Evaluating a virtual reality dementia training experience using psychophysiological methods: A randomised controlled study.

OBJECTIVES: Virtual reality (VR) is increasingly used for training the dementia care workforce. It is unknown whether VR is superior to traditional training techniques in improving dementia care amongst practicing nurses. This study compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video-based, non-immersive training. METHODS: Twenty-two registered and enrolled nurses were randomised to either interactive VR experience or video footage captured from within the app. Participants completed surveys pre- and post-training to assess their knowledge of dementia, attitudes towards dementia and person-centredness. Engagement with training was assessed objectively using facial electromyography, and subjectively with self-reported scales. RESULTS: Virtual reality evoked objectively significant greater positive and negative emotional responses than video (positive emotion fEMG: VR mean .012 mV vs. video .005 mV, F[1, 20] = 8.70, p = .01; negative emotion fEMG: VR mean .018 mV vs. video .008 mV, F[1, 20] = 18.40, p < .001). Self-ratings of engagement and emotional state were similar. There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved (total DKAS mean differences: VR .1 t = .07, df = 9, p = .95 vs. video -2.3 t = -2.265, df = 11, p = .045). CONCLUSIONS: Virtual reality is more engaging than traditional training in highly experienced dementia care practitioners. Despite this, VR may not be superior to traditional training techniques to improve knowledge and attitude for many learners. A focus of future research in the area should be on how to capitalise on VR's greater emotional engagement so that Australia's nursing workforce is better equipped to care for the increasing number of people living with dementia.

An Evaluation of Zebrafish, an Emerging Model Analyzing the Effects of Toxicants on Cognitive and Neuromuscular Function.

An emerging alternative to conventional animal models in toxicology research is the zebrafish. Their accelerated development, regenerative capacity, transparent physical appearance, ability to be genetically manipulated, and ease of housing and care make them feasible and efficient experimental models. Nonetheless, their most esteemed asset is their 70% (+) genetic similarity with the human genome, which allows the model to be used in a variety of clinically relevant studies. With these attributes, we propose the zebrafish is an excellent model for analyzing cognitive and neuromuscular responses when exposed to toxicants. Neurocognition can be readily analyzed using visual discrimination, memory and learning, and social behavior testing. Neuromuscular function can be analyzed using techniques such as the startle response, assessment of activity level, and evaluation of critical swimming speed. Furthermore, selectively mutated zebrafish is another novel application of this species in behavioral and pharmacological studies, which can be exploited in toxicological studies. There is a critical need in biomedical research to discover ethical and cost-effective methods to develop new products, including drugs. Through mutagenesis, zebrafish models have become key in meeting this need by advancing the field in numerous areas of biomedical research.

Medications and cognitive risk in Aboriginal primary care: a cross-sectional study.

BACKGROUND: Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. AIM: The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). METHODS: Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression. RESULTS: The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24-0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62-4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08-16.81), hypertension (OR = 2.14, 95% CI = 1.34-3.44), diabetes (OR = 2.72, 95% CI = 1.69-4.39) or depression (OR = 1.91, 95% CI = 1.19-3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03-3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19-0.85) and remote (OR = 0.58, 95% CI = 0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37-4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02-8.83), depression (OR = 2.67, 95% CI = 1.50-4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39-5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31-5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03-0.34) and remote (OR = 0.51, 95% CI = 0.25-1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50-6.30) or depression (OR = 3.32, 95% CI = 1.70-6.47). CONCLUSION: Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.

