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1.
J Prim Care Community Health ; 10: 2150132719890227, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31808725

RESUMEN

Background: Older persons with frailty take multiple medications and are vulnerable to inappropriate prescribing. Objective: This study assesses the impact of a team-based, pharmacist-led structured medication review process in primary care on the appropriateness of medications taken by older adults living with frailty. Methods: This was a quasi-experimental pretest-posttest design in 6 primary care practices within an academic clinic in Edmonton, Alberta, Canada. We enrolled community dwelling older adults 65 years and older with frailty who have polypharmacy and/or 2 or more chronic conditions (ie, high-risk group for drug-related issues). The intervention was a structured pharmacist-led medication review using evidence-based explicit criteria (ie, Beers and STOPP/START criteria) and implicit criteria (ie, pharmacist expertise) for potentially inappropriate prescribing, done in the context of a primary care team-based seniors' program. We measured the changes in the number of medications pre- and postmedication review, number of medications satisfying explicit criteria of START and STOPP/Beers and determined the association with frailty level. Data were analyzed using descriptive and inferential statistics (a priori significance level of P < .05). Results: A total of 54 participants (61.1% females, mean age 81.7 years [SD = 6.74]) enrolled April 2017 to May 2018 and 52 participants completed the medication review process (2 lost to hospitalization). Drug-related problems noted on medication review were untreated conditions (61.1%), inappropriate medications (57.4%), and unnecessary therapy (40.7%). No significant changes in total number of medications taken by patients before and after, but the intervention significantly decreased number of inappropriate medications (1.15 meds pre to 0.9 meds post; P = .006). Conclusion: A pharmacist-led medication review is a strategy that can be implemented in primary care to address inappropriate medications.

3.
Infect Control Hosp Epidemiol ; 40(4): 432-437, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30782227

RESUMEN

OBJECTIVES: To measure the impact of an antimicrobial stewardship initiative on the rate of urine culture testing and antimicrobial prescribing for urinary tract infections (UTIs) between control and intervention sites. Secondary objectives included evaluation of potential harms of the intervention and identifying characteristics of the population prescribed antimicrobials for UTI. DESIGN: Cluster randomized controlled trial. SETTING: Nursing homes in rural Alberta, Canada. PARTICIPANTS: The study included 42 nursing homes ranging from 8 to 112 beds.Methods/interventions:Intervention sites received on-site staff education, physician academic detailing, and integrated clinical decision-making tools. Control sites provided standard care. Data were collected for 6 months prior to and 12 months after the intervention. RESULTS: Resident age (83.0 vs 83.8 years) and sex distribution (female, 62.5% vs 64.5%) were similar between the groups. Statistically significant decreases in the rate of urine culture testing (-2.1 tests per 1,000 resident days [RD]; 95% confidence interval [CI], -2.5 to -1.7; P < .001) and antimicrobial prescribing for UTIs (-0.7 prescriptions per 1,000 RD; 95% CI, -1.0 to -0.4; P < .001) were observed in the intervention group. There was no difference in hospital admissions (0.00 admissions per 1,000 RD; 95% CI, -0.4 to 0.3; P = .76), and the mortality rate decreased by 0.2 per 1,000 RD in the intervention group (95% CI, -0.5 to -0.1; P = .002). Chart reviews indicated that UTI symptoms were charted in 16% of cases and that urine culture testing occurred in 64.5% of cases. CONCLUSION: A multimodal antimicrobial stewardship intervention in rural nursing homes significantly decreased the rate of urine culture testing and antimicrobial prescriptions for UTI, with no increase in hospital admissions or mortality.

