PHARMACIST INVOLVEMENT TO DECREASE DRUG-RELATED PROBLEMS AMONG GERIATRIC PATIENTS IN INDONESIAN PRIMARY HEALTH CENTERS


Desi Suryani, Anton Bahtiar, Retnosari Andrajati

Abstract


 

 Objective: The studies have demonstrated that older people often suffer from multiple diseases and are thus prescribed many different drugs. Therefore, drug-related problems (DRPs) are common in the elderly. The main objectives of this study were to reduce the number of DRPs in the elderly through pharmacist involvement and to analyze differences after pharmacist recommendations.

Methods: In a quasi-experimental study, 12 primary health centers were selected and randomly divided into two groups (six in each group). In the first group, the physicians received pharmacist recommendations verbally through discussions, and in the second group, the physicians received recommendations through letters. DRPs were analyzed from all older inpatients’ medical records 1 month before and 1 month after the pharmacist recommendations. The main outcome being measured was the incidence of DRPs, classified into problems, and causes according to the Indonesian translated version of Pharmaceutical Care Network Europe, Version 6.2 (PCNE V 6.2). The problems were identified based on journal articles and other relevant literature.

Results: A total of 205 patients were analyzed before pharmacist intervention (Group 1: 121; Group 2: 84) and 202 patients after the intervention (Group 1: 108; Group 2: 94). The most common problem in these elderly patients was that they suffered from toxic effects. The most common cause was inappropriate drug selection. The number of DRPs and causes were decreased significantly through the discussions (Wilcoxon signed-rank test, problems p=0.027, causes p=0.028). DRPs were also significantly decreased through the recommendation letters (paired t-test, number of problems p=0.003, and causes p=0.004). Discussion with physicians seemed more effective and decreased more problems (p=0.001) and causes (p=0.002). Through discussions, the decrease in a number of problems was 20.83±8.931, and the decrease in the number of causes was 25.33±11.431 versus the recommendation letter, at 4.17±1.941 and 5.17±2.483, respectively.

Conclusion: Pharmacist involvement decreased DRPs among older inpatients. Discussing DRPs with the physicians treating the patients is more effective than giving recommendations in writing only. The PCNE V 6.2 DRP classification system is useful for documenting DRPs among the elderly as it can help pharmacists develop plans to reduce DRPs.


Keywords


Drug-related problem, Geriatric, Pharmaceutical Care Network Europe, Pharmacist, Primary Health Center, Indonesia.

| PDF |

References


Pharmaceutical Care Network Europe. Classification for Drug-Related Problems Help (Revised 14-01-2010vm) V6.2. PCNE Classification. : Pharmaceutical Care Network Europe; 2010. p. 1-9. on drug-related problems in the elderly. Am J Geriatr Pharmacother 2003;1(1):38-43.

Hanlon JT, Lindblad CI, Hajjar ER, McCarthy TC. Update on drug-related problems in the elderly. Am J Geriatr Pharmacother 2003;1(1):38-43.

Chan DC, Chen JH, Kuo HK, We CJ, Lu IS, Chiu LS, et al. Drug-related problems (DRPs) identified from geriatric medication safety review clinics. Arch Gerontol Geriatr 2012;54(1):168-74.

Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br J Clin Pharmacol 2004;57(1):6-14.

Blix HS, Viktil KK, Reikvam A, Moger TA, Hjemaas BJ, Pretsch P, et al. The majority of hospitalised patients have drug related problems; result from prospective study in general hospital. Eur J Clin Pharmacol 2004;60(9):651-8.

Rahmawati F, Sulaiman SA, Pramantara ID, Rochmah W. Involvement of Ward Pharmacist During Theurapeutic Process in Hospitalised Geriatric Patients in Dr. Sardjito Hospital Yogyakarta Indonesia; 2012. p. 1-11. Available from: http://www.mfk.farmasi.ugm.ac.id/files/news/ Full_paper_ACCP_Hongkong_Fita.pdf.

van Mil JW, Fernandez-Llimos F. What is “pharmaceutical care” in 2013? Pharm Pract (Granada) 2013;11(1):1-2.

