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Aspects on optimisation of drug therapy in the elderly

Bondesson, Åsa ÅB LU (2008) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2008:110.
Abstract
Introduction: Elderly patients often use many drugs, increasing the risk for drug-related problems.

Aim: To optimise drug therapy in the elderly by identifying, resolving and preventing drug-related problems.

Methods: (Paper I) Medication reviews were conducted on nursing home patients’ with epilepsy or Parkinson’s disease by a multi-speciality team, whom identified drug-related problems and when appropriate suggested therapy changes to the intervention patients’ responsible physician. The effect of this intervention was evaluated on health-related quality of life. (Paper II) GPs’ and nurses’ opinions towards the previous pharmacotherapeutic intervention, in Paper I, were evaluated using a questionnaire. (Paper III)... (More)
Introduction: Elderly patients often use many drugs, increasing the risk for drug-related problems.

Aim: To optimise drug therapy in the elderly by identifying, resolving and preventing drug-related problems.

Methods: (Paper I) Medication reviews were conducted on nursing home patients’ with epilepsy or Parkinson’s disease by a multi-speciality team, whom identified drug-related problems and when appropriate suggested therapy changes to the intervention patients’ responsible physician. The effect of this intervention was evaluated on health-related quality of life. (Paper II) GPs’ and nurses’ opinions towards the previous pharmacotherapeutic intervention, in Paper I, were evaluated using a questionnaire. (Paper III) Medication errors during the transfer between primary care and hospital were investigated for patient providing care by the community, by collecting and reviewing all medication notes used for the information transfer. (Paper IV) Clinical pharmacists interviewed patients admitted to the hospital using the developed Structured Medication Questionnaire, to identify medication errors and assess patients’ compliance to and beliefs about medicines. (Paper V) Systematic medication reviews and medication care plans were conducted on intervention inpatients, by a multidisciplinary team, to reduce the number of unidentified drug-related problems during the hospital stay, which were identified and evaluated retrospectively. The physicians’ and nurses’ opinions towards this working model were evaluated using a questionnaire.

Result: (Paper I) Many drug-related problems were identified among the nursing home patients, but no improvement in health-related quality of life. (Paper II) Both GPs and nurses were positive towards further cooperation regarding pharmacotherapeutic interventions. (Paper III) On average two medication errors occurred each time a patient was transferred between primary and secondary care. (Paper IV) A majority of the patients (62%, CI 45-77%) had at least one medication error. Using this questionnaire, poor compliance and negative beliefs were also identified. (Paper V) Inpatients in the intervention group benefited from a reduction of unidentified drug-related problems. In general physicians and nurses were very positive towards this working model.

Conclusion: The research comprising this thesis has demonstrated a need for attention towards drug treatment and drug-related problems in the elderly. The Structured Medication Questionnaire and structured medication reviews may be used as tools to identify drug-related problems. Once identified the drug-related problems have the potential to be prevented or resolved, thereby optimising drug therapy. (Less)
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author
supervisor
opponent
  • Ass Prof Anders, Carlsten, Institution of medicine, University of Gothenburg
organization
publishing date
type
Thesis
publication status
published
subject
keywords
medication histories, medication reviews, drug-related problems, elderly, medication errors, pharmacists, drug therapy
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2008:110
pages
103 pages
publisher
Clinical Chemistry and Pharmacology, Dept of Laboratory Medicine
defense location
Föreläsningssalen, byggnad 11, Barngatan 2A, 2a våningen, Universitetssjukhuset i Lund
defense date
2008-12-05 13:15
ISSN
1652-8220
ISBN
978-91-86059-63-7
language
English
LU publication?
yes
id
8b47eb29-5cb9-461e-bef6-c6e46a36f1df (old id 1267069)
date added to LUP
2008-11-12 14:44:56
date last changed
2016-09-19 08:44:46
@phdthesis{8b47eb29-5cb9-461e-bef6-c6e46a36f1df,
  abstract     = {Introduction: Elderly patients often use many drugs, increasing the risk for drug-related problems. <br/><br>
Aim: To optimise drug therapy in the elderly by identifying, resolving and preventing drug-related problems. <br/><br>
Methods: (Paper I) Medication reviews were conducted on nursing home patients’ with epilepsy or Parkinson’s disease by a multi-speciality team, whom identified drug-related problems and when appropriate suggested therapy changes to the intervention patients’ responsible physician. The effect of this intervention was evaluated on health-related quality of life. (Paper II) GPs’ and nurses’ opinions towards the previous pharmacotherapeutic intervention, in Paper I, were evaluated using a questionnaire. (Paper III) Medication errors during the transfer between primary care and hospital were investigated for patient providing care by the community, by collecting and reviewing all medication notes used for the information transfer. (Paper IV) Clinical pharmacists interviewed patients admitted to the hospital using the developed Structured Medication Questionnaire, to identify medication errors and assess patients’ compliance to and beliefs about medicines. (Paper V) Systematic medication reviews and medication care plans were conducted on intervention inpatients, by a multidisciplinary team, to reduce the number of unidentified drug-related problems during the hospital stay, which were identified and evaluated retrospectively. The physicians’ and nurses’ opinions towards this working model were evaluated using a questionnaire. <br/><br>
Result: (Paper I) Many drug-related problems were identified among the nursing home patients, but no improvement in health-related quality of life. (Paper II) Both GPs and nurses were positive towards further cooperation regarding pharmacotherapeutic interventions. (Paper III) On average two medication errors occurred each time a patient was transferred between primary and secondary care. (Paper IV) A majority of the patients (62%, CI 45-77%) had at least one medication error. Using this questionnaire, poor compliance and negative beliefs were also identified. (Paper V) Inpatients in the intervention group benefited from a reduction of unidentified drug-related problems. In general physicians and nurses were very positive towards this working model. <br/><br>
Conclusion: The research comprising this thesis has demonstrated a need for attention towards drug treatment and drug-related problems in the elderly. The Structured Medication Questionnaire and structured medication reviews may be used as tools to identify drug-related problems. Once identified the drug-related problems have the potential to be prevented or resolved, thereby optimising drug therapy.},
  author       = {Bondesson, Åsa ÅB},
  isbn         = {978-91-86059-63-7},
  issn         = {1652-8220},
  keyword      = {medication histories,medication reviews,drug-related problems,elderly,medication errors,pharmacists,drug therapy},
  language     = {eng},
  pages        = {103},
  publisher    = {Clinical Chemistry and Pharmacology, Dept of Laboratory Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Aspects on optimisation of drug therapy in the elderly},
  volume       = {2008:110},
  year         = {2008},
}