Assessing feasibility of conducting medication review with follow-up among older adults at community pharmacy: a pilot randomised controlled trial.

BACKGROUND: Medication review with follow-up is essential for optimising medication utilisation among the older adult population in primary healthcare. AIM: This study aimed to evaluate the feasibility of implementing medication reviews with follow-up for older adults in community pharmacies and examined potential outcomes on medication use. METHOD: A pilot randomised controlled trial was conducted with 4 cluster-randomised community pharmacies to assess the feasibility of the intervention. Two community pharmacies served as intervention and control groups. Both groups recruited older adults over 60 who were followed over 6 months. The translated Medication use Questionnaire (MedUseQ) was administered at baseline and 6 months for both groups. The outcomes were to assess the feasibility of conducting medication review with follow-up and the probable medication use outcomes from the intervention. RESULTS: The intervention and control groups comprised 14 and 13 older adults. A total of 35 recommendations were made by pharmacists in the intervention group and 8 in the control group. MedUseQ was easily administered, providing some evidence the feasibility of the intervention. However, there were feasibility challenges such as a lack of pharmacists, collaborative practice, difficulties with the tool language, time constraints, and limited funds. Questionnaire results provided a signal of improvement in medication administration, adherence, and polypharmacy among intervention participants. The incidence of drug related problems was significantly higher in the control group (median = 1) after 6 months, U = 15, z = - 2.98, p = 0.01. CONCLUSION: Medication review with follow-up is potentialy practical in community pharmacies, but there are feasibility issues. While these challenges can be addressed, it is essential to study larger sample sizes to establish more robust evidence regarding outcomes. CLINICAL TRIAL REGISTRY: ClinicalTrials.Gov NCT05297461.

Medication use problems and factors affecting older adults in primary healthcare.

BACKGROUND: As the largest demographic group utilizing primary healthcare facilities, older adults often face the challenge of managing multiple chronic illnesses, leading to numerous medications. OBJECTIVE: The present study aims to assess medication use problems among older adults and explore the factors affecting them in primary healthcare settings. METHODS: A mixed-method study was conducted to establish a baseline understanding of the perspectives and challenges faced by older adults, with regards to medication use. Translated Medication Use Questionnaire (MedUseQ), a patient-centered tool, was distributed to older adults above 60 in primary healthcare settings to assess their frequency of problems related to medication use. Fifteen semi-structured interviews were conducted to explore this topic in depth. Descriptive and inferential analyses were conducted with quantitative data. Interviews were transcribed verbatim, and thematic analysis was conducted. Quantitative and qualitative findings data were triangulated. RESULTS: The study involved 393 participants. The most common problems with regards to medication use were polypharmacy (55.4%), administration difficulties (48.4%), limited awareness about adverse drug events (47.3%), issues with adherence (46.5%), and accessibility to primary healthcare (42.7%). Approximately 55% were satisfied with the older adult-centered medication use services by pharmacist and doctors. The qualitative findings showed that major factors affecting medication use were forgetfulness, language barriers, lack of awareness, transportation problems, long waiting times, and multiple visits to healthcare facilities. CONCLUSION: The findings of this study reveal that a significant proportion, around 50%, of the older adult population face challenges with medication use in Penang. These difficulties mainly stem from medication administration, adherence, accessibility, polypharmacy, and inadequate medication knowledge. The qualitative analysis further highlighted several factors that contribute to such medication-related problems. Given the rapidly aging Association of Southeast Asian Nations (ASEAN) population, it is essential to devise effective solutions and strategies to tackle medication use-related issues among older adults.

Helping older adults with their medication use problems: A qualitative study on perspectives and challenges of primary health care providers.

BACKGROUND: Primary care providers help older adults with medication use problems in Malaysia and globally. They help older adults with medication management, appropriate use, and administration; however, their perspectives and challenges regarding medication use problems in older adults have not been adequately explored. METHODS: The study used a qualitative methodology comprising 30 in-depth interviews among general practitioners and pharmacists in Penang, Malaysia, in public and private primary care settings. Participants were recruited based on purposive sampling. Interviews were transcribed verbatim, and data were coded based on the principles of thematic analysis in NVivo. OBJECTIVE: This study aims to understand primary care providers' perspectives and challenges regarding medication use problems experienced by older adults. RESULTS: Six themes emerged from the study. Theme one highlighted the pharmaceutical care needs of older adults with sensory impairments and accessibility issues. The second and third themes explored medicines management support and potentially inappropriate medication use. Theme four supported collaborative practice, prescribing, and deprescribing among primary health care providers. Theme five discussed health service delivery aligned to older adults' health care needs. The final theme emphasised social and welfare support. CONCLUSION: This study identified various challenges professional primary care providers face in providing aligned healthcare services for older adults and proposed recommendations for further strengthening healthcare quality. Inputs from the primary healthcare system frontier are essential to reduce the challenges and uplift the quality of ageing populations' healthcare in Malaysia.