Sreelalitha N, Vigneshwaran E, Narayana G, Reddy P, Reddy R. Review of phaemaceutical care services provided by the pharmacists. Int Res J Pharm 2012;3(4):76-9.

Levy Y, Ellis TJ. A guide for novice researchers on experimental and quasi-experimental studies in information systems research. Interdiscip J Inf Knowl Manage 2011;6:151-61.

Harris AD, McGregor JC, Perencevich EN, Furuno JP, Zhu J, Peterson DE, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc 2006;13(1):16-23.

Shah RR. Drug development and use in the elderly: Search for the right dose and dosing regimen (Parts I and II). Br J Clin Pharmacol 2004;58(5):452-69.

American Geriatric Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60(4):616-31.

Sugumar A, Singh A, Pasricha PJ. A systematic review of the efficacy of domperidone for the treatment of diabetic gastroparesis. Clin Gastroenterol Hepatol 2008;6(7):726-33.

Huerta C, Castellsague J, Varas-Lorenzo C, García Rodríguez LA. Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population. Am J Kidney Dis 2005;45(3):531-9.

Somberg JM. Pharmacotherapy: A pathophysiologic approach. Am J Ther 2007;14(4):418.

Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328(7447):434.

Mehta DK, Ryan RS, Hogerzeil HV. WHO Model Formulary. London: Royal Pharmaceutical Society of Great Britain; 2004.

McGregor A, Brown M, Thway K, Wright SG. Fulminant amoebic colitis following loperamide use. J Travel Med 2007;14(1):61-2.

Honore PH. Drug interactions. Eur J Hosp Pharm 2014;21(2):73.

Fournier JP, Sommet A, Bourrel R, Oustric S, Pathak A, Lapeyre-Mestre M, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: A population-based cohort study. Eur J Clin Pharmacol 2012;68(11):1533-40.

Rogulj D, Hauptfeld M, Iskra MS, Zorko VK, Strasek M. Extreme hyperkalaemia caused by concomitant use of a NSAID and an ace inhibitor in an elderly patient. Arh Hig Rada Toksikol 2010;61(2):241-5.

McConnell KJ, Newlon C, Dickerhofe J. A model for continuing pharmacy education. Am J Pharm Educ 2009;73(5):87.

Bolser DC. Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest 2006;129 1 Suppl:238S-49.

Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion of red blood cells. Blood Transfus 2009;7(1):49-64.

Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002;55(8):809-17.

Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007;63(2):187-95.

Koh Y, Kutty FB, Li SC. Drug-related problems in hospitalized patients on polypharmacy: The influence of age and gender. Ther Clin Risk Manag 2005;1(1):39-48.

Abraham RR, Devi AS. Drug related problems and reactive pharmacist interventions for patients receiving cardiovascular drugs. Am J PharmTech Res 2012;2(3):42-8.

Rahayu R, Andrajati R, Supardi S. Effect of drug information on doctors on decreased incidence of Drug Related Problems (PTO) on prescription of heart and blood vessel disease in Apotek X Jakarta. Bul Penelit Kesehatan 2010;38(3):147-59.

Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005;4:CD003539.




About this article

Title

PHARMACIST INVOLVEMENT TO DECREASE DRUG-RELATED PROBLEMS AMONG GERIATRIC PATIENTS IN INDONESIAN PRIMARY HEALTH CENTERS

Keywords

Drug-related problem, Geriatric, Pharmaceutical Care Network Europe, Pharmacist, Primary Health Center, Indonesia.

DOI

10.22159/ajpcr.2017.v10s5.23109

Date

01-10-2017

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol. 10, Special Issue (Oct.), 2017 [PTMDS 2017] Page: 102-107

Print ISSN

0974-2441

Online ISSN

2455-3891

Statistics

132 Views | 75 Downloads

Authors & Affiliations

Desi Suryani
Health Office in Karanganyar, Jawa Tengah, Indonesia.
Indonesia

Anton Bahtiar
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.
Indonesia

Retnosari Andrajati
Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.
Indonesia


Article Tools


Email this article (Login required)
Email the author (Login required)

Refbacks

  • There are currently no refbacks.