Download pharmaceutical care form application in elderly patients research

Acta Poloniae Pharmaceutica ñ Drug Research, Vol. 73 No. 5 pp. 1375ñ1380, 2016
ISSN 0001-6837
Polish Pharmaceutical Society
GENERAL
PHARMACEUTICAL CARE FORM APPLICATION IN ELDERLY PATIENTS
RESEARCH
MAGDALENA WASZYK-NOWACZYK1*, KLAUDIA B£ASZCZYK2, MICHA£ MICHALAK3
and MAREK SIMON4
1
Department of Pharmaceutical Technology, 2Studentís Pharmaceutical Care Group, Department of
Pharmaceutical Technology, Pharmacy Practice Division,
Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 PoznaÒ, Poland
3
Department of Computer Science and Statistics, Poznan University of Medical Sciences,
Dπbrowskiego 79, 60-529 PoznaÒ, Poland
4
Chair and Department of Pathophysiology, Poznan University of Medical Sciences,
Rokietnicka 8, 60-806 PoznaÒ, Poland
Abstract: Many patients, especially elderly, very often donít inform family physicians about drugs prescribed
by other specialist and use a number of preparations to self-medicate. These actions may supply negative consequences in recovery process and can be significantly reduced through the implementation of a well-run pharmaceutical care (PC) in the community pharmacy. Therefore, it is necessary to design proper PC documentation,
which allows for comprehensive gathering information needed to carry out the analysis of relevant factors
impacting on the prescribed pharmacotherapy effectiveness. The aim of this study was to develop the proper documentation to conduct PC in community pharmacy and verification of its correctness in the group of elderly
patients, who is receiving treatment from family physician and additionally at least two specialized doctors. Also
an assessment of PC implementation validity as a specialized service was presented. A study was carried out
from January 2014 to June 2015. The research covered 54 elderly (41.0% men and 59.0% women) in Jarocin
(Poland). Pharmacist was filling in the designed PC form, which subsequently was analyzed mainly for pharmacotherapy problems. The study indicated that 48.1% of patients were counselled by at least 3 specialists;
66.7% of patients were treated by cardiologist and 55.6% by the ophthalmologist; 75.9% of participants had
hypertension. 42.6% of the patients used 10 or more pharmaceuticals and 24.1% took 8 or 9 drugs. Moreover,
20.4% of participants used drugs irregularly and 7.4% of them took too low doses of medications. Additionally,
during the pharmacotherapy analysis, very significant and significant drug-drug interactions were noticed (1.1%
and 18.4%, respectively). Very significant drug-food interactions occurred in 1.4% cases and significant in 3.3%
cases. Total number of detected interactions were 553. The substantial analysis of participantsí data allowed for
48 patients selection for pharmaceutical counselling. Six patients were involved into the group where PC process
was reasonable. These patients often used 10 or more drugs (p = 0.0026), discontinued using medication without doctor consulting (p = 0.0201) and did not follow up the prescribed pharmacotherapy (p = 0.0351). This study
provides new data about implementation of PC in Poland. The designed PC documentation may be helpful for
proper analysis of the patientís pharmacotherapy to avoid drug problems and to improve elderly patientsí quality of life. This project may contribute to PC implementation in Polish community pharmacy.
Keywords: pharmaceutical care, elderly, documentation, drug problems, non-adherence
Elderly patients often receive care from several doctors which makes the scheme of pharmacotherapy more complicated. This is overlapping
with the effect of over the counter medications and
dietary supplements self-treatment, which additionally increases the risk of drugs problems (1). For this
reason, for many years, pharmaceutical care (PC) is
practiced all over the world as a documented serv-
ice, where pharmacist collaborates with the patient
and the physician and, if necessary, with other
health care professionals and ensures the proper
conduct of pharmacotherapy in order to achieve specific outcomes, which improve the patientís quality
of life (2). It is especially important for elderly
patients, who very often suffer from chronic disorders and multi-disease. It requires using large
* Corresponding author: e-mail: [email protected]; phone: 61-854-66-55
1375
1376
MAGDALENA WASZYK-NOWACZYK et al.
amount of drugs and leads to polypharmacy (3).
