Ac Stafford

Inappropriate prescribing in older residents of Australian care homes

What is known and objective:  The incidence of inappropriate prescribing is higher amongst the older age group than the younger population. Inappropriate prescribing potentially leads to drug‐related problems such as adverse drug reactions. We aimed to determine the prevalence of inappropriate prescribing in residents of Tasmanian (Australia) residential care homes using Beers and McLeod criteria.

DOCUMENT: a system for classifying drug-related problems in community pharmacy

Background Drug-related problems (DRPs) are a major burden on the Australian healthcare system. Community pharmacists are in an ideal position to detect, prevent, and resolve these DRPs. Objective To develop and validate an easy-to-use documentation system for pharmacists to classify and record DRPs, and to investigate the nature and frequency of clinical interventions undertaken by Australian community pharmacists to prevent or resolve them. Setting Australian community pharmacies. Method The DOCUMENT classification system was developed, validated and refined during two pilot studies. The system was then incorporated into software installed in 185 Australian pharmacies to record DRPs and clinical interventions undertaken by pharmacists during a 12-week trial. Main outcome measure The number and nature of DRPs detected within Australian community pharmacies. Results A total of 5,948 DRPs and clinical interventions were documented from 2,013,923 prescriptions dispensed during the trial (intervention frequency 0.3%). Interventions were commonly related to Drug selection problems (30.7%) or Educational issues (23.7%). Pharmacists made an average of 1.6 recommendations per intervention, commonly relating to A change in therapy (40.1%) and Provision of information (34.7%). Almost half of interventions (42.6%) were classified by recording pharmacists as being at a higher level of clinical significance. Conclusion The DOCUMENT system provided pharmacists with a useful and easy-to-use tool for recording DRPs and clinical interventions. Results from the trial have provided a better understanding of the frequency and nature of clinical interventions performed in Australian community pharmacies, and lead to a national implementation of the system.

Drug-related problems identified in post-discharge medication reviews for patients taking warfarin

Objective To characterise the nature of the drug-related problems with warfarin therapy identified in pharmacist-conducted medication reviews during a collaborative post-discharge warfarin management service, with a focus on potentially serious drug interactions. Setting Australian community pharmacy practice. Method Medication review reports submitted by pharmacists to patients’ general practitioners as part of the service were reviewed and the type and clinical significance of the warfarin-associated drug-related problems, and the pharmacists’ recommendations were classified. The prevalence of prescribing of ‘potentially hazardous’ warfarin drug interactions was investigated and compared with the frequency of documentation of these interactions in the medication review reports. Main outcome measure The number and nature of warfarin-associated drug-related problems identified and the rate of documentation of ‘potentially hazardous’ warfarin drug interactions in the reports from pharmacist-conducted medication reviews. Results A total of 157 warfarin-associated drug-related problems were documented in 109 medication review reports (mean 1.4 per patient, 95% CI 1.3–1.6, range 0–5). Drug selection and Education or information were the most commonly identified warfarin-associated drug-related problems; most drug-related problems were of moderate clinical significance. Eight of 23 potentially serious warfarin drug interactions (34.8%) were identified in the medication review reports. Conclusion Pharmacists addressing drug selection and warfarin education drug-related problems during medication reviews may have contributed to the positive outcomes of the post-discharge service. Warfarin drug interactions were frequently identified; however, well-recognised potentially hazardous interactions were under-reported. Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting, especially in relation to preventable drug interactions.

The potential for intelligent decision support systems to improve the quality and consistency of medication reviews

What is known and Objective:  Drug‐related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of a consistently high standard, and there is often room for improvement in the quality of their findings. Our aim was to produce computerized intelligent decision support software that can improve the consistency and quality of medication review reports, by helping to ensure that DRPs relevant to a patient are overlooked less frequently. A system that largely achieved this goal was previously published, but refinements have been made. This paper examines the results of both the earlier and newer systems.

