|The Senior Care Pharmacist|
IN THIS ISSUE
May 2019 | Volume 34 | Number 5
Pharmacists play a key role in overseeing medication management with a goal of protecting the public—and individual patients—from adverse drug events.
A focus on patient populations—as opposed to their care settings—encompasses a broad array of health care models: accountable care organizations, managed care, bundled payments, and other value-based care medical models. Pharmacists have a key role to play in streamlining medication management within these settings, ensuring a smooth transition as patients move through the care continuum and preventing avoidable hospitalizations and readmissions.
The findings of this study suggest that nitrofurantoin therapy for urinary tract infections (UTIs) is safe and effective in frail, community-dwelling older adults with renal impairment. The data suggest that nitrofurantoin is an underutilized option in medically complex older adults in this population. These results highlight the opportunities for pharmacists to promote antimicrobial stewardship by considering nitrofurantoin as an option for UTIs in the older adult population with multimorbidities. It is important to have treatment options other than fluoroquinolones and sulfamethoxazole/trimethoprim for patients with recurrent UTIs and frequent antibiotic use to sustain optimal antimicrobial stewardship practices.
A just-in-time approach in making recommendations to primary care providers was successful in leading to medication changes. A total of 252 recommendations were made, with 26.2% recommendations being accepted (22.1% for benzodiazepines and 22.7% for tricyclic antidepressants). Of the recommendations accepted, 56% had a pharmacist in the clinic. A total of 96.7% of primary care providers preferred a message to be sent through the patient’s medication record. There was no statistical difference between physician acceptances of pharmacist recommendations if a pharmacist was embedded in the clinic.
Discrepancies Between the Medication List in Electronic Prescribing Systems and Patients’ Actual Use of Medicines
Medication reconciliation is an important tool in reducing the risk of medication-related errors. Denmark has an electronic prescribing system that is used for all patients in primary and secondary care; still, an average of 2.4 medication discrepancies per patient was found in this study. The most prevalent discrepancies noted were prescriptions listed in the this country’s Shared Medication Record that were not currently used or the use of medication was missing from the record. The study found that this record should not be used as the only source of information regarding patients’ acquisition of medications and indicates the need for a routine thorough medication reconciliation.
Proton-pump inhibitors (PPIs) have been associated with adverse renal outcomes in older adults; however, there are little data regarding the magnitude of the change in renal function in this population. The purpose of this study was to quantify the change in kidney function associated with chronic PPI therapy at two years in older adults using estimated glomerular filtration rate. This study shows provider awareness of the potential harms of chronic PPI therapy is imperative to help reduce both the unnecessary and inappropriate prescribing of PPIs as well as adverse kidney outcomes.
While the health care talk in the nation’s Capitol has been dominated by proposed repeal of the Affordable Care Act and the opioid crisis, attention is shifting to another critical issue—the high price of drugs.
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The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists (ASCP). It is the only journal dedicated exclusively to the medication therapy needs of older adults. ASCP members receive The Senior Care Pharmacist® as a member benefit. All articles (2004 to present) are free online for members.
2019 ASCP Integrated Media Kit
Nonmembers can access online abstracts to journal articles. Full articles are available for $35.00 each.
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