Clinical impact of an individualised clinical pharmacy programme into the memory care pathway of older people: an observational study.
Aged
Alzheimer’s disease
Clinical pharmacy
Cognitive iatrogenic risk
Critical pathway
France
Journal
International journal of clinical pharmacy
ISSN: 2210-7711
Titre abrégé: Int J Clin Pharm
Pays: Netherlands
ID NLM: 101554912
Informations de publication
Date de publication:
20 Apr 2024
20 Apr 2024
Historique:
received:
12
06
2023
accepted:
08
03
2024
medline:
20
4
2024
pubmed:
20
4
2024
entrez:
20
4
2024
Statut:
aheadofprint
Résumé
In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia. To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint. This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient's hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool. Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12). The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.
Sections du résumé
BACKGROUND
BACKGROUND
In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia.
AIM
OBJECTIVE
To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint.
METHOD
METHODS
This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient's hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool.
RESULTS
RESULTS
Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12).
CONCLUSION
CONCLUSIONS
The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.
Identifiants
pubmed: 38642248
doi: 10.1007/s11096-024-01723-z
pii: 10.1007/s11096-024-01723-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Références
Mion L, Odegard PS, Resnick B, et al. Interdisciplinary care for older adults with complex needs: American Geriatrics Society position statement. J Am Geriatr Soc. 2006;54:849–52. https://doi.org/10.1111/j.1532-5415.2006.00707.x .
doi: 10.1111/j.1532-5415.2006.00707.x
pubmed: 16696754
Hébert R, Durand PJ, Dubuc N, et al. PRISMA: a new model of integrated service delivery for the frail older people in Canada. Int J Integr Care. 2003;3:e08. https://doi.org/10.5334/ijic.73 .
doi: 10.5334/ijic.73
pubmed: 16896376
pmcid: 1483944
Khan S, Barve KH, Kumar MS. Recent advancements in pathogenesis, diagnostics and treatment of Alzheimer’s disease. Curr Neuropharmacol. 2020;18:1106–25. https://doi.org/10.2174/1570159X18666200528142429 .
doi: 10.2174/1570159X18666200528142429
pubmed: 32484110
pmcid: 7709159
Dauphinot V, Ravier A, Novais T, et al. Risk factors of caregiver burden evolution, for patients with subjective cognitive decline or neurocognitive disorders: a longitudinal analysis. J Am Med Dir Assoc. 2016;17:1037–43. https://doi.org/10.1016/j.jamda.2016.07.003 .
doi: 10.1016/j.jamda.2016.07.003
pubmed: 27575984
Dauphinot V, Garnier-Crussard A, Moutet C, et al. Determinants of medical direct costs of care among patients of a memory center. J Prev Alzheimers Dis. 2021;8:351–61. https://doi.org/10.14283/jpad.2021.16 .
doi: 10.14283/jpad.2021.16
pubmed: 34101794
Krolak-Salmon P, Letrilliart L, Ceccaldi M, et al. Towards a national strategy on the diagnosis of neurocognitive disorders. A shared approach among the French National College of General Practitioners and specialists of neurocognitive disorders. Presse Med. 2018;47:75–83. https://doi.org/10.1016/j.lpm.2017.10.029 .
doi: 10.1016/j.lpm.2017.10.029
pubmed: 29287728
Alzheimer’s Disease International. World Alzheimer report 2019: attitudes to dementia. London: Alzheimer’s Disease International; 2019. p. 160. https://www.alzint.org/u/WorldAlzheimerReport2019.pdf .
Fried TR, O’Leary J, Towle V, et al. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc. 2014;62:2261–72. https://doi.org/10.1111/jgs.13153 .
doi: 10.1111/jgs.13153
pubmed: 25516023
pmcid: 4270076
Lai S-W, Lin C-H, Liao K-F, et al. Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatr Gerontol Int. 2012;12:491–8. https://doi.org/10.1111/j.1447-0594.2011.00800.x .
doi: 10.1111/j.1447-0594.2011.00800.x
pubmed: 22233227
Mouchoux C, Loue C, Krolak-Salmon PP. La iatrogénie cognitive. Savoir l’identifier chez le sujet âgé. Repères en gériatrie. 2016;18:5.
Wastesson JW, Morin L, Tan ECK, et al. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf. 2018;17:1185–96. https://doi.org/10.1080/14740338.2018.1546841 .
doi: 10.1080/14740338.2018.1546841
pubmed: 30540223
Coupland CAC, Hill T, Dening T, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019;179:1084–93. https://doi.org/10.1001/jamainternmed.2019.0677 .
doi: 10.1001/jamainternmed.2019.0677
pubmed: 31233095
pmcid: 6593623
Nakham A, Myint PK, Bond CM, et al. Interventions to reduce anticholinergic burden in adults aged 65 and older: a systematic review. J Am Med Dir Assoc. 2020;21:172-180.e5. https://doi.org/10.1016/j.jamda.2019.06.001 .
doi: 10.1016/j.jamda.2019.06.001
pubmed: 31351858
Lee JK, Slack MK, Martin J, et al. Geriatric patient care by U.S. pharmacists in healthcare teams: systematic review and meta-analyses. J Am Geriatr Soc. 2013;61:1119–27. https://doi.org/10.1111/jgs.12323 .
doi: 10.1111/jgs.12323
pubmed: 23796001
Altowaijri A, Phillips CJ, Fitzsimmons D. A systematic review of the clinical and economic effectiveness of clinical pharmacist intervention in secondary prevention of cardiovascular disease. J Manag Care Pharm. 2013;19:408–16. https://doi.org/10.18553/jmcp.2013.19.5.408 .
doi: 10.18553/jmcp.2013.19.5.408
pubmed: 23697478
Nkansah N, Mostovetsky O, Yu C, et al. Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev. 2010. https://doi.org/10.1002/14651858.CD000336.pub2 .
doi: 10.1002/14651858.CD000336.pub2
pubmed: 20614422
pmcid: 7087444
Graabaek T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol. 2013;112:359–73. https://doi.org/10.1111/bcpt.12062 .
doi: 10.1111/bcpt.12062
pubmed: 23506448
Tan ECK, Stewart K, Elliott RA, et al. Pharmacist services provided in general practice clinics: a systematic review and meta-analysis. Res Social Adm Pharm. 2014;10:608–22. https://doi.org/10.1016/j.sapharm.2013.08.006 .
doi: 10.1016/j.sapharm.2013.08.006
pubmed: 24161491
Reumerman MO, Richir MC, Sultan R, et al. An inter-professional student-run medication review programme. Reducing adverse drug reactions in a memory outpatient clinic: a controlled clinical trial. Expert Opin Drug Saf. 2022. https://doi.org/10.1080/14740338.2022.2069748 .
doi: 10.1080/14740338.2022.2069748
pubmed: 35469517
Possin KL, Merrilees JJ, Dulaney S, et al. Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the care ecosystem randomized clinical trial. JAMA Intern Med. 2019;179:1658–67. https://doi.org/10.1001/jamainternmed.2019.4101 .
doi: 10.1001/jamainternmed.2019.4101
pubmed: 31566651
pmcid: 6777227
Levine AMP, Emonds EE, Smith MA, et al. Pharmacist identification of medication therapy problems involving cognition among older adults followed by a home-based care team. Drugs Aging. 2021;38:157–68. https://doi.org/10.1007/s40266-020-00821-7 .
doi: 10.1007/s40266-020-00821-7
pubmed: 33354755
Pfister B, Jonsson J, Gustafsson M. Drug-related problems and medication reviews among old people with dementia. BMC Pharmacol Toxicol. 2017;18:52. https://doi.org/10.1186/s40360-017-0157-2 .
doi: 10.1186/s40360-017-0157-2
pubmed: 28655357
pmcid: 5488493
Sjölander M, Lindholm L, Pfister B, et al. Impact of clinical pharmacist engagement in ward teams on the number of drug-related readmissions among older patients with dementia or cognitive impairment: an economic evaluation. Res Social Adm Pharm. 2019;15:287–91. https://doi.org/10.1016/j.sapharm.2018.05.006 .
doi: 10.1016/j.sapharm.2018.05.006
pubmed: 29778344
Gustafsson M, Sjölander M, Pfister B, et al. Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial. Eur J Clin Pharmacol. 2017;73:827–35. https://doi.org/10.1007/s00228-017-2249-8 .