Proper patient adherence to the doctorís recommendation is meaningful for therapy effectiveness. Nonadherence contributes to the failure of medical treatment. This problem affects many patients e.g.,
almost 25.0% of them reduce alone the number of
drugs used without doctorís consultation. These
actions may lead to serious consequences such as
pharmacotherapy failure, prolonged treatment or
exacerbate patientís health condition, hospitalization and in the most severe cases death (4).
PC is an integral element of patientís health
care which requires proper documentation for its
conducting. It has a crucial impact on the running of
the PC service, because it allows to collect patientís
health and lifestyle data in a proper way. Then, it
gives the possibility of the detailed drug analysis
arrangement which improves patientsí pharmacotherapy (5-7).
The aim of this study was to prepare a standard
draft form to conduct PC in community pharmacy
and verification of its correctness in the group of
elderly patients who is treated by family physician
and at least two specialized doctors. The essence of
this study was to determine the PC implementation
validity as a specialized service carried out in community pharmacy among elderly patients.
MATERIAL AND METHOD
The research was conducted in Jarocin
(Poland) between January 2014 and June 2015. This
Figure 1. The number of physicians who counselled the patients, n = 54
Figure 2. The specializations of physicians involved in patientsí treatment, n = 54
Pharmaceutical care form application in elderly patients research
1377
Figure 3. Valuation of selected patientsí lifestyle diseases, n = 54
Figure 4. The number of medications used by patients, n = 54
study was based on the PC authorís draft form and
was filled in by the investigator. There were
involved 54 elderly patients (59.0% women, 41.0%
men) treated additionally by two or more specialized
doctor. Elderly patients were referred from family
doctors working in Primary Care Physicians Clinic.
Patients aged 65 year and more were mostly in the
65-74 years and 75-84 years subgroups (48.2% and
44.4%, respectively). The rest of the patients had
more than 85 years. About 60.0% of the study group
was characterized by a basic or vocational education. The rest declared secondary or higher education.
The study was based on the designed form to
conduct PC. During the interview patientís basic
information was evaluated. The collected data were
analyzed among others in terms of the proper pharmacotherapy and interaction occurring between the
prescribed drugs and food components. Substantive
analysis where very significant and significant interactions were detected allowed for patients selection
where PC implementation is reasonable.
Pharmaceutical counselling was provided for each
patient who wasnít classified to PC. The study
received Ethical Board revision and acceptance.
The results were statistically analyzed with the
use of Statistica 10.0 application (StatSoftÆ). To
compare the pharmacotherapy risk factors in the two
groups of patients with and without indication for
PC test for proportions was applied. All statistical
analyses were performed at p < 0.05.
RESULTS
The study indicated that 48.1% of patients were
counselled by at least 3 specialists (Fig. 1); 66.7% of
patients were treated by cardiologist, 55.6% by the
ophthalmologist and 25.9% by the endocrinologist
(Fig. 2). 75.9% of patients had hypertension and
33.3% had hypercholesterolemia (Fig. 3). 42.6% of
the patients used 10 or more pharmaceuticals and
24.1% took 8 or 9 drugs (Fig. 4). Moreover, 20.4%
of participants used drugs irregularly and 7.4% of
them took too low dose of medications (Fig. 5).
Additionally, during the pharmacotherapy analysis,
very significant and significant drug-drug interactions were noticed (1.1% and 18.4%, respectively).
Very significant drug-food interactions occurred in
1.4% cases and significant in 3.3% cases. Total number of detected interactions were 553 (Fig. 6).
1378
MAGDALENA WASZYK-NOWACZYK et al.
The substantial analysis of participantsí data
allowed for 48 patients selection for pharmaceutical
counselling, 6 patients were involved into the group
where PC process was reasonable (Table 1). These
patients often used 10 or more drugs (p = 0.0026),
discontinued using medication without doctor consulting (p = 0.0201) and did not follow up the prescribed pharmacotherapy (p = 0.0351).