Impact of a Multifaceted, Pharmacist-Led Intervention on Psychotropic Medication Use for Residents of Aged Care Facilities: A Parallel Cluster Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of a multifaceted intervention on reduction in psychotropic medication use, falls, agitation, emergency department (ED) visits, and hospitalization in residential aged care facilities (RACFs). DESIGN: Parallel cluster randomized controlled trial. RACFs were randomized to the multifaceted intervention, Medication Management Consultancy (MMC) (n = 5) or control (n = 6) groups. MMC, comprising online education, medication audits, and resources on psychotropic medications and nonpharmacological strategies, educates RACF staff to help reduce the use of antipsychotic medication among RACF residents through a comprehensive understanding of behavioral and psychological symptoms of dementia. SETTING AND PARTICIPANTS: A total of 439 residents from 11 RACFs in Western Australia. METHODS: The primary outcome was change in monthly total equivalent doses (mg) of antipsychotic, antidepressant, and benzodiazepine medication use over 12 months compared with a control group. Clinical outcomes included falls, restraints, agitation, ED visits, hospitalization, and knowledge of psychotropic medications among RACF staff at pre- and postintervention were measured. The duration of the intervention was 3 to 6 months. Data were collected at T0 (baseline), T1 (6 months), and T2 (12 months). RESULTS: The MMC group showed a significant 44% reduction in antipsychotic use compared with the control group at T1 (incidence rate ratios [IRR], 0.56; 95% CI, 0.32-0.99; P = .048) and also significantly reduced the number of ED visits at T1 (IRR, 0.15; 95% CI, 0.06-0.35; P < .0005) and T2 (IRR, 0.04; 95% CI, 0.01-0.13; P < .0005). Staff knowledge about psychotropic medications improved significantly from T0 to T1 and from T0 to T2. Reduction in antidepressant use at either T1 or T2 and benzodiazepine use, compared with control, at T1 and T2 were not significantly different. Other clinical outcomes showed limited impact. CONCLUSION AND IMPLICATIONS: The MMC intervention reduced the use of antipsychotics and ED visits and improved staff knowledge in RACFs, which impacts the safety and quality of aged care in Australia.

Bleeding related hospitalizations and mortality in England 2014-2019.

Acute bleeding is common and associated with increased morbidity and mortality. Epidemiological studies evaluating trends in bleeding-related hospitalisations and mortality are important as they have potential to guide resource allocation and service provision, however, despite this literature evaluating the national burden and annual trends are lacking. Our objective was to report the national burden and incidence of bleeding-related hospitalisation and mortality.This was a population-based review of all people in England between 2014 and 2019 either admitted to an acute care ward of a National Health Service (NHS) English hospital, or who died. Admissions and deaths were required to have a primary diagnosis of significant bleeding.There was a total of 3,238,427 hospitalisations with a mean of 539,738 ± 6033 per year and 81,264 deaths with a mean of 13,544 ± 331 per year attributable to bleeding. The mean annual incident rate for bleeding-related hospitalisations was 975 per 100,000 patient years and for mortality was 24.45. Over the study period there was a significant 8.2% reduction in bleeding related deaths (χ2 test for trend 91.4, p < 0.001). A direct relationship between increasing age and incidence of bleeding-related hospitalisation and mortality was seen.Bleeding remains a common cause of hospitalisation and death. The reduction in bleeding related mortality requires further investigation. This data may serve to guide future interventions designed to reduce bleeding-related morbidity and mortality.

Association of Psychotropic Education with Quality of Life: A Before-After Study in Residential Aged Care Facilities.

BACKGROUND: Improving or maintaining quality of life (QoL) is an important aim for caring for people with dementia living in residential aged care facilities (RACFs). OBJECTIVES: This study aimed to investigate the effect of a specific intervention, the Medication Management Consultancy (MMC), on the QoL of residents of RACFs in Western Australia, and to examine the association between psychotropic medications and QoL. METHODS: A before-after study was conducted. Staff from four RACFs participated in the MMC, and 56 residents with dementia from these RACFs were included. The MMC consisted of an online interactive staff education training course comprising educational videos, and a case study encompassing non-pharmacological strategies, person-centred care for behavioural and psychological symptoms of dementia (BPSD), and strategies to reduce the use of antipsychotics. Following the training, posters, reference cards, reminder stickers, administration of the Older Age Psychotropic Quiz (OAPQ), and 30-min video conferences with action groups in RACFs were utilised. At baseline (T0), QoL, neuropsychiatric symptoms (NPS) and staff distress, cognition, and activities of daily living were assessed by QoL in Alzheimer's Disease (QoL-AD), Neuropsychiatric Inventory-Questionnaire (NPI-Q), Standardised Mini-Mental State Examination (SMMSE) and Bristol Activity of Daily Living Scale (BADLS), respectively, and repeated at 6 (T1) and 12 months (T2). Medication data were obtained from residents' medication charts. RESULTS: At baseline, of the 56 participants, 33 completed the study. Compared with baseline (31.2, 95% confidence interval [CI] 28.9-33.6), QoL significantly improved at 6 months (33.5, 95% CI 30.9-36.0; p < 0.001) but not from baseline to 12 months (31.09, 95% CI 28.5-33.7; p = 0.58). The NPI-Q severity (residents) significantly improved from 9 (interquartile range [IQR] 11) at T0 to 6 (IQR 9.5) at T1 (p = 0.014) and to 7 (IQR 11) at T2 (p = 0.026). The medians of NPI-Q distress (staff) significantly improved from 12 (IQR 13.5) at T0 to 8 (IQR 9) at T1 (p = 0.013) and to 6 (IQR 11.5) at T2 (p = 0.018). Monthly doses of antipsychotics declined significantly by 51.8% at 6 months (p = 0.003) and by 43.5% at 12 months (p = 0.003); antidepressant doses declined significantly by 25.4% at 6 months (p = 0.013) and by 39.4% at 12 months (p = 0.016); benzodiazepines doses remained stable. QoL and use of psychotropics, age, sex, NPI-severity, and BADLS were not correlated. CONCLUSION: The MMC was associated with improvement in QoL, NPS, staff distress, and reduction in monthly use of antipsychotics and antidepressants among RACF residents. There was no correlation between improved QoL and reduction in use of psychotropic medications, but due to the limitations of our study, this should be confirmed in additional studies.

