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Identification of Potential Drug-related Problems in the Elderly: The Role of the Community Pharmacist

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Abstract

Objective: The high prevalence of multiple drug use combined with age-related changes in pharmacokinetics and pharmacodynamics makes older adults more vulnerable to drug-related problems (DRPs). This pharmacy-based study was performed to identify potential DRPs from prescription records of the elderly and the role of the pharmacist in this process. Method: The study was performed from June 2002 to February 2003 in 16 community pharmacies in the Netherlands. Medication assessment of elderly patients aged 65 and over using six or more drugs concomitantly took place on the date of inclusion. Ten types of potential DRPs, grouped into three categories, were determined. The three groups were patient-related, prescriber-related or drug-related potential DRPs. We looked at the occurrence, nature and determinants of differential potential DRPs. Results: The mean number of prescriptions per patient was 8.7. In total 3.9 potential DRPs per elderly person were identified. The distribution of the potential DRPs over the three categories was: patient related 4.7%, prescriber related 55.7% and drug related 39.6%. Use of NSAIDs (OR 29.9; 95% CI 4.1–219) and digoxin (OR 15.7; 95% CI 4.9–50.5) were associated with the highest risk for potential DRPs. Conclusion: In this vulnerable group of elderly patients potential DRPs frequently occur. Community pharmacists can play an important role in the identification, assessment and prevention of potential DRPs in the elderly. It is useful to investigate which part of potential DRPs can be avoided by the intervention of the community pharmacist in collaboration with the prescriber and the patient.

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References

  1. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE and Mitchell AA (2002). Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 287: 337–344

    Article  PubMed  Google Scholar 

  2. Veehof LJ, Stewart R, Haaijer-Ruskamp FM and Meyboom-de Jong B (1999). Chronic polypharmacy in one-third of the elderly in family practice. Ned Tijdschr Geneeskd 143: 93–97

    CAS  PubMed  Google Scholar 

  3. Masoudi FA and Krumholz HM (2003). Polypharmacy and comorbidity in heart failure. BMJ 327: 513–514

    Article  PubMed  Google Scholar 

  4. Murray MD and Callahan CM (2003). Improving medication use for older adults: an integrated research agenda. Ann Intern Med 139: 425–429

    PubMed  Google Scholar 

  5. Veehof L, Stewart R, Haaijer-Ruskamp F and Jong BM (2000). The development of polypharmacy. A longitudinal study. Fam Pract 17: 261–267

    Article  CAS  PubMed  Google Scholar 

  6. Mangoni AA and Jackson SH (2004). Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 57: 6–14

    Article  CAS  PubMed  Google Scholar 

  7. Rochon PA and Gurwitz JH (1997). Optimising drug treatment for elderly people: the prescribing cascade. BMJ 315: 1096–1099

    CAS  PubMed  Google Scholar 

  8. Lau HS (1998) Drug related problems in the elderly: studies on occurrence and interventions. Thesis, University of Utrecht

  9. Heerdink ER (1995) Clustering of drug use in the elderly: population based studies into prevalence and outcomes. Thesis, University of Utrecht

  10. van Dijk KN (2002) Pharmacotherapy in frail elderly: pharmacy data as a tool for improvement. Thesis, University of Groningen

  11. Bernsten C, Bjorkman I, Caramona M, Crealey G, Frokjaer B and Grundberger E (2001). Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries. Drugs Aging 18: 63–77

    Article  CAS  PubMed  Google Scholar 

  12. Veehof LJG (1999) Polypharmacy in the elderly. Thesis, University of Groningen

  13. Strand LM, Morley PC, Cipolle RJ, Ramsey R and Lamsam GD (1990). Drug-related problems: their structure and function. DICP 24: 1093–1097

    CAS  PubMed  Google Scholar 

  14. Schaefer M (2002). Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc. Pharm World Sci 24: 120–127

    Article  PubMed  Google Scholar 

  15. van Mil JW, Westerlund LO, Hersberger KE and Schaefer MA (2004). Drug-related problem classification systems. Ann Pharmacother 38: 859–867

    Article  PubMed  Google Scholar 

  16. KNMP (2002) Informatorium Medicamentorum. ISBN 90-70605-70-8

  17. Health Base Foundation (2002) Comments on medication surveillance Pharmacom and Medicom. GrafiData, Deventer. ISBN 90-74027-17-2