General practitioners' perceptions on home medicines reviews: A qualitative analysis

BackgroundHome Medicines Review (HMR) is an Australian initiative introduced in 2001 to improve quality use of medicines. Medication management services such as HMRs have the potential to reduce medication related problems. In 2011, changes to the HMR program were introduced to allow for referrals directly to accredited pharmacists in addition to the community pharmacy referral model. These changes were introduced to improve efficiency of the process. This study explored the perceptions of Western Australian general practitioners (GPs) on benefits and barriers of the HMR service and process, including their insights into the direct referral model.MethodsPurposive sampling of GPs who had experience ensured that participants had a working knowledge of the HMR service. Semi structured interviews with 24 GPs from 14 metropolitan Western Australian medical centres between March and May 2013. Transcribing and thematic analysis of data were performed.ResultsMost GPs had positive attitudes towards the HMR service. Main perceived benefits of the service were poly-pharmacy reduction and education for both the GP and patient. Strategies identified to improve the service were introduction of a standard HMR report template for pharmacists and better use of technology. Whilst reliability and GPs’ familiarity were the main perceived benefits of the direct referral model, a number of GPs agreed that patient unfamiliarity with the HMR pharmacist was a barrier.ConclusionsDespite recognition of the value of the HMR service participating GPs were of the opinion that there are aspects of the HMR service that could be improved. As one of the success factors of HMRs is relying on GPs to utilise this service, this study provides valuable insight into issues that need to be addressed to improve HMR uptake.

Repeatable antibiotic prescriptions: an assessment of patient attitudes, knowledge and advice from health professionals

BACKGROUND Previous Australian research has identified that general practice software systems appear to be associated with an increase in repeatable antibiotic prescriptions. Such prescriptions potentially facilitate the use of antibiotics without medical consultation and may be inconsistent with attempts to promote prudent use of antimicrobials. AIMS We sought to assess knowledge and attitudes to antibiotics amongst patients presenting with a repeatable prescription; and the provision of supporting advice from healthcare professionals regarding use of these repeats. METHOD Six community pharmacies across Tasmania invited patients presenting with a repeatable antibiotic prescription to participate in the study. Participants were asked to complete a questionnaire and return this to the research team in a pre-paid envelope. RESULTS Fifty-seven of 244 (23 per cent) surveys were returned. Regarding provision of advice on use of the repeat, 14 (25 per cent) of respondents stated that they were given no advice by the prescriber and 19 (30 per cent) no advice from the pharmacist. Five (9 per cent) were given no advice from either prescriber or pharmacist. One-third of respondents indicated that they would keep the repeat for future use and around three-quarters perceived no major safety concerns with antibiotics. CONCLUSION Further research is needed, however, this small study suggests that provision of information to patients regarding appropriate use of repeatable antibiotic prescriptions is suboptimal. This coupled with existing patient knowledge and attitudes may contribute to inappropriate use of antibiotics.

A methodological framework for estimating the clinical and economic value of community pharmacists’ clinical interventions using expert opinion

What is known and Objective:  Studies of the outcomes of clinical interventions (CIs) performed by community pharmacists are limited. The economic models used in most studies of CIs have been simplistic, often failing to fully capture the counterfactual when estimating savings in health resources resulting from CIs. This paper aimed to describe the complexities involved in estimating the clinical and economic outcomes of CIs performed by community pharmacists when using expert opinion and suggest avenues for improvement.

Home medicines reviews in Australian war veterans taking warfarin do not influence International Normalised Ratio control.

The clinical outcomes of warfarin are largely dependent on the international normalised ratio (INR) control achieved, and strategies to improve the time in therapeutic range (TTR) should be identified and widely implemented in practice.

Knowing when to stop antibiotic therapy

A simple way to reduce these costs is to cure patients when they present with de novo disease. Improving the cure rate is achieved by enrolling patients in clinical trials. Until cancer has 100% cure without toxicity, there is always a question to be asked by means of a randomised controlled trial. These trials may or may not include new drugs and interactions with industry (at arm’s length to avoid any real or perceived conflicts of interest).

How patients use repeat antibiotic prescriptions: the impact of dosing directions

Repeat prescribing of antibiotics is widespread in Australia. This may be associated with risks to individual patients and contribute to inappropriate antibiotic use.