Medication Use Questionnaire for Older Adults in Malaysia: Translation, Cultural Adaptation, and Reliability.

OBJECTIVES: This study aimed to translate the Medication Use Questionnaire into a Malay version, adapt it to Malaysia's culture, and verify its reliability among Malaysia's older adults. METHODS: Methodological approaches were used to translate, validate, and modify the questionnaire. The subjects were older adults aged ≥ 60 years in primary care settings in Penang, Malaysia. Two forward translations (English to Malay) were developed, reviewed, and back translated to English. The reconciliation phase was conducted to compare the translated and original questionnaires. Five older adults were then interviewed for the cognitive debriefing of the reconciled questionnaire to assess the linguistic and cultural equivalence. Two experts assessed content validity, and the translated questionnaire was proofread and finalized. After that, pilot test was done to examine the internal consistency among 20 older adults. RESULTS: Translation of the questionnaire was done with no major disagreements. The main issues identified in cognitive debriefing and content validity were terms, number of questions, and phrases used in the questionnaire. Most participants reported that the questionnaires were not difficult to complete during the cognitive debriefing phase. The issues were then judged and revised accordingly. Further pilot testing on 20 older adults demonstrated good internal consistency reliability, Cronbach α (0.902). CONCLUSIONS: This study findings suggest promising data supporting the use of translated version of the Medication Use Questionnaire that can be used to identify medication use problems among older adults in Malaysia.

Types and outcomes of pharmacist-managed travel health services: A systematic review.

BACKGROUND AND AIM: Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. METHODS: A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. RESULTS: Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94-100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%-94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. CONCLUSION: Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations.

Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review.

BACKGROUND: Pharmacists in high-income countries routinely provide efficient pharmacy or pharmaceutical care services that are known to improve clinical, economic, and humanistic outcomes (ECHO) of patients. However, pharmacy services in low- and middle-income countries, mainly South Asia, are still evolving and limited to providing traditional pharmacy services such as dispensing prescription medicines. This systematic review aims to assess and evaluate the impact of pharmacists' services on the ECHO of patients in South Asian countries. METHODS: We searched PubMed/Medline, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 20th September 2021. Original studies (only randomised controlled trials) conducted in South Asian countries (published only in the English language) and investigating the economic, clinical (therapeutic and medication safety), and humanistic impact (health-related quality of life) of pharmacists' services, from both hospital and community settings, were included. RESULTS: The electronic search yielded 430 studies, of which 20 relevant ones were included in this review. Most studies were conducted in India (9/20), followed by Pakistan (6/20), Nepal (4/20) and Sri Lanka (1/20). One study showed a low risk of bias (RoB), 12 studies showed some concern, and seven studies showed a high RoB. Follow-up duration ranged from 2 to 36 months. Therapeutic outcomes such as HbA1c value and blood pressure (systolic blood pressure and diastolic blood pressure) studied in fourteen studies were found to be reduced. Seventeen studies reported humanistic outcomes such as medication adherence, knowledge and health-related quality of life, which were found to be improved. One study reported safety and economic outcomes each. Most interventions delivered by the pharmacists were related to education and counselling of patients including disease monitoring, treatment optimisation, medication adherence, diet, nutrition, and lifestyle. CONCLUSION: This systematic review suggests that pharmacists have essential roles in improving patients' ECHO in South Asian countries via patient education and counselling; however, further rigorous studies with appropriate study design with proper randomisation of intervention and control groups are anticipated.

Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis.

This review and meta-analysis aimed to determine the clinical and humanistic outcomes of community pharmacy-based interventions on medication-related problems of older adults at the primary care level. We identified randomized controlled trials (RCTs) examining the impact of various community pharmacy-based interventions from five electronic databases (namely, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, APA PSYInfo, and Scopus) from January 2010 to December 2020. Consequently, we assessed these interventions' clinical and humanistic outcomes on older adults and compared them with non-intervention. We included 13 RCTs in the current review and completed a meta-analysis with six of them. The included studies had a total of 6173 older adults. Quantitative analysis showed that patient education was significantly associated with an increase in the discontinuation of sedative-hypnotics use (risk ratio 1.28; 95% CI (1.20, 1.36) I2 = 0%, p < 0.00001). Moreover, the qualitative analysis showed that medication reviews and education with follow-ups could improve various clinical outcomes, including reducing adverse drug events, reducing uncontrolled health outcomes, and improving appropriate medication use among the elderly population. However, medication review could not significantly reduce the number of older adults who fall (risk ratio 1.25; 95% CI (0.78, 1.99) I2 = 0%, p = 0.36) and require hospitalization (risk ratio 0.72; 95% CI (0.47, 1.12) I2 = 45%, p = 0.15). This study showed that community pharmacy-based interventions could help discontinue inappropriate prescription medications among older adults and could improve several clinical and humanistic outcomes. However, more effective community pharmacy-based interventions should be implemented, and more research is needed to provide further evidence for clinical and humanistic outcomes of such interventions on older adults.