Provision of a comprehensive medicines review is associated with lower mortality risk for residents of aged care facilities: a retrospective cohort study.

BACKGROUND: no studies have examined the impact of residential medication management review (RMMR, a 24-year government subsidised comprehensive medicines review program) in Australian residential aged care facilities (RACFs) on hospitalisation or mortality. OBJECTIVE: to examine associations between RMMR provision in the 6-12 months after RACF entry and the 12-month risk of hospitalisation and mortality among older Australians in RACFs. DESIGN: retrospective cohort study. SUBJECTS: individuals aged 65-105 years taking at least one medicine, who entered an RACF in three Australian states between 1 January 2012 and 31 December 2015 and spent at least 6 months in the RACF (n = 57,719). METHODS: Cox regression models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for associations between RMMR provision and mortality. Adjusted subdistribution hazard ratios were estimated for associations between RMMR provision and next (i) emergency department (ED) presentation or unplanned hospitalisation or (ii) fall-related ED presentation or hospitalisation. RESULTS: there were 12,603 (21.8%) individuals who received an RMMR within 6-12 months of RACF entry, of whom 22.2% (95%CI 21.4-22.9) died during follow-up, compared with 23.3% (95%CI 22.9-23.7) of unexposed individuals. RMMR provision was associated with a lower risk of death due to any cause over 12-months (aHR 0.96, 95%CI 0.91-0.99), but was not associated with ED presentations or hospitalisations for unplanned events or falls. CONCLUSIONS: provision of an RMMR in the 6-12 months after RACF entry is associated with a 4.4% lower mortality risk over 12-months but was not associated with changes in hospitalisations for unplanned events or falls.

Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study.

BACKGROUND: Residential Medication Management Review (RMMR) is a subsidized comprehensive medicines review program for individuals in Australian residential aged care facilities (RACFs). This study examined weekly trends in medicines use in the four months before and after an RMMR and among a comparison group of residents who did not receive an RMMR. METHODS: This retrospective cohort study included individuals aged 65 to 105 years who first entered permanent care between 1/1/2012 and 31/12/2016 in South Australia, Victoria, or New South Wales, and were taking at least one medicine. Individuals with an RMMR within 12 months of RACF entry were classified into one of three groups: (i) RMMR within 0 to 3 months, (ii) 3 to 6 months, or (iii) within 6 to 12 months of RACF entry. Individuals without RMMRs were included in the comparison group. Weekly trends in the number of defined daily doses per 1000 days were determined in the four months before and after the RMMR (or assigned index date in the comparison group) for 14 medicine classes. RESULTS: 113909 individuals from 1979 RACFs were included, of whom 55021 received an RMMR. Across all three periods examined, decreased use of statins and proton pump inhibitors was observed post-RMMR in comparison to those without RMMRs. Decreases in calcium channel blockers, benzodiazepines/zopiclone, and antidepressants were observed following RMMR provision in the 3-6 and 6-12 months after RACF entry. Negligible changes in antipsychotic use were also observed following an RMMR in the 6-12 months after RACF entry by comparison to those without RMMRs. No changes in use of opioids, ACE inhibitors/sartans, beta blockers, loop diuretics, oral anticoagulants, or medicines for osteoporosis, diabetes or the cognitive symptoms of dementia were observed post-RMMR. CONCLUSIONS: For six of the 14 medicine classes investigated, modest changes in weekly trends in use were observed after the provision of an RMMR in the 6-12 months after RACF entry compared to those without RMMRs. Findings suggest that activities such as medicines reconciliation may be prioritized when an RMMR is provided on RACF entry, with deprescribing more likely after an RMMR the longer a resident has been in the RACF.