4.
Aging Male ; 22(2): 141-149, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29921150

RESUMEN

OBJECTIVE: To describe the quality of online information on testosterone replacement therapy (TRT) in men. METHODS: A quantitative content analysis was conducted on websites providing patient-directed information on TRT for the purpose of treating late onset hypogonadism (LOH). Websites were identified through Google in March 2017. The DISCERN instrument was used to determine the quality of health information. RESULTS: A total of 20 websites met inclusion criteria. Websites were primarily from the United States (45%), United Kingdom (25%), and Australia (15%). Sources of information were cited by 40% of websites. Several websites (40%) claimed that TRT had benefits, with 25% claiming that TRT was effective for treating LOH. TRT was described as a safe therapy by one website (5%), with gynecomastia (35%) and increased hematocrit (35%) representing the most commonly described side effects. Prostate specific antigen (35%) and serum testosterone monitoring (30%) were the most commonly described monitoring parameters. The mean DISCERN score was 46.4, indicating fair quality information. The Flesh-Kincaid Grade Level was 12.2. CONCLUSION: Online TRT information is incomplete, often failing to describe important safety information and the need for regular monitoring.


Asunto(s)
Información de Salud al Consumidor/normas , Terapia de Reemplazo de Hormonas , Conducta en la Búsqueda de Información , Testosterona/administración & dosificación , Comprensión , Humanos , Internet , Testosterona/efectos adversos
5.
Inform Health Soc Care ; 44(3): 246-261, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30102117

RESUMEN

PURPOSE: Slow changes in older adults' health status are often not detected until they escalate. Our aim was to understand if e-technology can enhance the safety and quality of older adult care by detecting changes in health status early. METHODS: E-technology was implemented with 30 seniors in an assisted living facility. We used wireless devices to monitor blood pressure, oxygen saturation, weight, and hydration. This 1-year feasibility study included: a readiness assessment, procuring devices, developing an alert software, training staff, and weekly monitoring for several months. RESULTS: Analysis of service utilization data showed no significant differences in number of emergency or hospital visits between the intervention and control group. Qualitative data suggested residents were satisfied with the e-technology. Among staff, several saw value in weekly monitoring, however staff emphasized the need for devices to be suitable for older adults. CONCLUSION: It is imperative that researchers work with facilities to ensure there is value-added in implementing new technology. Staff feedback helped fine-tune devices, training materials, and measurement process. It took longer than anticipated to procure suitable devices, set up the software, and recruit residents, thus limiting data collection. Future studies should dedicate more time to implementation and propose longer timelines.

6.
Curr Pharm Teach Learn ; 10(9): 1184-1196, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30497621

RESUMEN

INTRODUCTION: Older adults constitute the largest population admitted to hospitals due to chronic diseases, which requires appropriate prescribing of medications and comprehensive pharmaceutical care. The views and perspectives of students and educators can inform curriculum review in geriatric education in pharmacy schools. METHODS: A cross sectional online survey containing 34 questions covering the areas of curriculum content and perceived needs for geriatric education was administered to students, faculty members, and preceptors. Data analysis included descriptive and inferential statistics. RESULTS: The majority of participants indicated that their pharmacy school offered geriatric education. Pharmacokinetic/Pharmacodynamic Considerations in the Elderly was the topic most frequently reported to be covered in the geriatric curricula. Significantly more use of small groups discussions for delivering the geriatric curriculum was reported by respondents in Qatar than in Canada. Experiential geriatric education was available in both countries, although duration of rotations were reported to be longer in Canada than in Qatar. The majority of respondents perceived that students were moderately prepared for providing geriatric care. DISCUSSION: This is the first study conducted to explore the current state of geriatric education in a pharmacy school in the Middle East in comparison with a well-established Canadian pharmacy curricula. CONCLUSION: Both pharmacy schools studied offer a compulsory course on special populations that includes a similar geriatric curriculum. Future surveys should investigate how geriatric content in the pharmacy curricula is being evaluated.


