|The Consultant Pharmacist|
IN THIS ISSUE
September 2018 | Volume 33 | Number 9
Pharmacists must listen to their patients and incorporate their feedback when evaluating the efficacy and appropriateness of medications.
Prescriptions for opioids and opioid-related overdoses have been on the rise—and in the news—in the United States for more than a decade. New guidelines and legislation related to opioid prescribing provide clinical challenges for many pharmacists and prescribers, particularly in the treatment of older adults with chronic pain. To assist pharmacists and prescribers in managing the complexities of pain treatment with opioids, the Centers for Disease Control and Prevention issued new prescribing guidelines in March 2016. Careful patient selection, along with proper opioid dosing and monitoring, enables the pharmacist and prescriber to continue to treat the older adult with pain effectively.
Assessment of medication complexity goes beyond the number of medications taken to include consideration of the complexity of the dosage form, frequency, and directions for use. The ability to draw definitive conclusions regarding causative effects of high Medication Regimen Complexity Index (MRCI) is limited by the retrospective and/or observational nature of the studies. This literature review found that high MRCI was associated with discharge to a nonhome setting, decreased medication adherence, and increased mortality. Medication number—but not MRCI—was associated with hospital readmission risk. New guidelines and legislation related to opioid prescribing provide clinical challenges for many pharmacists and prescribers, particularly in the treatment of older adults with chronic pain.
Long-term use of proton pump inhibitors (PPIs) is associated with several adverse drug events, including acute interstitial nephritis, fractures, and Clostridium difficile-associated diarrhea. Cautious prescribing and regular monitoring is essential, especially for older adults, as they may be at a higher risk for these adverse effects. Deprescribing, defined as lowering dosage, switching to as-needed use, or complete discontinuation, should be considered for many PPI users. Patient education is critical.
This study developed the first model to predict patients who require a consultant pharmacist intervention in the skilled nursing facility setting for such ssues as medication dose adjustment or patientspecific factors, e.g., demographics, medication dispensings, diagnoses. Application of this model in real time is expected to result in better prioritization of consultant pharmacist workflow and, possibly, allow for expansion of pharmacy services to more facilities while maintaining the current quality of care. Additionally, application of this model may lead to cost-savings with the reduction of a consultant pharmacist's time to conduct medication reviews on every patient in a skilled nursing facility.
This study of Medicare beneficiaries in 2010 found that fewer than 33% of high-risk nonvalvular atrial fibrillation patients received oral anticoagulants within 60 days of diagnosis. Despite increased use over time, oral anticoagulation (OAC) was below 53% at the study’s end, suggesting opportunities for improvement in care. Use of OACs declined with a CHA2DS2-VASc score greater than 6. Expanded efforts are warranted to augment OAC use in high stroke-risk patients.
A recent report on Medicaid by the Centers for Medicare & Medicaid Services shows that institional care is on the wane.
READ THE JOURNAL
The Consultant Pharmacist® is the official monthly peer-reviewed journal of the American Society of Consultant Pharmacists (ASCP). It is the only journal dedicated exclusively to the medication therapy needs of seniors. ASCP members receive The Consultant Pharmacist® as a member benefit. All articles (2004 to present) are free online for members.
2018 ASCP Integrated Media Kit
Nonmembers can access online abstracts to journal articles. Full articles are available for $35.00 each.
Content can be tailored and customized to fit your marketing and promotional needs and can be delivered via print or electronic format. For more information, contact: