Introduction: With growing age, multiple chronic diseases may result in polypharmacy. Drugs that should be avoided in older adults are called potentially inappropriate medications (PIM). Beyond PIM, drug-drug interactions (DDI) are known to be related to adverse drug events. This analysis examines the risk of frequent falling, hospital admission, and death in older adults associated with PIM and/or DDI (PIM/DDI) prescription. Materials and methods: This post hoc analysis used data of a subgroup of the getABI study participants, a large cohort of community-dwelling older adults. The subgroup comprised 2120 participants who provided a detailed medication report by telephone interview at the 5-year getABI follow-up. The risks of frequent falling, hospital admission, and death in the course of the following 2 years were analysed by logistic regression in uni- and multivariable models with adjustment for established risk factors. Results: Data of all 2,120 participants was available for the analysis of the endpoint death, of 1,799 participants for hospital admission, and of 1,349 participants for frequent falling. The multivariable models showed an association of PIM/DDI prescription with frequent falling (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.06–2.60, p = 0.027) as well as with hospital admission (OR 1.29, 95% CI 1.04–1.58, p = 0.018), but not with death (OR 1.00, 95% CI 0.58–1.72, p = 0.999). Conclusion: PIM/DDI prescription was associated with the risk of hospital admission and frequent falling. No association was found with death by 2 years. This result should alert physicians to provide a closer look at PIM/DDI prescriptions.

/pdf/potentially-inappropriate-medication-including-drug-drug-250gxeag.pdf

Potentially inappropriate medication including drug-drug interaction and the risk of frequent falling, hospital admission, and death in older adults - results of a large cohort study (getABI)

A medication list (ML) is a document listing the patient's entire medication, instructions for use, and indications. In Germany, a national standard was established in 2016 by law. However, data on patients' use of this standardized ML are scarce. We investigated (i) patients' practical use of the ML, (ii) patients' understanding of the ML, (iii) completeness and correctness of the current ML version, and (iv) reasons why patients did not adhere to their ML.Community pharmacists recruited patients possessing a standardized ML with ≥5 medications. Information sources to evaluate the ML were: (a) brown bag analysis, (b) practical demonstration, (c) patient interview, and (d) patient file. Data were analyzed using qualitative and quantitative methods.Two hundred and eighty-eight patients (median age: 76 years, range: 27-95) were enrolled. (i) 38.5% of the patients used their ML regularly to prepare their medication and 73.3% to inform their physician. (ii) Overall, patients' understanding of the ML was good, with >80% of the patients being able to identify all relevant information. (iii) While n = 2779 medications were actually taken, n = 2539 were documented on the ML. No ML was fully correct and complete. Regarding particularly relevant items, ie, active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% of ML were incorrect or incomplete. Handwritten modifications on the ML were frequent. (iv) Almost 60% of all patients did not follow their ML with "fear of adverse drug reactions" being the most frequently (n = 50) mentioned reason.Completeness and correctness of the current ML version was poor with handwritten modifications being frequent. Additionally, most of the patients did not adhere to their ML. This indicates that measures that lead to correct and up-to-date ML and improvements in patient counseling about their medication should be developed and implemented into routine practice. 

Patients’ Use of a Standardized Medication List - A Mixed Methods Study

Background The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care. Methods and findings Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders’ tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients’ medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management. Conclusions The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding.

Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study

Journal Article Let us start a dialogue about interprofessional research Get access Joon Soo Park, Joon Soo Park International Research Collaborative—Oral Health and Equity, University of Western Australia, Crawley, Western Australia, AustraliaUWA Dental School, University of Western Australia, Nedlands, Western Australia, AustraliaSchool of Allied Health, University of Western Australia, Crawley, Western Australia, AustraliaInstitute for Sustainable Industries & Liveable Cities, Victoria University, Melbourne, Victoria, Australia Correspondence: Joon Soo Park, International Research Collaborative—Oral Health and Equity, University of Western Australia, Crawley, Western Australia, Australia. Email: alex.park@uwa.edu.au https://orcid.org/0000-0002-2052-558X Search for other works by this author on: Oxford Academic Google Scholar Manorika Ratnaweera Manorika Ratnaweera UWA Dental School, University of Western Australia, Nedlands, Western Australia, Australia Search for other works by this author on: Oxford Academic Google Scholar International Journal of Pharmacy Practice, riad039, https://doi.org/10.1093/ijpp/riad039 Published: 24 June 2023 

Let us start a dialogue about interprofessional research.

Objectives Experiential rotation preceptors may lack confidence in instructing interprofessional learners. This study examined the effect of a 12-episode, professionally produced video Mini-Series on attitudinal, satisfaction, and confidence outcomes in a cohort of interprofessional preceptors comprised of pharmacy, medicine, nursing, and other allied health professionals. Methods An invitation to view the Mini-Series was distributed to all health science preceptors within one large, public health science university. Participants were asked survey questions addressing their attitudes toward the Mini-Series, their comfort in precepting, and their satisfaction with the Mini-Series. Results Sixty-one interprofessional preceptors enrolled into the study with 33 completing the entire Mini-Series. Participants displayed highly positive attitudes towards the Mini-Series. Additionally, members of all professions enrolled demonstrated an increase in precepting confidence after viewing Mini-Series episodes (2.31 vs. 2.7 on a 3-point Likert scale). Subgroup analyses demonstrated that preceptors with greater than 10 years of professional experience displayed less positive attitudes towards the Mini-Series than those with 2-10 years of professional experience. Conclusion The Mini-Series model proved effective as a preceptor development strategy for a group of health professional preceptors. Given the diversity of learners, a collection of training options that allows for preceptor self-selection of programming may be beneficial. 