Asunto(s)
Docentes de Farmacia/psicología , Geriatría/educación , Facultades de Farmacia/normas , Estudiantes de Farmacia/psicología , Adulto , Canadá , Estudios Transversales , Curriculum/normas , Curriculum/tendencias , Educación en Farmacia/normas , Docentes de Farmacia/estadística & datos numéricos , Femenino , Humanos , Masculino , Qatar , Facultades de Farmacia/estadística & datos numéricos , Estudiantes de Farmacia/estadística & datos numéricos
7.
Pharmacy (Basel) ; 6(4)2018 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-30314314
8.
Can Fam Physician ; 64(5): 339-351, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29760253

RESUMEN

OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists (BZRAs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: The overall team comprised 8 clinicians (1 family physician, 2 psychiatrists, 1 clinical psychologist, 1 clinical pharmacologist, 2 clinical pharmacists, and 1 geriatrician) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated by conducting a systematic review of BZRA deprescribing trials for insomnia, as well as performing a review of reviews of the harms of continued BZRA use and narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality of evidence ratings were used to generate recommendations. The team refined guideline content and recommendations through consensus and synthesized clinical considerations to address front-line clinician questions. The draft guideline was reviewed by clinicians and stakeholders. RECOMMENDATIONS: We recommend that deprescribing (tapering slowly) of BZRAs be offered to elderly adults (≥ 65 years) who take BZRAs, regardless of duration of use, and suggest that deprescribing (tapering slowly) be offered to adults aged 18 to 64 who have used BZRAs for more than 4 weeks. These recommendations apply to patients who use BZRAs to treat insomnia on its own (primary insomnia) or comorbid insomnia where potential underlying comorbidities are effectively managed. This guideline does not apply to those with other sleep disorders or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia. CONCLUSION: Benzodiazepine receptor agonists are associated with harms, and therapeutic effects might be short term. Tapering BZRAs improves cessation rates compared with usual care without serious harms. Patients might be more amenable to deprescribing conversations if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice. This guideline provides recommendations for making decisions about when and how to reduce and stop BZRAs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.


Asunto(s)
Deprescripciones , Medicina Basada en la Evidencia/normas , Agonistas de Receptores de GABA-A/administración & dosificación , Atención Primaria de Salud/normas , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Consenso , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Humanos , Revisiones Sistemáticas como Asunto
10.
Pharm Pract (Granada) ; 16(1): 1068, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29619133

RESUMEN

Objective: Study objectives were to develop a questionnaire to assess factors influencing pharmacists' adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties. Methods: Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach's alpha. Scale responses were described. Results: Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support from interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliability while the remaining six scales had strong evidence for reliability and validity. Conclusion: Through a multi-stage process, a survey instrument was developed to capture pharmacists' perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists.

11.
J Am Geriatr Soc ; 66(7): 1428-1436, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29684250

RESUMEN

OBJECTIVES: To map the extent, range, and nature of research on the effectiveness, level of use, and perceptions about electronic medication administration records (eMARs) in long-term care facilities (LTCFs) and identify gaps in current knowledge and priority areas for future research. DESIGN: Scoping review of quantitative and qualitative literature. SETTING: Literature review. PARTICIPANTS: Original research relating to eMAR in LTCF was eligible for inclusion. MEASUREMENTS: We systematically searched MEDLINE, CINAHL, Scopus, ProQuest, and the Cochrane Library and performed general and advanced searches of Google to identify grey literature. Two authors independently screened for eligibility of studies. Independent reviewers extracted data regarding country of origin, design, study methods, outcomes studied, and main results in duplicate. RESULTS: We identified 694 articles, of which 34 met inclusion criteria. Studies were published between 2006 and 2016 and were mostly from the United States (n=25). Twenty studies (59%) used quantitative methods, including surveys and analysis of eMAR data; 7 (21%) used qualitative methods, including interviews, focus groups, document review, and observation; and 7 (21%) used mixed methods. Three major research areas were explored: medication and medication administration error rates (n=11), eMAR benefits and challenges (n=19), and eMAR prevalence and uptake (n=15). Evidence linking eMAR use and reductions in medication errors is weak because of suboptimal study design and reporting. The majority of studies were descriptive and documented inconsistent benefits and challenges and low levels of eMAR implementation. CONCLUSION: Further investigation is required to rigorously evaluate the effect of standalone eMAR systems on medication administration errors and patient safety, the extent of eMAR implementation, pharmacists' perceptions, and cost effectiveness of eMAR systems in LTCF.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Registros Electrónicos de Salud/estadística & datos numéricos , Cuidados a Largo Plazo/estadística & datos numéricos , Errores de Medicación/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Medicamentos bajo Prescripción , Anciano , Anciano de 80 o más Años , Humanos , Errores de Medicación/prevención & control
12.
Pharm. pract. (Granada, Internet) ; 16(1): 0-0, ene.-mar. 2018. tab, graf
Artículo en Inglés | IBECS | ID: ibc-171849