Outcomes and anticoagulation use for elderly patients that present with an acute hip fracture: multi-centre, retrospective analysis.

BACKGROUND: Hip fractures are a common problem and corrective surgery is recommended within 24 h. However, most peri-operative direct oral anticoagulant (DOAC) guidelines suggest a washout period of 48 h before major surgery. There are limited data on utility of drug levels. AIM: To investigate the effect of DOAC therapy on time to surgery and patient outcomes, and to explore the impact of different pre-operative protocols on surgical delay. METHODS: A multi-centre, retrospective analysis of all adult patients that presented with acute hip fracture at three tertiary hospitals in Perth, Western Australia, was performed. Data were collated from the West Australian hip fracture registry and electronic records. Time to theatre, DOAC levels, bleeding and transfusion rates were compared between sites. RESULTS: Of 1240 hip fracture patients, 146 (11.9%) were on anticoagulation, with more patients taking a DOAC than warfarin. The time to surgery was significantly longer for those on a DOAC compared with those on warfarin (P = 0.003). There was no difference in bleeding, transfusion requirement or 30-day mortality in patients taking a DOAC compared to those on warfarin. Fifty-eight (70.7%) patients had a DOAC level prior to surgery. Of 25 patients who had a level performed within 12 h of presentation, 13 (52%) had a result of ≤50 ng/mL. Outcomes were similar between sites. CONCLUSION: People on DOAC treatment had a significant delay before corrective surgery compared with those on warfarin. The frequent finding of early DOAC levels <50 ng/mL suggests this delay may be unnecessary in a significant proportion of patients.

Aged care staff perceptions of an online training program for responsive behaviours of residents with dementia.

OBJECTIVE: To explore residential aged care staff perceptions of an online training program on the management of antipsychotic medications for responsive behaviour in residential aged care. METHODS: A qualitative process evaluation was undertaken in four residential aged care facilities of one organisation in Australia. Five focus group interviews were conducted with 25 participants including nurses, care workers, occupational therapists and assistants. RESULTS: Direct care staff found that the training program increased their awareness and knowledge of responsive behaviours associated with dementia. Inductive thematic analysis identified three themes: (1) impact of online learning for dementia care; (2) applying online learning in dementia practice; and (3) realising the benefits and challenges of online learning. CONCLUSIONS: From the perspective of the participants, the online training program had a positive effect on their knowledge, communication and practice of caring for residents with dementia with responsive behaviours.

Pattern of prescription of psychotropics (antipsychotics, antidepressants and benzodiazepines) in Western Australian residential aged care facilities.

Behavioural and psychological symptoms of dementia are exhibited by up to 90% of residents in aged care facilities and are associated with a risk of inappropriate use of psychotropic drugs. This study examined the prevalence pattern of psychotropic drug use in 409 residents from 11 residential aged care facilities in Western Australia. Sixty-four (n = 64; 15.6%) residents were not prescribed any psychotropic drug, 345 (84.4%) were prescribed at least one psychotropic drug and between 4 and 10% were prescribed high doses, depending on the class of psychotropic. Despite increasing awareness of inappropriate psychotropic drug use in this population, targeted and effective interventions are required to improve psychotropic prescribing practices.

Optimisation of medications used in residential aged care facilities: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Frail older adults living in residential aged care facilities (RACFs) usually experience comorbidities and are frequently prescribed multiple medications. This increases the potential risk of inappropriate prescribing and its negative consequences. Thus, optimising prescribed medications in RACFs is a challenge for healthcare providers. OBJECTIVE: Our aim was to systematically review interventions that increase the appropriateness of medications used in RACFs and the outcomes of these interventions. METHODS: Systematic review and meta-analysis of randomised control trials (RCTs) and cluster randomised control trials (cRCTs) were performed by searching specified databases (MEDLINE, PubMed, Google scholar, PsycINFO) for publications from inception to May 2019 based on defined inclusion criteria. Data were extracted, study quality was assessed and statistically analysed using RevMan v5.3. Medication appropriateness, hospital admissions, mortality, falls, quality of life (QoL), Behavioural and Psychological Symptoms of Dementia (BPSD), adverse drug events (ADEs) and cognitive function could be meta-analysed. RESULTS: A total of 25 RCTs and cRCTs comprising 19,576 participants met the inclusion criteria. The studies tested various interventions including medication review (n = 13), staff education (n = 9), multi-disciplinary case conferencing (n = 4) and computerised clinical decision support systems (n = 2). There was an effect of interventions on medication appropriateness (RR 0.71; 95% confidence interval (CI): 0.60,0.84) (10 studies), and on medication appropriateness scales (standardised mean difference = - 0.67; 95% CI: - 0.97, - 0.36) (2 studies). There were no apparent effects on hospital admission (RR 1.00; 95% CI: 0.93, 1.06), mortality (RR 0.98; 95% CI: 0.86, 1.11), falls (RR 1.06; 95% CI: 0.89,1.26), ADEs (RR 1.04; 95% CI: 0.96,1.13), QoL (standardised mean difference = 0.16; 95% CI:-0.13, 0.45), cognitive function (weighted mean difference = 0.69; 95% CI: - 1.25, 2.64) and BPSD (RR 0.68; 95% CI: 0.44,1.06) (2 studies). CONCLUSION: Modest improvements in medication appropriateness were observed in the studies included in this systematic review. However, the effect on clinical measures was limited to drive strong conclusions.