doi: 10.1007/s00228-017-2249-8
pubmed: 28391409
pmcid: 5486919
Burns E, Nair S. New horizons in care home medicine. Age Ageing. 2014;43:2–7. https://doi.org/10.1093/ageing/aft186 .
doi: 10.1093/ageing/aft186
pubmed: 24334750
McDerby N, Kosari S, Bail K, et al. Pharmacist-led medication reviews in aged care residents with dementia: a systematic review. Australas J Ageing. 2020;39:e478–89. https://doi.org/10.1111/ajag.12827 .
doi: 10.1111/ajag.12827
pubmed: 32748980
Schmidt I, Claesson CB, Westerholm B, et al. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. J Am Geriatr Soc. 1998;46:77–82. https://doi.org/10.1111/j.1532-5415.1998.tb01017.x .
doi: 10.1111/j.1532-5415.1998.tb01017.x
pubmed: 9434669
van der Spek K, Koopmans RTCM, Smalbrugge M, et al. The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial. Age Ageing. 2018;47:430–7. https://doi.org/10.1093/ageing/afy001 .
doi: 10.1093/ageing/afy001
pubmed: 29432518
Dobesh PP, Bosso J, Wortman S, et al. Critical pathways: the role of pharmacy today and tomorrow. Pharmacotherapy. 2006;26:1358–68. https://doi.org/10.1592/phco.26.9.1358 .
doi: 10.1592/phco.26.9.1358
pubmed: 16945060
Allenet B, Juste M, Mouchoux C, et al. De la dispensation au plan pharmaceutique personnalisé: vers un modèle intégratif de pharmacie clinique. Le Pharmacien Hospitalier et Clinicien. 2019;54:56–63. https://doi.org/10.1016/j.phclin.2018.12.003 .
doi: 10.1016/j.phclin.2018.12.003
Brown EA, Farrington K. Geriatric assessment in advanced kidney disease. Clin J Am Soc Nephrol. 2019;14:1091–3. https://doi.org/10.2215/CJN.14771218 .
doi: 10.2215/CJN.14771218
pubmed: 31118213
pmcid: 6625622
Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. https://doi.org/10.1186/s12877-017-0621-2 .
doi: 10.1186/s12877-017-0621-2
pubmed: 29017448
pmcid: 5635569
Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71:861–75. https://doi.org/10.1007/s00228-015-1860-9 .
doi: 10.1007/s00228-015-1860-9
pubmed: 25967540
pmcid: 4464049
O’Mahony D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8. https://doi.org/10.1093/ageing/afu145 .
doi: 10.1093/ageing/afu145
pubmed: 25324330
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674–94. https://doi.org/10.1111/jgs.15767 .
doi: 10.1111/jgs.15767
Park H-Y, Park J-W, Song HJ, et al. The association between polypharmacy and dementia: a nested case-control study based on a 12-year longitudinal cohort database in South Korea. PLoS ONE. 2017;12:e0169463. https://doi.org/10.1371/journal.pone.0169463 .
doi: 10.1371/journal.pone.0169463
pubmed: 28056068
pmcid: 5215897
Buckley E, Jonsson A, Flood Z, et al. Potentially inappropriate medication use and mortality in patients with cognitive impairment. Eur J Clin Pharmacol. 2022;78:2013–20. https://doi.org/10.1007/s00228-022-03410-2 .
doi: 10.1007/s00228-022-03410-2
pubmed: 36329311
Griese-Mammen N, Hersberger KE, Messerli M, et al. PCNE definition of medication review: reaching agreement. Int J Clin Pharm. 2018;40:1199–208. https://doi.org/10.1007/s11096-018-0696-7 .
doi: 10.1007/s11096-018-0696-7
pubmed: 30073611
Allenet B, Bedouch P, Rose F-X, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28:181–8. https://doi.org/10.1007/s11096-006-9027-5 .
doi: 10.1007/s11096-006-9027-5
pubmed: 17066245
Vo HT, Charpiat B, Chanoine S, et al. CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions. Eur J Hosp Pharm. 2021;28:193–200. https://doi.org/10.1136/ejhpharm-2020-002642 .
doi: 10.1136/ejhpharm-2020-002642
pubmed: 33883205
pmcid: 8239266
WHOCC—Structure and principles n.d. https://www.whocc.no/atc/structure_and_principles/ . Accessed 8 July 2021.