RESUMEN

Objective: Study objectives were to develop a questionnaire to assess factors influencing pharmacists’ adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties. Methods: Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach’s alpha. Scale responses were described. Results: Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support fro interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliabilit while the remaining six scales had strong evidence for reliability and validity. Conclusion: Through a multistage process, a survey instrument was developed to capture pharmacists’ perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists (AU)


No disponible


Asunto(s)
Humanos , Prescripciones de Medicamentos/estadística & datos numéricos , Servicios Farmacéuticos/estadística & datos numéricos , Motivación , Psicometría/instrumentación , Servicios Farmacéuticos/organización & administración , Encuestas y Cuestionarios/normas , Reproducibilidad de los Resultados , Rol Profesional
13.
Curr Drug Targets ; 19(5): 451-459, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28676000

RESUMEN

BACKGROUND: Osteoporosis is a debilitating disease characterized by bone micro-architecture degradation contributing to fragility fractures. Currently, determining bone mineral density (BMD) via dual-energy X-ray absorptiometry (DXA) is the most reliable form of diagnosing osteoporosis and managing pharmacological treatment regimens. However, changes in BMD occur slowly (i.e., several months) and DXA does not reflect the metabolic rate of bone turnover. Alternatively, biochemical bone turnover markers are metabolic indicators released into serum and/or urine, and their quantity reflects the metabolic activity of bone. bone turnover markers show a rapid response following antiresorptive drug administration, and enzyme-linked immunosorbent assays (ELISA) have been established and used in clinical trials to help assess and predict fracture risk independent of BMD. OBJECTIVE: This review highlights various established bone turnover markers that have found utility in the clinic as reliable and standardized indicators of bone turnover, with attention to those used to assess efficacy of bisphosphonate drug therapy - particularly in monitoring medication adherence in patients with postmenopausal osteoporosis. RESULTS: We posit that the use of urinary bone turnover markers values determined by immunoassay or ELISA at routine clinic visits might serve as valuable feedback to healthcare professionals and patients to help monitor the efficacy and adherence of bisphosphonate therapy and disease progression. CONCLUSION: Our belief is that when assessed in combination with an algorithm of independent risk factors, measuring urinary bone turnover markers using a point of care kit may find utility in the osteoporosis clinic as an accessible, non-invasive and cost-effective alternative for the routine assessment of efficacy of bisphosphonate therapies.


Asunto(s)
Biomarcadores/orina , Difosfonatos/efectos adversos , Osteoporosis/inducido químicamente , Absorciometría de Fotón , Densidad Ósea/efectos de los fármacos , Difosfonatos/farmacología , Humanos , Osteoporosis/diagnóstico por imagen , Osteoporosis/orina , Cooperación del Paciente , Sistemas de Atención de Punto
14.
Can Pharm J (Ott) ; 150(4): 251-258, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29163726