General practitioners' perceptions on home medicines reviews: a qualitative analysis.

BACKGROUND: Home Medicines Review (HMR) is an Australian initiative introduced in 2001 to improve quality use of medicines. Medication management services such as HMRs have the potential to reduce medication related problems. In 2011, changes to the HMR program were introduced to allow for referrals directly to accredited pharmacists in addition to the community pharmacy referral model. These changes were introduced to improve efficiency of the process. This study explored the perceptions of Western Australian general practitioners (GPs) on benefits and barriers of the HMR service and process, including their insights into the direct referral model. METHODS: Purposive sampling of GPs who had experience ensured that participants had a working knowledge of the HMR service. Semi structured interviews with 24 GPs from 14 metropolitan Western Australian medical centres between March and May 2013. Transcribing and thematic analysis of data were performed. RESULTS: Most GPs had positive attitudes towards the HMR service. Main perceived benefits of the service were poly-pharmacy reduction and education for both the GP and patient. Strategies identified to improve the service were introduction of a standard HMR report template for pharmacists and better use of technology. Whilst reliability and GPs' familiarity were the main perceived benefits of the direct referral model, a number of GPs agreed that patient unfamiliarity with the HMR pharmacist was a barrier. CONCLUSIONS: Despite recognition of the value of the HMR service participating GPs were of the opinion that there are aspects of the HMR service that could be improved. As one of the success factors of HMRs is relying on GPs to utilise this service, this study provides valuable insight into issues that need to be addressed to improve HMR uptake.

Repeatable antibiotic prescriptions: an assessment of patient attitudes, knowledge and advice from health professionals.

BACKGROUND: Previous Australian research has identified that general practice software systems appear to be associated with an increase in repeatable antibiotic prescriptions. Such prescriptions potentially facilitate the use of antibiotics without medical consultation and may be inconsistent with attempts to promote prudent use of antimicrobials. AIMS: We sought to assess knowledge and attitudes to antibiotics amongst patients presenting with a repeatable prescription; and the provision of supporting advice from healthcare professionals regarding use of these repeats. METHOD: Six community pharmacies across Tasmania invited patients presenting with a repeatable antibiotic prescription to participate in the study. Participants were asked to complete a questionnaire and return this to the research team in a pre-paid envelope. RESULTS: Fifty-seven of 244 (23 per cent) surveys were returned. Regarding provision of advice on use of the repeat, 14 (25 per cent) of respondents stated that they were given no advice by the prescriber and 19 (30 per cent) no advice from the pharmacist. Five (9 per cent) were given no advice from either prescriber or pharmacist. One-third of respondents indicated that they would keep the repeat for future use and around three-quarters perceived no major safety concerns with antibiotics. CONCLUSION: Further research is needed, however, this small study suggests that provision of information to patients regarding appropriate use of repeatable antibiotic prescriptions is suboptimal. This coupled with existing patient knowledge and attitudes may contribute to inappropriate use of antibiotics.

DOCUMENT: a system for classifying drug-related problems in community pharmacy.

