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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