RESUMEN

Background: Almost 14% of Canadians have a disability, and older adults are most commonly affected. People living with disabilities have challenges accessing health care services, including medications and other services provided in pharmacies. Methods: A literature review was conducted regarding disability and pharmacy services. Resources regarding accessibility were also incorporated. Results: A number of organizations provide guidance on caring for those with disabilities. A primary concern for these vulnerable individuals relates to being invisible or overlooked by the health care system. There are also the stresses of physical, communication and attitudinal barriers. Pharmacists may be unaware of these barriers and may actually be contributing to them. To understand their patients' accessibility needs, pharmacists can consider physical and nonphysical barriers and engage in education, advocacy and communications training to improve their patient-centred care for individuals with disabilities. Discussion and Conclusion: Pharmacists can improve the care of individuals with disabilities by learning more about accessibility. Within the community pharmacy environment, there are physical and nonphysical interventions that pharmacists can implement to ensure that patient-centred care is prioritized.

16.
Trials ; 18(1): 55, 2017 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-28166816

RESUMEN

BACKGROUND: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends). METHODS/DESIGN: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration. DISCUSSION: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014.


Asunto(s)
Envejecimiento/psicología , Cuidadores/psicología , Servicios de Salud Comunitaria , Diabetes Mellitus Tipo 2/enfermería , Afecciones Crónicas Múltiples/enfermería , Autocuidado/métodos , Apoyo Social , Factores de Edad , Anciano , Alberta , Cuidadores/economía , Protocolos Clínicos , Servicios de Salud Comunitaria/economía , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/psicología , Femenino , Costos de la Atención en Salud , Estilo de Vida Saludable , Humanos , Masculino , Afecciones Crónicas Múltiples/economía , Afecciones Crónicas Múltiples/psicología , Ontario , Calidad de Vida , Proyectos de Investigación , Conducta de Reducción del Riesgo , Autocuidado/economía , Autocuidado/psicología , Factores de Tiempo , Resultado del Tratamiento
17.
Am J Health Syst Pharm ; 74(2): 62-69, 2017 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-28069679

RESUMEN

PURPOSE: Results of a survey to characterize pharmacist prescribing in the Canadian province of Alberta are reported. METHODS: A cross-sectional survey of a random sample of pharmacists registered with the Alberta College of Pharmacists was conducted. The survey was developed in four stages, with evidence of reliability and construct validity compiled. Analysis of variance and chi-square testing were used to compare prescribing behaviors. RESULTS: Three hundred fifty of 692 invited pharmacists (51%) completed the survey, with 76.9% and 11.1% indicating that they practiced in community and hospital settings, respectively, and 12.0% practicing in a consultant role (i.e., on a primary care team or in a long-term care setting). Overall, 93.4% of the pharmacists had prescribed. The most common practices were renewing prescriptions for continuity of therapy (92.3%), altering doses (74.3%), and substituting a medication due to a shortage (80.6%). Twenty-three pharmacists (6.6%) indicated that they did not prescribe because they were on an interprofessional team, had a consulting role, or preferred to fax physicians to request orders. Pharmacists with additional prescribing authorization (6.3% of the total survey population) were more likely to prescribe to adjust ongoing medications (63.6%) than to initiate a new medication (18.2%). CONCLUSION: A survey showed that Alberta pharmacists prescribed in a manner that mirrored their practice environment. Compared with other groups, hospital and consultant pharmacists were more likely to adapt prescriptions, and community pharmacists were more likely to renew medications. Pharmacists in rural areas were prescribing most frequently.