  18. Simon SR and Gurwitz JH (2003). Drug therapy in the elderly: improving quality and access. Clin Pharmacol Ther 73: 387–393

    Article  PubMed  Google Scholar 

  19. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J and Beck JC (1991). Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151: 1825–1832

    Article  CAS  PubMed  Google Scholar 

  20. Beers MH (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 157: 1531–1536

    Article  CAS  PubMed  Google Scholar 

  21. Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B and Wickizer SW (2001). Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 286: 2823–2829

    Article  CAS  PubMed  Google Scholar 

  22. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM and Lewis IK (1992). A method for assessing drug therapy appropriateness. J Clin Epidemiol 45: 1045–1051

    Article  CAS  PubMed  Google Scholar 

  23. Kassam R, Martin LG and Farris KB (2003). Reliability of a modified medication appropriateness index in community pharmacies. Ann Pharmacother 37: 40–46

    Article  PubMed  Google Scholar 

  24. Knight EL and Avorn J (2001). Quality indicators for appropriate medication use in vulnerable elders. Ann Intern Med 135: 703–710

    CAS  PubMed  Google Scholar 

  25. Sorensen L, Grobler MP and Roberts MS (2003). Development of a quality use of medicines coding system to rate clinical pharmacists’ medication review recommendations. Pharm World Sci 25: 212–217

    Article  PubMed  Google Scholar 

  26. Meyboom RH, Lindquist M and Egberts AC (2000). An ABC of drug-related problems. Drug Saf 22: 415–423

    Article  CAS  PubMed  Google Scholar 

  27. van Dijk KN, de Vries CS, van den Berg PB, Brouwers JRBJ and de Jong-van den Berg LTW (2001). Occurrence of potential drug-drug interaction in nursing home residents. Int J Pharm Pract 9: 45–52

    Google Scholar 

  28. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH and Bakker A (1998). NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics. Arch Intern Med 158: 1108–1112

    Article  CAS  PubMed  Google Scholar 

  29. Hanlon JT, Schmader KE, Boult C, Artz MB, Gross CR and Fillenbaum GG (2002). Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 50: 26–34

    Article  PubMed  Google Scholar 

  30. Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM and Lewis IK (1996). A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 100: 428–437

    Article  CAS  PubMed  Google Scholar 

  31. Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A and Lowe CJ (2001). Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ 323: 1340–1343

    Article  CAS  PubMed  Google Scholar 

  32. Pullar T, Birtwell AJ, Wiles PG, Hay A and Feely MP (1988). Use of a pharmacologic indicator to compare compliance with tablets prescribed to be taken once, twice, or three times daily. Clin Pharmacol Ther 44: 540–545

    Article  CAS  PubMed  Google Scholar 

  33. Salzman C (1995) Medication compliance in the elderly. J Clin Psychiatry 56(Suppl 1):18–22; discussion 23

    Google Scholar 

  34. Rollason V and Vogt N (2003). Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 20: 817–832

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), P.O. Box 80082, 3508 TB, Utrecht, The Netherlands

    Thijs H. A. M. Vinks, Fred H. P. de Koning & Toine C. G. Egberts

  2. Venloon Pharmacy, Loon op Zand, The Netherlands

    Thijs H. A. M. Vinks

  3. Kring Pharmacies, s-Hertogenbosch, The Netherlands

    Fred H. P. de Koning

  4. Brabant Institute for Pharmaceutical Research and Development (BIRD), Tilburg, The Netherlands

    Thijs H. A. M. Vinks, Fred H. P. de Koning & Toine C. G. Egberts

  5. Ton de Lange Management b.v, Bloemendaal, The Netherlands

    Ton M. de Lange

Authors
  1. Thijs H. A. M. Vinks
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  2. Fred H. P. de Koning
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  3. Ton M. de Lange
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  4. Toine C. G. Egberts
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Correspondence to Toine C. G. Egberts.

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Vinks, T.H.A.M., de Koning, F.H.P., de Lange, T.M. et al. Identification of Potential Drug-related Problems in the Elderly: The Role of the Community Pharmacist. Pharm World Sci 28, 33–38 (2006). https://doi.org/10.1007/s11096-005-4213-4

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  • DOI: https://doi.org/10.1007/s11096-005-4213-4

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