Kay Stewart

Development and Validation of the Medication Regimen Complexity Index

BACKGROUND: Medication regimen attributes, such as the number of drugs, dosage frequency, administration instructions, and the prescribed dosage forms, have been shown to influence patient outcomes. No single tool for quantifying the complexity of general medication regimens has been published in the medical literature. OBJECTIVE: To develop and validate a tool to quantify the complexity of prescribed medication regimens. METHODS: Literature findings and the expertise of the authors were used for developing the tool. Eight pharmacy researchers helped in establishing the tools face and content validity. The new tool was tested on 134 medication regimens from patients with moderate to severe chronic obstructive pulmonary disease. Six regimens with a spread of scores on the tool were presented to a 5–member expert panel that subjectively ranked these regimens to confirm the tools criterion-related validity. The relationships between scores on the tool and various independent variables were tested to judge the tools construct validity. Two raters scored 25 regimens using the tool to test its inter-rater and test—retest reliabilities. RESULTS: A 65–item Medication Regimen Complexity Index (MRCI) was developed. The expert panel had strong agreement (Kendalls W = 0.8; p = 0.001) on their individual rankings of the 6 regimens. The panels consensus ranking had perfect correlation with the MRCI ranking. The total MRCI score had significant correlation with the number of drugs in the regimen (Spearmans Rho = 0.9; p < 0.0001), but not with the age and gender of the patients. Inter-rater and test—retest reliabilities for the total score and scores for individual sections on the MRCI were ≥0.9. CONCLUSIONS: The MRCI is a reliable and valid tool for quantifying drug regimen complexity with potential applications in both practice and research.

The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia

Aim  To assess the impact of a community pharmacy diabetes service model on patient outcomes in Type 2 diabetes.

Development and Validation of the Medication-Based Disease Burden Index

Background: Medication lists offer an alternative source of data on comorbidities and disease burden. Objective: To develop and validate the Medication-Based Disease Burden Index (MDBI). Methods: A list of medications corresponding to the leading causes of global death was pilot tested and finalized by an expert panel. The resulting index was tested on drug regimens of patients at risk of medication misadventure. Criterion validity of the index was established against Charlsons index and Chronic Disease Score (CDS). Sensitivity, specificity, predictive validity, convergent and discriminant validity, and interrater and test–retest reliabilities of the index were also assessed. Results: The MDBI consisting of specific medications for 20 chronic medical conditions and corresponding disability weightings was developed. The MDBI was tested on 317 patients with mean ± SD Charlsons index scores of 2.8 ± 2.2 and CDS scores of 7.3 ± 2.8. Mean MDBI scores (0.33 ± 0.28) demonstrated significant correlations with Charlsons index scores (r = 0.31; p < 0.001) and CDS (r = 0.53; p < 0.001). MDBI had satisfactory sensitivity and high specificity. Age of the patients and number of medications had significant correlation with the MDBI scores, but the MDBI scores were not significantly different in males and females. MDBI scores could successfully predict death and planned or unplanned readmissions (OR = 4.7, 95% CI 1.4 to 15.5; p = 0.01). MDBI demonstrated high inter-rater (intraclass correlation coefficient [ICC] = 0.99) and test–retest reliabilities (ICC = 0.98). Conclusions: Initial testing suggests that MDBI could offer an alternative low-cost and convenient method for quantifying disease burden and predicting health outcomes.

Assessing patient satisfaction with community pharmacy in the UAE using a newly-validated tool

BACKGROUND Patient satisfaction has become an integral component of the quality of healthcare services. It has been used for the purpose of performance assessment, reimbursement, and quality management of health service delivery. It has been suggested that patient satisfaction could be a predictor of health-related behavior. OBJECTIVES To develop and validate a tool for use within the Arabic context to assess patient satisfaction. To assess patient satisfaction with current community pharmacy services in the UAE using the validated tool. METHODS A systematic process was used to develop an assessment tool that could be used within the Arabic context and establish its validity and reliability. Survey participants assessed their satisfaction with the services based on a 5-point Likert-type scale: Poor = 1, Fair = 2, Good = 3, Very good = 4, Excellent = 5. The anonymous questionnaire was distributed over a 5-month period to eligible participants in public places such as malls and shopping markets, in various emirates across the UAE. Those who were 21 years or older, taking at least one scheduled (regular) medication and having adequate Arabic or English language proficiency were included. RESULTS The instrument comprised four dimensions: Information, Relationship, Accessibility and Availability. Participants required more information about medications and self-management (Mean = 2.49 ± 1.19). Measures of competence, i.e., care, interest, time, confidence and trust, could also be improved (Mean = 3.05 ± 1.07). Accessibility scores measuring physical, geographical and financial items were lowest (Mean = 2.80 ± 1.33). Overall scores on availability of medications indicated relative satisfaction with this dimension (Mean = 3.51 ± 0.7). CONCLUSIONS This study is the first to use a patient satisfaction tool specifically developed for the Arabic context. Patient satisfaction scores in all dimensions were significantly lower than published data, suggesting patients have unmet expectations of community pharmacy services in the UAE. Stakeholders could utilize this information to help in the design and delivery of improved services that could lead to increased demand.