BACKGROUND: Drug-related problems (DRPs) are a major burden on the Australian healthcare system. Community pharmacists are in an ideal position to detect, prevent, and resolve these DRPs. Objective To develop and validate an easy-to-use documentation system for pharmacists to classify and record DRPs, and to investigate the nature and frequency of clinical interventions undertaken by Australian community pharmacists to prevent or resolve them. Setting Australian community pharmacies. METHOD: The DOCUMENT classification system was developed, validated and refined during two pilot studies. The system was then incorporated into software installed in 185 Australian pharmacies to record DRPs and clinical interventions undertaken by pharmacists during a 12-week trial. MAIN OUTCOME MEASURE: The number and nature of DRPs detected within Australian community pharmacies. RESULTS: A total of 5,948 DRPs and clinical interventions were documented from 2,013,923 prescriptions dispensed during the trial (intervention frequency 0.3%). Interventions were commonly related to Drug selection problems (30.7%) or Educational issues (23.7%). Pharmacists made an average of 1.6 recommendations per intervention, commonly relating to A change in therapy (40.1%) and Provision of information (34.7%). Almost half of interventions (42.6%) were classified by recording pharmacists as being at a higher level of clinical significance. CONCLUSION: The DOCUMENT system provided pharmacists with a useful and easy-to-use tool for recording DRPs and clinical interventions. Results from the trial have provided a better understanding of the frequency and nature of clinical interventions performed in Australian community pharmacies, and lead to a national implementation of the system.

Drug-related problems identified in post-discharge medication reviews for patients taking warfarin.

OBJECTIVE: To characterise the nature of the drug-related problems with warfarin therapy identified in pharmacist-conducted medication reviews during a collaborative post-discharge warfarin management service, with a focus on potentially serious drug interactions. SETTING: Australian community pharmacy practice. METHOD: Medication review reports submitted by pharmacists to patients' general practitioners as part of the service were reviewed and the type and clinical significance of the warfarin-associated drug-related problems, and the pharmacists' recommendations were classified. The prevalence of prescribing of 'potentially hazardous' warfarin drug interactions was investigated and compared with the frequency of documentation of these interactions in the medication review reports. MAIN OUTCOME MEASURE: The number and nature of warfarin-associated drug-related problems identified and the rate of documentation of 'potentially hazardous' warfarin drug interactions in the reports from pharmacist-conducted medication reviews. RESULTS: A total of 157 warfarin-associated drug-related problems were documented in 109 medication review reports (mean 1.4 per patient, 95% CI 1.3-1.6, range 0-5). Drug selection and Education or information were the most commonly identified warfarin-associated drug-related problems; most drug-related problems were of moderate clinical significance. Eight of 23 potentially serious warfarin drug interactions (34.8%) were identified in the medication review reports. CONCLUSION: Pharmacists addressing drug selection and warfarin education drug-related problems during medication reviews may have contributed to the positive outcomes of the post-discharge service. Warfarin drug interactions were frequently identified; however, well-recognised potentially hazardous interactions were under-reported. Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting, especially in relation to preventable drug interactions.

Drug-related problems identified in medication reviews by Australian pharmacists.

OBJECTIVE: In Australia, accredited pharmacists perform medication reviews for patients to identify and resolve drug-related problems. We analysed the drug-related problems identified in reviews for both home-dwelling and residential care-facility patients. The objective of this study was to examine the number and nature of the drug-related problems identified and investigate differences between each type of review. SETTING: Australian patients living at home or in residential care-facilities. METHOD: We collected a nation-wide sample of medication reviews conducted between 1998 and 2005. These reviews had been self-selected by pharmacists and submitted as part of the reaccreditation process to the primary body responsible for accrediting Australian pharmacists to perform medication reviews. The drug-related problems identified in each review were classified by type and drugs involved. MAIN OUTCOME MEASURE: The number and nature of drug-related problems identified in pharmacist-conducted medication reviews. RESULTS: There were 1,038 drug-related problems identified in 234 medication reviews (mean 4.6 (+/-2.2) problems per review). The number of problems was higher (4.9 +/- 2.0 vs. 3.9 +/- 2.2; P < 0.001) in reviews for home-dwelling patients compared with care-facility residents. The number of clinically-significant problems was higher (2.1 +/- 1.1 vs. 1.5 +/- 0.7; P < 0.001) for home-dwelling patients. Oral hypoglycaemics and analgesics/antipyretics were significantly more likely to be associated with problems in home-dwelling patients than in residential care-facility patients. CONCLUSION: These data illustrate the prevalence of drug-related problems and the ability of pharmacists to identify these problems in the Australian models of medication review. The nature and frequency of problems varied between reviews for home-dwelling and care-facility patients. Such information may be used to better focus the training of practitioners based on the most frequently encountered health problems and the nature of common drug-related problems in the two settings.