Ashley M Campbell1, Kim C Coley2, Jason M Corbo3, Teresa M DeLellis4, Matthew Joseph5, Carolyn T Thorpe6, Melissa S McGivney7, Patricia Klatt8, Lora Cox-Vance9, Vincent Balestrino10, Heather Sakely8. 1. Assistant Professor, Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson. 2. Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, PA. 3. Clinical Pharmacy Specialist, South Texas Veterans Health Care System, San Antonio. 4. Assistant Professor, Pharmacy Practice, Manchester University College of Pharmacy, Natural & Health Sciences, Fort Wayne, IN. 5. Clinical Pharmacist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center (UPMC). 6. Associate Professor, Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, and Research Health Scientist, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System. 7. Associate Dean for Community Partnerships and Associate Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy. 8. Clinical Pharmacist, UPMC St. Margaret. 9. Chief, Geriatrics and Extended Care, Chillicothe VA Medical Center, OH. 10. Director, Geriatric Services, UPMC St. Margaret.
Abstract
BACKGROUND: Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE: To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS: This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS: A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION: Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.
BACKGROUND: Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE: To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS: This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS: A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION: Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.
Entities:
Keywords:
assisted-living facilities; drug therapy problems; geriatric patients; geriatric pharmacists; interprofessional; medication dosing; skilled-nursing facility; transitions of care
Authors: F A Sorond; A Galica; J M Serrador; D K Kiely; I Iloputaife; L A Cupples; L A Lipsitz Journal: Neurology Date: 2010-05-18 Impact factor: 9.910
Authors: Meera Viswanathan; Leila C Kahwati; Carol E Golin; Susan J Blalock; Emmanuel Coker-Schwimmer; Rachael Posey; Kathleen N Lohr Journal: JAMA Intern Med Date: 2015-01 Impact factor: 21.873
Authors: Ashley M Campbell; Kim C Coley; Jason M Corbo; Teresa M DeLellis; Matthew Joseph; Carolyn T Thorpe; Melissa S McGivney; Patricia Klatt; Lora Cox-Vance; Vincent Balestrino; Heather Sakely Journal: Am Health Drug Benefits Date: 2018-12