Prescription medication use practices among non‐institutionalised older persons

Objective — To investigate the prescription medication use practices of a sample of non‐institutionalised older persons and to determine any differences with age (65–74 years versus 75 years and over).

Clinical intervention rates in community pharmacy: a randomised trial of the effect of education and a professional allowance

Objectives To quantify the rate of clinical interventions by community pharmacists, and to determine the effect of providing targeted education and/or fee‐for‐service professional remuneration on the rate of clinical interventions.

Diabetes management in an Australian primary care population.

What is known and objective:  Worldwide studies have shown that significant proportions of patients with type 2 diabetes (T2DM) do not meet targets for glycaemic control, blood pressure (BP) and lipids, putting them at higher risk of developing complications. However, little is known about medicines management in Australian primary care populations with T2DM. The aim of this study was to (i) describe the management of a large group of patients in primary care, (ii) identify areas for improvement in management and (iii) determine any relationship between adherence and glycaemic, BP and lipid control.

A comparison between senior medical students' and pharmacy pre-registrants' knowledge and perceptions of generic medicines

Objective  To ascertain any differences in knowledge and perceptions of generic medicines between senior (final year) medical students and pharmacy pre‐registrants in Australia.

Prevalence of medication-related risk factors among retirement village residents: a cross-sectional survey

BACKGROUND information on medication use and risk factors among older people residing in retirement villages and their uptake of medication reviews are scant. OBJECTIVES to identify medication use issues and risk factors for medication-related problems among retirement village residents and to evaluate the uptake of government-subsidised Home Medicines Review (HMR) services in this population. DESIGN cross-sectional, mail survey. SETTING retirement villages in Victoria, Australia. PARTICIPANTS members of the Residents of Retirement Villages of Victoria residing in retirement villages (2,116, aged 54-100 years). METHODS a questionnaire was developed incorporating validated scales and items to measure medication risk, medication adherence, co-morbidity, disability, information on medication use, health and the uptake of HMR services. Questionnaires were mailed to participants for self-completion and returned using reply-paid envelopes. RESULTS of the 2,116 respondents (70.7% response rate), 2,006 (94.8%; 95% confidence interval (CI) 93.9-95.7%) reported using prescribed medications. Three or more health conditions were present in 993 (46.9%; 95% CI 44.8-49.0%) respondents. Five or more regular medications were used by 988 (46.7%; 95% CI 44.6-48.8%) respondents. Twelve or more tablets/capsules per day were used by 229 (10.8%; 95% CI 9.5-12.1%) respondents. The use of narrow therapeutic index medications was reported by 264 (12.5%; 95% CI 11.1-13.9%) respondents. Changes to medication regimens in the previous 3 months were reported by 356 (16.8%; 95% CI 15.2-18.4%) respondents. One or more medication-related risk factors were seen in 1,374 (64.9%; 95% CI 62.9-66.9%) respondents. Of these at-risk residents, 76 (5.5%; 95% CI 4.5-6.5%) reported receiving an HMR in the previous 12 months, who were older (P < 0.001), were using more medicines (P < 0.001) and had greater disability (P = 0.002). CONCLUSIONS reasons for the low uptake of medication reviews in retirement village residents despite the high prevalence of medication risk require further investigation.

Knowledge and perceptions of recent pharmacy graduates about generic medicines

The ever-rising price of prescription medicines is a phenomenon that affects nearly every developed country across the globe. An effective strategy to contain escalating costs is by using cheaper generic medicines. Within this context, most policy makers are encouraging healthcare professionals to prescribe or substitute generic medicines whenever possible. Whichever policy—generic prescribing or generic substitution—is adopted, the main challenge is how to maintain the confidence of patients and carers in using generics. This is where the role of the pharmacist becomes vital. The availability of different brands of the same drug at the same strength and in the same dosage form poses a special challenge to healthcare professionals, making these issues very relevant to pharmacists in all practice settings. To date in Australia and elsewhere, no studies have been conducted to assess the knowledge and perceptions of recent pharmacy graduates with regard to generic medicines and generic substitution. Therefore, a national web-based survey was undertaken to evaluate pharmacy pre-registrants’ perceptions and knowledge of generic medicines. More than 80% of study participants thought that generic medicines are inferior, less effective and produce more side effects compared to brand name medicines. These findings highlight that pharmacy pre-registrants need a better understanding of the principles and concepts of bioavailability and bioequivalence if they are to contribute appropriately to generic medicine use.