living in long-term care facilities. Our aim, therefore, was to identify adverse events in this setting and to assess plausible concomitant drug causes. METHODS: A cross-sectional observational study was performed in three facilities as follows: (i) adverse event identification: we structurally identified adverse events using nurses' interviews and chart review. (ii) Analysis of the concomitantly administered drugs per patient was performed in two ways: (ii.a) a review of summary of product characteristics for listed adverse drug reactions to identify possible causing drugs and (ii.b) a causality assessment according to Naranjo algorithm. RESULTS: (i) We found 424 adverse events with a median of 4 per patient (range 1-14) in 103 of the 104 enrolled patients (99%). (ii.a) We identified a median of 3 drugs (range 0-11) with actually occurring adverse events listed as an adverse drug reaction in the summary of product characteristics. (ii.b) Causality was classified in 198 (46.9%) of adverse events as "doubtful," in 218 (51.2%) as "possible," in 7 (1.7%) as "probable," and in 1 (0.2%) adverse event as a "definitive" cause of the administered drugs. In 340 (80.2%) of all identified adverse events several drugs simultaneously reached the highest respective Naranjo score. CONCLUSION: Patients in long-term facilities frequently suffer from many adverse events. Concomitantly administered drugs have to be frequently considered as plausible causes for adverse events. These additive effects of drugs should be more focused in patient care and research.

What is the attitude towards and the current practice of information exchange during self-medication counselling in German community pharmacies? An assessment through self-report and non-participant observation.

BACKGROUND: Guidelines encourage relevant information exchange between pharmaceutical staff and patients during self-medication consultation. Thereby, assessing the patient's situation and providing information is crucial for patient safety. So far, limited studies have investigated this information exchange, particularly in Germany. We aimed to assess the attitude towards and the current practice of guideline-recommended information exchange in German community pharmacies. METHODS: In total, twelve guideline-recommended parameters were predefined for gathering patient-related information and for the provision of information. These information exchange parameters were evaluated in two parts: Firstly, in a self-report of pharmaceutical staff via an online questionnaire to assess the reported importance, difficulty and frequency of the parameters as well as barriers to their implementation; secondly, in a non-participant observation in five pharmacies to evaluate the actual consultation practice. RESULTS: In the self-report, all parameters were rated by more than 76% of 1068 participants as important. 'Concurrent medication' was determined to be the most difficult parameter to address (54%). All parameters of information gathering were rated to be addressed during routine counselling by at least 70% of the respondents. Parameters of information provision were all rated to be addressed by at least 45%. 'Lack of patient's interest' was identified as the most frequent barrier to appropriate counselling (84%). During the observation, the information gathering parameters were each addressed between 8 to 63% in the consultations, parameters of information provision between 3 to 34%. CONCLUSION: Despite broad acceptance, the guideline parameters of information exchange were comparatively little addressed during the actual routine care. This might be due to a perceived 'lack of patient's interest' in counselling. Our results suggest to scrutinize whether patients are in fact not interested in counselling and to further explore how the positive intention of pharmaceutical staff towards information exchange can be further translated into everyday practice.

Screening for impaired liver function as a risk factor for drug safety at hospital admission of surgical patients.

Background Hepatic insufficiency can affect patient safety and should therefore be considered during drug therapy. Hospital admission offers an ideal point to screen for patients at risk and to adjust drug therapy accordingly. Objective To assess the number of patients admitted to hospital with clinically elevated liver parameters. To identify high-risk patients in need of potential drug therapy adjustment to liver function by calculation of liver scores. Finally, to investigate whether pre-hospital medication needed adjustment to liver function. Setting Patients admitted to surgical wards of a tertiary teaching hospital. Method Surgical patients were included in a 3-month retrospective study. A pharmacist-led screening process, including recording of elevated liver parameters and calculation of liver scores (Child-Pugh-score, Model of End-stage Liver Disase [MELD], MELDNa), was used to assess frequency of hepatic insufficiency and patients potentially needing medication adjustment. Additionally, pre-hospital medication was checked for contraindications and correct dosage with regard to liver function. Main outcome measure Percentage of surgical patients with clinically elevated liver parameters at admission, percentage of patients with hepatic insufficiency potentially needing drug therapy adjustment, and percentage of pre-hospital drug intakes not adjusted to liver function. Results Of 1200 patients, 130 (11%) had at least one clinically relevant elevated liver parameter at hospital admission. Of these, need for drug adjustment to liver function was found for 16-36%, depending on the liver score used (equivalent to 2-4% of all patients), with the highest number of patients detected by the MELD- and MELDNa-score. Pre-hospital medication concerned 719 drug intakes and was contraindicated in 2%, dosage not adjusted in 3%, and evaluation not possible in 44% of all drug intakes due to lack of information on the drug. Conclusion A significant proportion of patients admitted for surgery have clinically elevated liver parameters and potentially need medication adjustment. A pharmacist-led screening already at hospital admission can support the identification of patients with clinically relevant elevated liver parameters and patients at risk by calculating liver scores under routine conditions. Evaluation of drug adjustment to liver function is challenging, since no data are available in routine resources for a considerable number of drugs.