Scope, content and quality of clinical pharmacy practice guidelines: a systematic review.

BACKGROUND: Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published in a number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude to developing internationally acceptable common guidelines. AIM: To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to quality standards as per the AGREE II instrument. METHOD: Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for grey literature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and any clinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers using the English version of the AGREE II instrument. RESULTS: Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) and USA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transition of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the lowest score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development. CONCLUSION: Clinical pharmacy guidelines development processes need to focus on all quality domains and should take a systematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical communication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographies.

Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks.

BACKGROUND: The use of vitamin and mineral (VMs) and non-vitamin/non-mineral supplements (non-VMs) in the general population and the older population in developed countries has increased. When combined with drugs, their use can be associated with benefit and potential risks. OBJECTIVE: The aims of this study were to determine the extent and associated factors of the combined use of drugs and VM/non-VM supplements, and to examine the potential major drug-supplement interactions METHODS: Cross-sectional analysis of first-wave data of TILDA, The Irish Longitudinal Study on Ageing, nationally representative a cohort including 8,081 community-dwelling persons aged ≥50 years. Prevalences including 95 % confidence intervals (CI) were weighted to the population. Group differences in drug and supplement use were assessed using Pearson's Chi-square test, and associations between concurrent drug-supplement use and covariates were assessed using logistic regression. Potential interactions between drugs and supplements were assessed using relevant sources. RESULTS: Every seventh respondent (14.0 %; 95 % CI 13.1-15.0) reported regular concurrent use of drugs and supplements; 7.9 % (95 % CI 7.3-8.6) took only VMs, 3.9 % (95 % CI 3.4-4.4) took only non-VMs, and 2.2 % (95 % CI 1.8-2.6) took at least one of each concurrently with drugs. Concurrent use was more prevalent in women and in the oldest (≥75 years) group. Chronic disease, female sex, third-level education and private medical insurance were associated with an increased likelihood of use of both supplement types, whereas those classed as employed were much less likely to use any supplements. Supplements were combined with drugs in all of the commonly prescribed therapeutic groups, ranging from just under 60 % with drugs for bone diseases to 15.7 % with drugs for diabetes. Potential major drug-supplement interactions were detected in 4.5 % (95 % CI 3.4-5.8) of concurrent drug-supplement users, and were more prevalent in older respondents. CONCLUSIONS: Concurrent use of drugs and supplements among those aged over 50 years in the Irish population is substantial and increases with age. There is considerable variation in usage, and the outcome of this approach is evidence of unmet need and therefore unrealised benefits among some subgroups, and of exposure to avoidable and potential serious drug interactions among others.

Food supplement use in the community dwelling population aged 50 and over in the Republic of Ireland.

OBJECTIVE: Use of food supplements in the developed world is increasing in all age groups. With older age, the prevalence of multimorbidity and pharmacotherapy increases. Aim was to explore the prevalence of food supplement use among population aged≥50 years in Ireland and to identify factors associated with food supplement use. DESIGN AND SETTING: Cross-sectional analysis of food supplements and medicines reported during in-home interviews by 8081 community dwelling participants aged≥50 years included in the first wave of the Irish Longitudinal Study on Ageing. RESULTS: The prevalence of regular use of food supplements was 16.6% (95% confidence interval (CI) 15.5-17.7%) and 14.1% (95% CI 13.2-15.1%) reported taking food supplements and medicines concomitantly. Associate factors for supplement use were being female (odds ratio (OR) 2.65; 95% CI 2.30-3.06), retired (OR 1.49; 95% CI 1.23-1.79), a non-smoker (OR 1.47; 1.21-1.77), having third level or higher education (OR 1.32; 95% CI 1.10-1.57) and living alone (OR 1.37; 1.07-1.76). Possession of private health insurance (OR 1.61; 95% CI 1.23-2.19), reporting three or more chronic conditions (OR 2.56; 95% CI 2.01-3.27) and polypharmacy were also associated factors (OR 2.35; 95% CI 1.85-2.98). CONCLUSIONS: Food supplement use is significant among the elderly in Ireland and increases with age. Its use is associated with having chronic conditions and taking (multiple) medicines, so further study is needed to assess the appropriateness and risks associated with food supplement use and to examine further the factors influencing their differential use by men and women.

Identification of risks associated with the prescribing and dispensing of oral anticancer medicines in Ireland.

BACKGROUND: Oral anticancer medicines (OAM) facilitate transfer of cancer care into the community, where safeguards developed in hospitals that control their prescribing, dispensing and administration may not exist. OBJECTIVE: To determine if the systems of prescribing and dispensing OAM in Ireland facilitate clinical verification of the prescription, thereby ensuring treatment is tailored and appropriate for the patient. SETTING: Randomly selected community pharmacies in Ireland and all Irish hospitals with cancer services. METHOD: A questionnaire was sent to a random selection of Irish community pharmacists. A different questionnaire was sent to all Irish hospitals treating cancer patients. One hundred OAM prescriptions were retrospectively reviewed, to assess the information presented and the potential barriers to a community pharmacist performing a clinical verification of the prescription. MAIN OUTCOME MEASURE: Community pharmacist survey: problems experienced when dispensing OAM and risk factors identified with the current system. Hospital pharmacist survey: proportion of hospitals that clinically verify prescriptions for parenteral versus oral anticancer medicines and associated policies. OAM prescription review: proportion of OAM prescriptions that contained sufficient information for a community pharmacist to clinically verify the prescription and safely dispense the medication. RESULTS: Sixty-four percent of community pharmacist respondents felt they did not have enough information available to them to safely dispense these prescriptions, and 74 % felt that patients are at risk with the current Irish system of prescribing and dispensing OAM. Irish hospitals do not have systems to ensure that all OAM prescriptions are clinically verified by a pharmacist. Seventeen different agents were prescribed on the prescriptions reviewed. The information provided to the community pharmacist would have allowed them to clinically verify 7 % of the OAM prescriptions. CONCLUSION: Prescriptions for OAM reach the community pharmacist with little chance that they have been clinically verified in the hospital and the medicine reaches the patient with little chance that the community pharmacist has been able to clinically verify it. Healthcare risks are increased when inadequate information about patients and their medicines are available. Appropriate specialist practitioners should be provided nationally to clinically oversee each stage of the OAM use process.