Trends in the receipt of medicines information among Finnish adults in 1999-2014: a nationwide repeated cross-sectional survey.

OBJECTIVE: The aim of this study was to examine long-term trends in the receipt of medicines information (MI) among adult medicine users from 1999 to 2014. DESIGN: Repeated cross-sectional postal survey from the years 1999, 2002, 2005 and 2008-2014. SETTING: Each study year, a new nationally representative sample of 5000 Finns aged 15-64 years was drawn from the Population Register Centre of Finland. PARTICIPANTS: The range of annual respondents varied from 2545 to 3371 and response rates from 53% to 67%. Of the total responses (n=29 465), 64% were from medicine users (n=18 862, ranging by year from 58% to 68%). OUTCOME MEASURES: Receipt of information on medicines in use within 12 months prior to the survey from a given list of consumer MI sources available in Finland. RESULTS: Physicians, community pharmacists and package leaflets were the most common MI sources throughout the study period. Receipt of MI increased most from the Internet (from 1% in 1999 to 16% in 2014), while decreased most from physicians (62% to 47%) and package leaflets (44% to 34%), and remained stable from community pharmacists (46% to 45%) and nurses (14% to 14%). In 1999, of the medicine users 4% did not report receipt of MI from any of the sources listed in the survey, while this proportion had remarkably increased to 28% in 2014. CONCLUSIONS: Healthcare professionals and package leaflets had still a dominating importance in 2014 despite the growing number of MI sources over time, but still a minority of adult medicine users reported receiving MI via the Internet in 2014. Worrying is that the proportion of adult medicine users who did not receive MI from any of the sources became seven fold during the study period.

Community Pharmacists' Contribution to Medication Reviews for Older Adults: A Systematic Review.

OBJECTIVES: To identify medication review interventions for older adults that involve community pharmacists and evidence of outcomes of these interventions. DESIGN: Systematic review. MEASUREMENTS: Cinahl, MEDLINE (Ovid), Scopus, International Pharmaceutical Abstracts, and Cochrane Library were searched for articles published between January 2000 and February 2016. Articles involving community pharmacists in medication reviews for outpatients aged 65 and older were included. Evidence of economic, clinical, and humanistic outcomes of interventions was summarized. RESULTS: Sixteen articles were found that described 12 medication review interventions, of which 6 were compliance and concordance reviews, 4 were clinical medication reviews, and 2 were prescription reviews according to a previously developed typology. Community pharmacists' contributions to reviewing medications varied from sending the dispensing history to other healthcare providers to comprehensive involvement in medication management. The most commonly assessed outcomes of the interventions were medication changes leading to reduction in actual or potential drug-related problems (n=12) and improved adherence (n=5). CONCLUSION: Regardless of community pharmacists' contributions to interventions, medication review interventions seem to reduce drug-related problems and increase medication adherence. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacists' contributions to reviewing medications and improving the health of older adults.

Can Practical Nurses Identify Older Home Care Clients at Risk of Drug-Related Problems-Geriatricians' Appraisal of Their Risk Screenings: A Pilot Study.

Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). Objective: Establish the sensitivity of practical nurse (PN) administered DRP risk assessment tool (DRP-RAT) compared with geriatrician's assessment of the medical record. Identify the clinically most significant DRPs needing action. Methods: Twenty-six PNs working in HC of Härkätie Health Center in Lieto, Finland, 46 HC clients (≥65 years), and a geriatrician participated in this pilot study. The geriatrician reviewed HC clients' medications using 3 different methods. The reviews were based on the following: (1) the PN's risk screening (ie, PN-completed DRP-RAT) and medication list, (2) health center's medical records, and (3) methods 1 and 2 together. The main outcome was the number of "at-risk patients" (ie, the patient is at risk of clinically significant DRPs) by using each review method. Secondary outcomes were clinically most significant DRP-risk predicting factors identified by the geriatrician. Results: The geriatrician reviewed 45 clients' medications using all 3 methods. Based on PN-completed DRP-RAT and medication list, 93% (42/45) of the clients were classified as "at-risk patients." Two other review methods resulted in 45/45 (100%) "at-risk patients." Symptoms suggestive of adverse drug reactions were the most significant risk predicting factors. Small sample size limits the generalizability of the results. Conclusions: The PN-completed DRP-RAT was able to provide clinically important timely patient information for clinical decision making. DRP-RAT could make it possible to more effectively involve PNs in medication risk management among older HC clients.

Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care.

AIM: To evaluate feasibility of a practical nurse-administered Drug-related Problem Risk Assessment Tool among home care clients ⩾65 years. METHODS: Altogether, 36 practical nurses participated in the study. They were trained about the purpose and use of the tool. The training consisted of a day long interactive workshop and involved reviewing four self-selected clients' medications using the tool (one as a pre-assignment before and three as post-assignments after the workshop). The data of this study were collected during the training. Triangulation, i.e. combination of methods and data, was used to evaluate the feasibility of the tool. Quantitative data were gathered from returned post-assignment tools and qualitative data from face-to-face discussions and open questions in feedback forms the practical nurses returned after the training. RESULTS: Practical nurses spent 10-45 minutes reviewing one client's medication using the tool (mean 20±8). They identified reliably 88% of the risk medicines used by the clients listed in the tool. Of the respondents (n=23) of the feedback forms, 43% reported that they felt it easy or quite easy to answer the questions of the tool. Generic names of medicines, time constraints, home-care workers'/client's lack of interest to client's pharmacotherapy and short client contacts were the most common barriers to use the tool. CONCLUSIONS: The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool.