Effect of an Educational Video Mini-Series on Interprofessional Preceptor Development

Pharmacist-led medication review and medication management programs (MMP) are well-known strategies to improve medication safety and effectiveness. If performed interprofessionally, outcomes might even improve. However, little is known about task sharing in interprofessional MMP, in which general practitioners (GPs) and community pharmacists (CPs) collaboratively perform medication reviews and continuously follow-up on patients with designated medical and pharmaceutical tasks, respectively. In 2016, ARMIN (Arzneimittelinitiative Sachsen-Thüringen) an interprofessional MMP was launched in two German federal states, Saxony and Thuringia. The aim of this study was to understand how GPs and CPs share tasks in MMP when reviewing the patients' medication.This was a cross-sectional postal survey among GPs and CPs who participated in the MMP. Participants were asked who completed which MMP tasks, e.g., checking drug-drug interactions, dosing, and side effects. In total, 15 MMP tasks were surveyed using a 5-point Likert scale ranging from "I complete this task alone" to "GP/CP completes this task alone". The study was conducted between 11/2020 and 04/2021. Data was analyzed using descriptive statistics.In total, 114/165 (69.1%) GPs and 166/243 (68.3%) CPs returned a questionnaire. The majority of GPs and CPs reported (i) checking clinical parameters and medication overuse and underuse to be completed by GPs, (ii) checking storage conditions of drugs and initial compilation of the patient's medication including brown bag review being mostly performed by CPs, and (iii) checking side-effects, non-adherence, and continuous updating of the medication list were carried out jointly. The responses differed most for problems with self-medication and adding and removing over-the-counter medicines from the medication list. In addition, the responses revealed that some MMP tasks were not sufficiently performed by either GPs or CPs.Both GPs' and CPs' expertise are needed to perform MMP as comprehensively as possible. Future studies should explore how GPs and CPs can complement each other in MMP most efficiently. 

/pdf/task-sharing-in-an-interprofessional-medication-management-1y8vnzxd.pdf

Task sharing in an interprofessional medication management program – a survey of general practitioners and community pharmacists

Interprofessional medication management in primary care is a recognized strategy for improving medication safety, but it is poorly implemented in Germany. As a pilot project, ARMIN [Arzneimittelinitiative Sachsen-Thüringen] was initiated in 2014 to establish better interprofessional medication management between general practitioners and community pharmacists.The aim of this study was to explore the views of non-participating general practitioners and community pharmacists towards interprofessional medication management within ARMIN and to identify barriers to participation.This was an interview study comprising a series of semi-structured telephone interviews. In total, 36 general practitioners and 15 community pharmacists were interviewed in the period between March and June 2020. Data were analyzed using thematic analysis as an inductive approach and the consolidated framework for implementation research as a deductive approach.Many general practitioners and community pharmacists had a generally positive attitude towards interprofessional medication management. However, various barriers were identified and categorized into five major themes: (I) collaboration between general practitioners and community pharmacists, e.g. concerning general practitioners' professional sovereignty and pharmacists' fear of jeopardizing their relationship with general practitioners when interfering in therapy; (II) eligibility for participation, e.g., the fact that patients had to be insured with a specific statutory health insurance fund; (III) local circumstances, e.g. many pharmacists could not find a collaborating general practitioner (and vice versa). Moreover, patient demand was low, probably because patients were not aware of the program; (IV) information technology, e.g. concerning the lack of available software and data security concerns; and (V) cost-benefit ratio, e.g. the fact that potential benefits were outweighed by program-associated costs.The perceived discrepancy between positive attitudes and multiple prevalent barriers indicates considerable potential for further interprofessional collaboration between general practitioners and community pharmacists. 

/pdf/attitudes-of-non-participating-general-practitioners-and-2oaozu73.pdf

Attitudes of non-participating general practitioners and community pharmacists towards interprofessional medication management in primary care: an interview study

YSi alloy is a promising candidate as oxidation resistant coatings for both the bond coat of environmental barrier coatings (EBCs) and anti-ablation coatings at a high temperature of ∼1300 °C. In this study, a one-step multi-compositional oxidation by rapid heating oxidation mode is proposed to reduce the oxidation rate by 3.6 times compared to conventional slow heating oxidation mode. Results show that preferentially formed Y2O3 oxide initiates a multi-step oxidation, produces a cracking and porous oxides, and thereby resulting in a fast oxidation with pesting. The one-step multi-compositional oxidation with a compact and dense Y2Si2O7 scale contributes to the much better oxidation resistance for rapid heating oxidation mode of YSi alloy. The stable formation of Y2Si2O7 scale is comprehensively understood by the energy barrier, charge density and electronic level based on density functional theory. This study demonstrates a promising application of YSi alloy by rapid heating oxidation mode. 

Exploring patient participation in an interprofessional medication management program in primary care

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Task sharing in an interprofessional medication management program – a survey of general practitioners and community pharmacists

Attitudes of non-participating general practitioners and community pharmacists towards interprofessional medication management in primary care: an interview study

Exploring patient participation in an interprofessional medication management program in primary care