DISCUSSION AND CONCLUSION
The elderly patients, as it was proved in this
study, compose a group with many pharmacotherapy problems. Very often it is due to many doctors
consultations and patientsí non-compliance (1, 8). In
this study, 76.0% of patients had hypertension and
about 30.0% had hypercholesterolemia. 48.1% of
patients were counselled by at least 3 specialists and
66.7% of patients were treated by cardiologist and
55.6% by ophthalmologist. Comparable results in
elderly population were presented in PolSenior
study (9). Nowadays, patients are counselled by
many specialists and very often they donít inform
physicians about other consultations. It leads to
many problems especially concerning pharmacotherapy. In such cases, pharmaceutical advice,
which is commonly practiced in Polish community
pharmacy, does not approve sufficient effect and so
becomes a necessity to implement a well-run PC as
it is applied in many countries (10-12).
This research presented that approximately 2/3
of the patients used 8 or more pharmaceuticals.
Additionally 20.3% of participants used drugs irregularly and 7.7% of them took too low dose of medications. According to the study from France, overuse (77.0% of the patients), underuse and at minor
degree of misuse were mostly evidenced at elderly
patient group (13). OíConnell et al. demonstrated
that about 23.0% of patients took wrong doses of
medications (14). Current investigation proved additionally that polypharmacy is a popular problem at
elderly and this is consistent with many studies (9,
Figure 5. Patientsí adherence to recommended treatment, n = 54
Figure 6. Division of detected interactions among the patients, n = 553
Pharmaceutical care form application in elderly patients research
1379
Table 1. The distinction of patients who required PC according to the risk factors.
Risk factors
n=6
n = 48
Patients who required PC
Patients who didn't require PC
p-Value
n
n (%)
n
n (%)
Application of 10
or more medicines
6
100.0
17
35.4
0.0026*
Self discontinuation
of treatment
3
50.0
6
12.5
0.0201*
Not following up
the prescribed
pharmacotherapy
4
66.7
12
25.0
0.0351*
*p < 0.05
15-17). Moreover, this issue is highly manifested in
the elderly women population (18).
Unnecessary drugs increased the risk of nonadherence and interactions occurrence (19). Some
studies indicated that at least 20.0% of elderly had
low adherence to treatment (20-22) so it resulted e.g.,
in significant drug-drug interactions (46.0% cases)
and in potential herb-drug interactions (33.0% cases)
(23). In study from 2016, 70.0% of participants used
at least one potentially inappropriate medication
(24). Additionally, Ahmad et al. followed drug related problems from hospital discharges. There were
992 potential problems with medication which were
observed in 340 patients. Ten percent of these cases
were drug-drug interactions (25).
Another significant problem found in this
study was an irregular treatment. The study of
Roberts et al. confirmed that it could be connected
even with 70.0% of patients (26). Additionally, the
most common mistakes made by patients at home
were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking outof-date or inappropriately stored drugs (27). So, it is
very important to provide reasonable PC in community pharmacy with drug history documentation
which include also over the counter medications and
health supplements analysis. Then, pharmacist can
prepare drug use review to search drug-drug and
drug-food interactions and suggests medicine with
lower risk of interactions to optimize drug therapy
(23).
Essential element of the study were preparation
of adequate PC documentation and proper patientsí
indication for PC or pharmaceutical counselling.
The selected patients for PC often used 10 or more
drugs, discontinued using medication without doctor
consulting and did not follow up the prescribed
pharmacotherapy. The PC recommendation and
documentation, in general, are similar in many
countries, but still there are different types of medication review procedures (28-30). Thus, there
should be organized a trial to get a better cooperation between countries to obtain standardized medication review practice nationally and internationally developed (28).
The obtained data confirm that there is a need
of PC implementation especially for elderly. This
documented analysis should be an integral part of
patientís health care because physician refers patient
or due to patientís request. Finally, it should be
refunded by the National Health Fund.
Implementation of PC brings many benefits for the
patients pharmacotherapy mainly for improving the
quality of elderly lives.
Acknowledgment
This study was supported by the funding for
young scientists from Poznan University of Medical
Sciences (grant no. 502-14-03314429-09415).
REFERENCES
1. Waszyk-Nowaczyk M., Simon M., Matwij K.:
Acta Pol. Pharm. Drug Res. 69, 971 (2012).
2. Hepler C.D., Strand L.M.: Am. J. Hosp. Pharm.
47, 533 (1990).
3. Waszyk-Nowaczyk M., Nowaczyk P.: Saudi
Pharm. J. 22, 537 (2014).