Mongaret C, Quillet P, Vo TH, et al. Predictive factors for clinically significant pharmacist interventions at hospital admission. Medicine (Baltimore). 2018;97:e9865. https://doi.org/10.1097/MD.0000000000009865 .
doi: 10.1097/MD.0000000000009865
pubmed: 29489684
Ziane A, Ngami C, Youb R, et al. Evaluating the quality of pharmacists’ interventions in older patient than 75 years. J Pharm Clin. 2013;32:243–9. https://doi.org/10.1684/jpc.2013.0261 .
doi: 10.1684/jpc.2013.0261
Barral M, Martin J, Carre E, et al. How a patient personalised clinical pharmacy programme can secure therapeutic care in an orthogeriatric care pathway (5P project)? Clin Interv Aging. 2021;16:1857–67. https://doi.org/10.2147/CIA.S325035 .
doi: 10.2147/CIA.S325035
pubmed: 34707352
pmcid: 8544550
Dong PTX, Pham VTT, Dinh CT, et al. Implementation and evaluation of clinical pharmacy services on improving quality of prescribing in geriatric inpatients in Vietnam: an example in a low-resources setting. Clin Interv Aging. 2022;17:1127–38. https://doi.org/10.2147/CIA.S368871 .
doi: 10.2147/CIA.S368871
pubmed: 35903286
pmcid: 9314755
Cortejoso L, Dietz RA, Hofmann G, et al. Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany. Clin Interv Aging. 2016;11:1343–50. https://doi.org/10.2147/CIA.S109048 .
doi: 10.2147/CIA.S109048
pubmed: 27713625
pmcid: 5045027
Ailabouni N, Mangin D, Nishtala PS. DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities. Int J Clin Pharm. 2019;41:167–78. https://doi.org/10.1007/s11096-019-00784-9 .
doi: 10.1007/s11096-019-00784-9
pubmed: 30659492
Novais T, Qassemi S, Cestac P, et al. Medication exposure of the dyad patient-caregiver in Alzheimer’s disease and related dementias: a cross-sectional study. Int J Clin Pharm. 2024;46:205–9. https://doi.org/10.1007/s11096-023-01623-8 .
doi: 10.1007/s11096-023-01623-8
pubmed: 37532841
Wilkes S, Zaal RJ, Abdulla A, et al. A cost-benefit analysis of hospital-wide medication reviews: a period prevalence study. Int J Clin Pharm. 2022;44:138–45. https://doi.org/10.1007/s11096-021-01323-1 .
doi: 10.1007/s11096-021-01323-1
pubmed: 34498214
Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging definition of “deprescribing” with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80:1254–68. https://doi.org/10.1111/bcp.12732 .
doi: 10.1111/bcp.12732
pubmed: 27006985
pmcid: 4693477
Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170:1648–54. https://doi.org/10.1001/archinternmed.2010.355 .
doi: 10.1001/archinternmed.2010.355
pubmed: 20937924
Reeve E, Wiese MD. Benefits of deprescribing on patients’ adherence to medications. Int J Clin Pharm. 2014;36:26–9. https://doi.org/10.1007/s11096-013-9871-z .
doi: 10.1007/s11096-013-9871-z
pubmed: 24242974
Smith D, Lovell J, Weller C, et al. A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS ONE. 2017;12:e0170651. https://doi.org/10.1371/journal.pone.0170651 .
doi: 10.1371/journal.pone.0170651
pubmed: 28166234
pmcid: 5293218
Bjerre LM, Farrell B, Hogel M, et al. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia: evidence-based clinical practice guideline. Can Fam Physician. 2018;64:17–27.
pubmed: 29358245
pmcid: 5962971
Harrison SL, Cations M, Jessop T, et al. Approaches to deprescribing psychotropic medications for changed behaviours in long-term care residents living with dementia. Drugs Aging. 2019;36:125–36. https://doi.org/10.1007/s40266-018-0623-6 .
doi: 10.1007/s40266-018-0623-6
pubmed: 30535930