Pc Tenni

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.

Development of an intelligent decision support system for medication review.

Background and objective:  The aim was to develop and evaluate a pilot version of a knowledge‐based system that can identify existing and potential medication‐related problems from patient information. This intelligent system could directly support pharmacists and other health professionals providing medication reviews.

Drug-Related Problems Detected in Australian Community Pharmacies: The PROMISe Trial

Background Drug-related problems (DRPs) are a major burden on health care systems. Community pharmacists are ideally placed to detect, prevent, and resolve these DRPs. Objective: To determine the number and nature of DRPs detected and clinical interventions performed by Australian community pharmacists, using an electronic system. Methods: An electronic documentation system was designed and integrated into the existing dispensing software of 186 pharmacies to allow pharmacists to record details about the clinical interventions they performed to prevent or resolve DRPs. Participating pharmacies were randomly allocated to 3 groups: group 1 had documentation software, group 2 had documentation software plus a timed reminder to document interventions, and group 3 had documentation software, a timed reminder, and an electronic decision support prompt. Pharmacists classified DRPs, entered recommendations they made, and estimated the clinical significance of the intervention. An observational substudy that included pharmacies without any documentation software was completed to verify intervention rates. Results: Over 12 weeks, 531 participating pharmacists recorded 6230 clinical interventions from 2,013,923 prescriptions, with a median intervention rate of 0.23% of prescriptions. No significant differences were seen between the 3 groups that used documentation software; as expected, however, the pharmacies that used this software had a significantly higher documentation rate compared to the pharmacies without documentation software. The most common interventions were related to drug selection problems (30.8%) and educational issues (24.4%). Recommendations were often related to a change in therapy (40.0%), and 41.6% of interventions were self-rated as highly significant. Drug groups most commonly subject to an intervention included antibiotics, glucocorticoids, nonsteroidal antiinflammatory drugs, and opioids. Conclusions: The documentation system allowed for the determination of the frequency and types of DRPs, as well as the recommendations made to resolve them In community pharmacy practice. Use of the software, including its electronic prompts, significantly increased the documentation of interventions by pharmacists.

Outcomes of a decision support prompt in community pharmacy dispensing software to promote step-down of proton pump inhibitor therapy

AIM To evaluate the effect of a computerized decision support prompt regarding high-dose proton pump inhibitor (PPI) therapy on prescribing and medication costs. METHODS A prompt activated on dispensing high-dose esomeprazole or pantoprazole was implemented in 73 of 185 pharmacies. Anonymized prescription data and a patient survey were used to determine changes in prescribing and associated medication costs. RESULTS The pharmacist-recorded PPI intervention rate per 100 high-dose PPI prescriptions was 1.67 for the PPI prompt group and 0.17 for the control group (P < 0.001). During the first 28 days of the trial, 196 interventions resulted in 34 instances of PPI step-down, with 28 of these occurring in PPI prompt pharmacies. Cost savings attributable to the prompt were AUD 7.98 (£4.95) per month per PPI prompt pharmacy compared with AUD 1.05 (£0.65) per control pharmacy. CONCLUSION The use of electronic decision support prompts in community pharmacy practice can promote the quality use of medicines.

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.

Vitamin B12 deficiency in Australian residential aged care facilities.

ObjectiveTo determine the prevalence of undiagnosed vitamin B12 deficiency among residential aged care facility residents in southern Tasmania, Australia, and to identify associated risk factors.Design and SettingCross-sectional study of residents from five southern Tasmanian residential aged care facilities.ParticipantsTwo hundred and fifty-nine residents without a prior diagnosis of vitamin B12 deficiency or recorded serum B12 level within the past 6 months were approached to have their serum B12 level tested. One hundred and sixty (61%) residents consented and their doctors were contacted for further consent. A total of 130 (50%) residents completed the study.MeasurementsClinical and demographic characteristics, and serum B12 level.ResultsOf the 130 residents tested, 18 residents (14%) were considered vitamin B12 deficient (serum level <150 pmol/L), 47 (36%) were equivocal (150 pmol/L to 250 pmol/L) and 65 (50%) had normal serum B12 levels (>250 pmol/L). There was a weak negative correlation between age and serum B12 level in those residents not taking a multivitamin (n=120, r=−0.19, p<0.05). The use of a multivitamin or antipsychotic drug were associated with altered mean serum B12 levels (+137 pmol/L, p<0.001 and −70 pmol/L, p<0.001 respectively).ConclusionAs vitamin B12 deficiency can manifest in a range of symptoms that are frequently misdiagnosed, the finding of undetected deficiency in 14% of residents is a cause for concern. Oral multivitamin supplementation may help prevent deficiency, and potentially treat existing deficiencies in older institutionalised people.

Applying MCRDR to a multidisciplinary domain

This paper details updated results concerning an implementation of a Multiple Classification Ripple Down Rules (MCRDR) system which can be used to provide quality Decision Support Services to pharmacists practicing medication reviews (MRs), particularly for high risk patients. The system was trained on 126 genuine cases by an expert in the field; over the course of 19 hours the system had learned 268 rules and was considered to encompass over 80% of the domain. Furthermore, the system was found able to improve the quality and consistency of the medication review reports produced, as it was shown that there was a high incidence of missed classifications under normal conditions, which were repaired by the system automatically. However, shortcomings were identified including an inability to handle absent data, and shortcomings concerning standardization in the domain, proposals to solve these shortcomings are included.

A clinical knowledge measurement tool to assess the ability of community pharmacists to detect drug‐related problems

Introduction  Drug‐related problems (DRPs) are associated with significant morbidity and mortality, with most DRPs thought to be preventable. Community pharmacists can detect and either prevent or resolve many of these DRPs. A survey‐based clinical knowledge measurement tool was designed and validated to estimate a community pharmacists clinical knowledge and ability to detect and appropriately resolve DRPs.

Intelligent decision support for medication review

This paper examines an implementation of a Multiple Classification Ripple Down Rules system which can be used to provide quality Decision Support Services to pharmacists practicing medication reviews (MRs), particularly for high risk patients. The system was trained on 84 genuine cases by an expert in the field; over the course of 15 hours the system had learned 197 rules and was considered to encompass around 60% of the domain. Furthermore, the system was found able to improve the quality and consistency of the medication review reports produced, as it was shown that there was a high incidence of missed classifications under normal conditions, which were repaired by the system automatically.