Asunto(s)
Farmacia/estadística & datos numéricos , Alberta , Estudios Transversales , Humanos , Legislación Farmacéutica , Rol Profesional , Encuestas y Cuestionarios
18.
Drugs Real World Outcomes ; 3(4): 401-407, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27747602

RESUMEN

BACKGROUND: Functional skills can affect the ability of older adults to appropriately manage their medication regimens. Research evaluating a patient's functional ability or the assessment of medication management is limited. OBJECTIVES: Our objective was to describe the documented components of functional medication management (FMM) in adults aged ≥65 years during an acute hospital stay. The secondary objective was to describe the characteristics of the healthcare providers (HCP) who document FMM. METHODS: This study was a retrospective chart review of a sample of patients aged ≥65 years admitted to medical units in a tertiary hospital from January 2013 to October 2014. FMM was defined as the steps required to take medications-including ordering, picking up, organizing, preparing, administering, and monitoring medications-and the functional abilities necessary to perform these tasks. RESULTS: The mean (standard deviation [SD]) age of patients was 78.9 (8.4) years; 72 (52 %) were female. Of the 190 charts screened, 140 were eligible for inclusion. The mean (SD) number of documented scheduled oral medications was eight (3.1) per patient, and 108 (77.1 %) charts contained documented FMM-related information. Commonly documented FMM components included whether the patient could administer medications independently (73 [52 %]) or schedule medication (46 [33 %]). These activities were most frequently documented by physicians (124 [39 %]) and occupational therapists (108 [34 %]). CONCLUSION: FMM assessments for older adult inpatients with multiple comorbidities and complex medication regimens were not documented comprehensively or frequently. Given the complexity of medication regimens and the functional skills required to manage medications at home, failing to document these assessments when evaluating patients in hospital reflects a lost opportunity.

19.
Can J Hosp Pharm ; 69(1): 14-22, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26985084

RESUMEN

BACKGROUND: Clinicians often face challenges in deciding how to treat osteoporosis in patients with chronic kidney disease. As background to offering guidance to health care providers, it is important to understand their practices and beliefs. OBJECTIVES: To describe the practices and beliefs of pharmacists regarding use of bisphosphonates for patients with osteoporosis and chronic kidney disease. METHODS: A cross-sectional survey of pharmacists working in hospitals and related health care settings was conducted. A 34-item online questionnaire was developed consisting of 4 sections: demographic characteristics, practices, beliefs, and comfort level with making decisions about osteoporosis treatment. An e-mail invitation was sent to members of the Canadian Society of Hospital Pharmacists (n = 2499) in November 2012. RESULTS: A total of 367 pharmacists completed the survey. Most of the respondents were women (258 [70%]), had more than 10 years in practice (213 [58%]), and were providing care to 1 or more osteoporosis patients per week (212 [58%]). Over one-third (150 [41%]) stated that they would use a bisphosphonate for patients with creatinine clearance (CrCl) of 15-30 mL/min, but more than half (207 [56%]) stated that they would avoid a bisphosphonate (and recommend another medication) for patients with CrCl below 15 mL/min. Forty-eight percent (176/363) agreed that oral bisphosphonates could be used for patients with renal failure (defined as CrCl < 30 mL/min), so long as dosage adjustments are made. More than half (206/363 [57%]) believed that the adverse effects of oral bisphosphonates increase for patients with renal failure. Respondents expressed a low level of comfort in assessing and initiating osteoporosis treatment for patients with renal failure. CONCLUSIONS: Pharmacists had varying beliefs about managing osteoporosis in patients with chronic kidney disease. This study highlights the need for practice tools and targeted education addressing the use of bisphosphonates for these patients.

20.
Clin Interv Aging ; 11: 73-81, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26869776

RESUMEN

BACKGROUND: Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. METHODS: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers' Criteria for medication management and the Cockcroft-Gault formula for estimating glomerular filtration rates (GFR). The "Seniors Medication Alert and Review Technologies" (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. RESULTS: Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. CONCLUSION: While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers' Criteria in ambulatory care EMRs.


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas/estadística & datos numéricos , Administración del Tratamiento Farmacológico/normas , Lista de Medicamentos Potencialmente Inapropiados , Atención Primaria de Salud/normas , Anciano , Interacciones de Drogas , Femenino , Humanos , Entrevistas como Asunto , Masculino , Médicos , Polifarmacia
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