Content validation of a tool for assessing risks for drug-related problems to be used by practical nurses caring for home-dwelling clients aged ≥65 years: a Delphi survey.

PURPOSE: Home care services are becoming a critically important part of health care delivery as populations are aging. Those using home care services are increasingly older, more frail than previously, and use multiple medications, making them vulnerable to drug-related problems (DRPs). Practical nurses (PN) visit home-dwelling aged clients frequently and, thus, are ideally situated to identify potential DRPs and, if needed, to communicate them to physicians for resolution. This study developed and validated the content of a tool to be used by PNs for assessing DRP risks for their home-dwelling clients aged ≥65 years. METHODS: The first draft of the tool was based on two systematic literature reviews and clinical experience of our research group. Content validity of the tool was determined by a three-round Delphi survey with a panel of 18 experts in geriatric care and pharmacotherapy. An agreement by ≥80% of the panel on an item was required. RESULTS: The final tool consists of 18 items that assess risks for DRPs in home-dwelling aged clients. It is divided into four sections: (1) Basic Client Data, (2) Potential Risks for DRPs in Medication Use, (3) Characteristics of the Client's Care and Adherence, and (4) Recommendations for Actions to Resolve DRPs. CONCLUSIONS: The Delphi process resulted in a structured DRP Risk Assessment Tool that is focused on the highest priority DRPs that should be identified and resolved. The tool also assists the PNs to identify solutions to these problems, which is a unique feature compared to similarly purposed prior tools.

Comprehensive medication reviews for elderly patients: findings and recommendations to physicians.

OBJECTIVES: To assess drug-related problems (DRPs) documented by specially trained community pharmacists during the Finnish comprehensive medication review (CMR) procedure and to describe the resulting interventions for home-dwelling and assisted-living primary care patients 65 years or older. METHODS: Retrospective analysis of applicable written CMR case reports for primary care patients 65 years or older by 26 community pharmacists attending a 1.5-year CMR accreditation training (174 patients recruited; 121 included in the analysis). The main outcome measures were DRPs and physicians' acceptance of pharmacists' recommendations. RESULTS: The pharmacists reported a total of 785 DRPs (average of 6.5/patient). DRPs were more common among home-dwelling patients (7.2) than those in the assisted-living setting (5.5; P = 0.014) but were similar in nature. Inappropriate drug choices were the most common DRPs (17% of DRPs), involving most often hypnotics and sedatives. Also, indications with no treatment were common (16%), particularly those associated with cardiovascular diseases and osteoporosis. Pharmacists made 649 recommendations, 55% (n = 360) of which were accepted by physicians without revision. In 51% of DRPs (n = 403), CMRs resulted in change of drug therapy; stopping a drug was the most common change. CONCLUSION: Specially trained pharmacists were able to identify DRPs among elderly primary care patients by using a CMR procedure, and more than one-half of the identified DRPs led to medication changes. The pharmacists' special knowledge of geriatric pharmacotherapy and access to clinical patient data were crucial for recognizing DRPs.

Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review.

Because inappropriate prescribing is prevalent in individuals aged 65 and older, various criteria to assess it have been developed. This study's aim was to systematically review articles that describe criteria for assessing inappropriate prescribing in individuals aged 65 and older and to define the circumstances of their use (explicit/implicit), origins, development processes, and content. A systematic search was conducted on MEDLINE and PubMed (1990-2010) and augmented with a manual search. Original articles written in English were included if they described the development of the criteria and were aimed at people aged 65 and older. Articles that described criteria applicable only in hospital settings, specific drugs, or a particular disease or condition were excluded. Sixteen of 535 articles met the inclusion criteria. They described 14 criteria, half originating in the United States. The English-language restriction limited the search results. Most criteria were explicit, consensus validated, based totally or partly on Beers criteria, and focused on pharmacological appropriateness of prescribing and some were old. Drug- and disease-oriented explicit criteria require regular updating and are country specific. Implicit, person-specific criteria are universal and do not need updating, although their use requires up-to-date professional skills. Unlike explicit criteria, implicit criteria have been validated in people. Some of the 14 criteria were noncomprehensive, mainly because of the intended purpose. To conclude, different criteria exist for optimizing prescribing for individuals aged 65 and older. Possible deficiencies must be recognized and trade-offs made when selecting criteria for use. In the future, more-comprehensive and -timely criteria are needed.

Continuing education course to attain collaborative comprehensive medication review competencies.

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.

Effect of therapeutic class on counseling in community pharmacies.

OBJECTIVE: To assess the effect and importance of the therapeutic class of a drug as a determinant for verbal counseling by community pharmacists. METHODS: Direct external observations (n = 1431) of pharmacist-customer interactions at the point of delivery of prescription medicines were conducted in 7 community pharmacies in Finland. Trained observers noted whether the pharmacist provided information on directions for use, mode of action, and adverse effects. To examine factors associated with counseling, a multiple logistic regression analysis was constructed, with the dependent variable being counseling of any of the 3 observed topics. In addition to therapeutic class, other independent variables were the pharmacy; pharmacist's age, gender, and degree; and the customer's age, gender, previous use of medicine, and question asking. RESULTS: Provision of counseling differed significantly according to therapeutic classes. Counseling on any of the 3 observed topics was most likely to be provided for customers with antibiotics (80%) and least likely for customers with gynecologic preparations (18%). Differences between therapeutic classes remained statistically significant when the effects of the other variables were controlled for. Other significant predictors for any verbal counseling were the pharmacy, customer's previous use of the medicine, and question asking. CONCLUSIONS: Therapeutic class is an important variable that should be included in further studies and considered when comparing studies on patient counseling in community pharmacies.