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Pharmacy
Special Issues
Drug-Related Problems in Elderly Patients
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Drug-Related Problems in Elderly Patients

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (15 February 2020) | Viewed by 16044

Special Issue Editors

Dr. Maria Gustafsson

E-Mail Website
Guest Editor
Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87 Umeå, Sweden
Interests: clinical pharmacy; drug-related problems; elderly; drug utilization research
Dr. Maria Sjölander

E-Mail Website
Guest Editor
Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87 Umeå, Sweden
Interests: drug-related problems; clinical pharmacy; medication adherence; drug utilization research; health technology assessment

Special Issue Information

Dear Colleagues,

Drug-related problems are common especially among the elderly and cause death and morbidity, reduce the quality of life, and increase healthcare costs. Adverse drug events, under-treatment, medication errors, adherence problems, and potentially inappropriate medications are all examples of drug-related problems. Through research on problems surrounding drug treatment and on ways to improve and optimize drug treatment in the elderly, we can hopefully contribute to the safe and effective use of drugs by this group of patients.

This Special Issue will focus on drug-related problems among the elderly. We invite you to submit manuscripts related to this topic. We welcome research that investigates strategies addressing drug-related problems and examines the prevalence and preventability of drug-related problems or their consequences.

We look forward to receiving your submissions.

Assoc. Prof. Maria Gustafsson
Dr. Maria Sjölander
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Drug-related problems
  • Elderly
  • Medication safety
  • Medication-related problems
  • Drug utilization
  • Pharmacy practice

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Published Papers (3 papers)

