Marie-Laure Laroche1,2,3, Thi Hong Van Ngo4,5, Caroline Sirois6,7, Amélie Daveluy8,9, Michel Guillaumin10,11, Marie-Blanche Valnet-Rabier10, Muriel Grau4,12, Barbara Roux4,5, Louis Merle4,12. 1. Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France. marie-laure.laroche@chu-limoges.fr. 2. Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France. marie-laure.laroche@chu-limoges.fr. 3. Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France. marie-laure.laroche@chu-limoges.fr. 4. Centre de Pharmacovigilance, de Pharmacoépidémiologie et D'information sur les Médicaments, Centre de Biologie et de Recherche en Santé, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, 87 042, Limoges Cedex, France. 5. Université de Limoges, INSERM 1248, Faculté de Médecine, Limoges, France. 6. Université Laval, Faculté de Pharmacie, Québec, Canada. 7. Centre de Recherche VITAM en Santé Durable, Centre D'excellence sur le Vieillissement de Québec, Québec, Canada. 8. Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France. 9. Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux, France. 10. Centre de Pharmacovigilance de Pharmacoépidémiologie et d'information sur les Médicaments de-Franche Comté, CHU Besançon, Besançon, France. 11. Département de Gériatrie, CHU de Besançon, Besançon, France. 12. Université de Limoges, Unité Vie-Santé, Faculté de Médecine, Limoges, France.
Abstract
PURPOSE: To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. MATERIALS AND METHODS: A narrative overview. RESULTS: The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. DISCUSSION/ CONCLUSION: Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.
PURPOSE: To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs. MATERIALS AND METHODS: A narrative overview. RESULTS: The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen. DISCUSSION/ CONCLUSION: Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.
Authors: J W Foppe van Mil; Tommy Westerlund; Lawrence Brown; Timothy F Chen; Martin Henman; Kurt Hersberger; James McElnay; Martin Schulz Journal: Int J Clin Pharm Date: 2016-01-21