4. Wieczorowska-Tobis K.: in Physiotherapy in
geriatrics (Polish). Wieczorowska-Tobis K.,
Kostka T., Borowicz A.M. Eds., p. 18, PZWL,
Warszawa 2011.
5. Derkacz M., Flisek J., Wicha J., Tarach J.: Fam.
Med. Prim. Care Rev. 5, 91 (2014).
6. Krass I., Mitchell B., Song Y., Stewart K.,
Peterson G. et al.: Diabet. Med. 28, 987 (2011).
1380
MAGDALENA WASZYK-NOWACZYK et al.
7. Manfrin A., Thomas T., Krska J.: BMC Health
Serv. Res. 15, 171 (2015).
8. Farrell B., Tsang C., Raman-Wilms L., Irving
H., Conklin J., Pottie K.: PLoS One 10,
e0122246 (2015).
9. Mossakowska M., WiÍcek A., B≥Ídowski P.:
PolSenior (2012).
10. Bπbelek T., Brandys J., Grzeúkowiak E.,
£azowski J., Marczak J. et al.: Bulletin of the
Polish Pharmaceutical Council (2007).
11. Bryant L., Coster G., Gamble G., McCormick
R.: J. Pharm. Pract. 19, 94 (2011).
12. Silva C., Ramalho C., Luz I., Monteiro J.,
Fresco P.: Int. J. Clin. Pharm. 37, 327 (2015).
13. Andro M., Estivin S., Gentric A.: Rev. Med.
Interne 33, 122 (2012).
14. OíConnell M.B., Chang F., Tocco A., Mills
M.E., Hwang J.M. et al.: J. Am. Geriatr. Soc.
63, 1900 (2015).
15. Al Hamid A., Ghaleb M., Aljadhey H.,
Aslanpour Z.: Br. J. Clin. Pharmacol. 78, 202
(2014).
16. Jafari F., Khatony A., Rahmani E.: Glob. J.
Health Sci. 7, 360 (2015).
17. Jerez-Roig J., Medeiros L.F., Silva V.A.,
Bezerra C.L., Cavalcante L.A. et al.: Drugs
Aging 31, 883 (2014).
18. Bijani A., Hasanjani Roshan A.R., Yazdanpour
S., Hosseini S.R.: Caspian J. Intern. Med. 5, 77
(2014).
19. Anthierens S., Tansens A., Petrovic M.,
Christiaens T.: BMC Fam. Pract. 11, 65 (2010).
20. Tavares N.U.L., Bertoldi A.D., ThumÈ E.,
Facchini L.A., Ara˙jo de FranÁa G.V., Serrate
Mengue S.S.: Rev. Saude Publica 47, 1092
(2013).
21. Osterberg L., Blaschke T.: N. Engl. J. Med.
353, 487 (2005).
22. Thume E., Facchini L.A., Wyshak G., Campbell
P.: Am. J. Public Health 101, 868 (2011).
23. Mallet L., Spinewine A., Huang A.: Lancet 370,
185 (2007).
24. Bazargan M., Yazdanshenas H., Han S., Orum
G.: J. Aging Health 28, 118 (2016).
25. Ahmad A., Mast M.R., Nijpels G., Elders P.J.,
Dekker J.M., Hugtenburg J.G.: Patient Prefer.
Adherence 4, 155 (2014).
26. Roberts B., Stickley A., Balabanova D.,
Haerpfer C., McKee M.: J. Epidemiol.
Community Health 66, 1079 (2012).
27. Mira J.J., Lorenzo S., Guilabert M., Navarro I.,
PÈrez-Jover V.: Expert Opin. Drug Saf. 14, 815
(2015).
28. Bulajeva A., Labberton L., Leikola S.,
Pohjanoksa-M‰ntyl‰ M., Geurts M.M. et al.:
Res. Social Adm. Pharm. 10, 731 (2014).
29. Geurts M.M., Ivens M., van Gelder E., de Gier
J.J.: Inform. Prim. Care 21, 53 (2013).
30. Maes K.A., Tremp R.M. GSASA Working
group on clinical pharmacy, Hersberger K.E.,
Lampert M.L.: Int. J. Clin. Pharm. 37, 1162
(2015).
Received: 10. 09. 2015