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Research

14 pages, 357 KiB  
Article
Cytochrome P450 (CYP450) Interactions Involving Atypical Antipsychotics Are Common in Community-Dwelling Older Adults Treated for Behavioral and Psychological Symptoms of Dementia
by Adriana Matos, Kevin T. Bain, David L. Bankes, Anna Furman, Briana Skalski, James Verzicco and Jacques Turgeon
Pharmacy 2020, 8(2), 63; https://doi.org/10.3390/pharmacy8020063 - 8 Apr 2020
Cited by 8 | Viewed by 5055
Abstract
Treatment of behavioral and psychological symptoms of dementia (BPSD) and comorbidities often necessitates the concomitant use of antipsychotics and non-antipsychotic drugs, thereby potentiating the risk for drug–drug interactions (DDIs). The primary objective of our study was to identify potentially clinically relevant cytochrome P450 [...] Read more.
Treatment of behavioral and psychological symptoms of dementia (BPSD) and comorbidities often necessitates the concomitant use of antipsychotics and non-antipsychotic drugs, thereby potentiating the risk for drug–drug interactions (DDIs). The primary objective of our study was to identify potentially clinically relevant cytochrome P450 (CYP)-mediated DDIs involving antipsychotics among participants enrolled in the Program of All-Inclusive Care for the Elderly (PACE) with BPSD. Additionally, we wanted to determine the prevalence of antipsychotic use in this population. The study included 10,001 PACE participants. The practice setting used a proprietary clinical decision support system (CDSS) to analyze simultaneous multidrug interactions. A retrospective analysis of pharmacy claims data was conducted to identify DDIs involving antipsychotics prescribed for BPSD, using snapshots of medication profiles paired with the CDSS. Of the participants who met inclusion criteria, 1190 (11.9%) were prescribed an antipsychotic; of those, 1071 (90.0%) were prescribed an atypical antipsychotic. Aripiprazole commonly caused (being a perpetrator drug 94.6% of the time) potential DDIs with antidepressants (e.g., duloxetine, venlafaxine, mirtazapine), opioids (e.g., hydrocodone, oxycodone, tramadol) and metoprolol via the CYP2D6 isoform. Risperidone commonly caused (85.7%) potential DDIs with donepezil, lamotrigine and trazodone via the CYP3A4 isoform. Quetiapine exclusively suffered (100%) from potential DDIs with amlodipine, buspirone, omeprazole or topiramate via the CYP3A4 isoform. Antipsychotics are commonly prescribed to PACE participants for BPSD treatment and they may interact with other drugs used to treat comorbidities. A thorough review of concomitant medications will help mitigate the likelihood of potentially dangerous CYP-mediated DDIs involving antipsychotics. Full article
(This article belongs to the Special Issue Drug-Related Problems in Elderly Patients)
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11 pages, 236 KiB  
Article
Preliminary Investigation of Pharmacist-Delivered, Direct-to-Provider Interventions to Reduce Co-Prescribing of Opioids and Benzodiazepines among a Medicare Population
by Jennifer M. Bingham, Ann M. Taylor, Kevin P. Boesen and David R. Axon
Pharmacy 2020, 8(1), 25; https://doi.org/10.3390/pharmacy8010025 - 21 Feb 2020
Cited by 12 | Viewed by 4030
Abstract
Co-prescribing of opioids and benzodiazepines can lead to overdoses and mortality. This retrospective study analyzed prescription claims data collected in 2016. A national medication therapy management (MTM) program conducted prescriber-based outreach interventions for patients with concurrent opioid and benzodiazepine prescriptions. The pharmacist’s direct-to-prescriber [...] Read more.
Co-prescribing of opioids and benzodiazepines can lead to overdoses and mortality. This retrospective study analyzed prescription claims data collected in 2016. A national medication therapy management (MTM) program conducted prescriber-based outreach interventions for patients with concurrent opioid and benzodiazepine prescriptions. The pharmacist’s direct-to-prescriber intervention was conducted following a targeted medication review. The pharmacist initiated interventions with the prescriber via facsimile to recommend discontinuation of concurrent use of these drugs. This study included 57,748 subjects who were predominantly female (67.83%) and aged ≥ 65 years (66.90%). Prescribers were most commonly located in the southern United States (46.88%). The top prescribed opioid medications were hydrocodone-acetaminophen (33.60%), tramadol (17.50%), and oxycodone-acetaminophen (15.66%). The top benzodiazepines prescribed concurrently with opioids were alprazolam (35.11%), clonazepam (21.16%), and lorazepam (20.09%). Based on the pharmacists’ recommendations, 37,990 (65.79%) resulted in a medication discontinuation (benzodiazepines 40.23%; opioids 59.77%) by the provider. There were significant differences in the proportion of opioids discontinued by subject age (p < 0.001) and prescriber geographical region (p = 0.0148). The top medications discontinued by the prescriber were hydrocodone-acetaminophen (18.86%), alprazolam (14.19%), and tramadol HCl (13.51%). This study provides initial evidence for pharmacist-supported, direct-to-prescriber programs as an effective medication safety strategy. Full article
(This article belongs to the Special Issue Drug-Related Problems in Elderly Patients)
12 pages, 573 KiB  
Article
A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes
by Kjell H. Halvorsen, Torunn Stadeløkken and Beate H. Garcia
Pharmacy 2019, 7(4), 148; https://doi.org/10.3390/pharmacy7040148 - 5 Nov 2019
Cited by 10 | Viewed by 6360
Abstract
Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration [...] Read more.
Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration in order to identify, resolve, and prevent medication related problems (MRPs). Methods: The service included residents from four rural Norwegian nursing homes during August 2016–January 2017. All residents were eligible if they (or next of kin) supplied oral consent. The interdisciplinary medication review service comprised four steps: (1) patient and medication history taking; (2) systematic medication review; (3) interdisciplinary case conference; and (4) follow-up of pharmaceutical care plan. The pharmacist collected information about previous and present medication use, and clinical and laboratory values necessary for the medication review. The nurses collected information about possible symptoms related to adverse drug reactions. The pharmacist conducted the medication reviews, identified medication-related problems (MRPs) which were discussed at case conferences with the responsible physician and the responsible nurses. The main outcome measures were number and types of MRPs, percentage agreement between pharmacists and physicians and factors associated with MRPs. Results: The service was delivered for 151 (94%) nursing home residents. The pharmacist identified 675 MRPs in 146 (97%) medication lists (mean 4.0, SD 2.6, range 0–13). The MRPs most frequently identified concerned ‘unnecessary drug’ (22%), ‘too high dosage’ (17%) and ‘drug interactions’ (16%). The physicians agreed upon 64% of the pharmacist recommendations, and action was taken immediately for 32% of these. We identified no association between the number of MRPs and sex (p = 0.485), but between the number of MRPs, and the number of medications and the individual nursing homes. Conclusion: The pharmacist-led medication review service in the nursing homes was highly successfully piloted with many solved and prevented MRPs in interdisciplinary collaboration between the pharmacist, physicians, and nurses. Implementation of this service as a standard in all four nursing homes seems necessary and feasible. If such a service is implemented, effects related to patient outcomes, interdisciplinary collaboration, and health economy should be studied. Full article
(This article belongs to the Special Issue Drug-Related Problems in Elderly Patients)
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