Browsing by Subject "medication therapy management"
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Item A Multisite Qualitative Analysis of Perceived Roles in Medication Safety: Older Adults' Perspectives(Cleveland Clinic, 2023-03-04) Jallow, Fatoumata; Stehling, Elisa; Sajwani-Merchant, Zara; Daniel, Kathryn M.; Fulda, Kimberly G.; Espinoza, Anna M.; Gurses, Ayse P.; Arbaje, Alicia I.; Xiao, YanOlder adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals' roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structured qualitative interviews were held with 28 community-dwelling older adults over 65 years who took five or more prescription medications daily. Results suggest that older adults' self-perceptions of their role in medication safety varied widely. Older adults perceived that self-learning about their medications and securing them are critical to avoiding medication-related harm. Primary care providers were perceived as coordinators between older adults and specialists. Older adults expected pharmacists to inform them of any changes in the characteristics of medications to ensure medications were taken correctly. Our findings provide an in-depth analysis of older adults' perceptions and expectations of their providers' specific roles in medication safety. Educating providers and pharmacists about the role expectations of this population with complex needs can ultimately improve medication safety.Item PATTERNS OF MEDICATION-RELATED PROBLEMS IDENTIFIED DURING A SIX-MONTH MEDICATION MANAGEMENT PROGRAM.(2013-04-12) Liou, AshleyPurpose: Using data from a parent study that evaluated a comprehensive medication management program, this study sought to follow the types of medication-related problems (MRPs) identified at baseline and describe patterns of MRPs over the course of the intervention. The study also examined the most prevalent drug classes contributing to MRPs. Methods: The study examined MRPs at baseline and at 6 months. Drugs were consolidated into a representative therapeutic class. Data on MRPs and drugs had been previously recorded by clinical pharmacists in the study database. Results: 273 MRPs were found at baseline and were reduced to 22 MRPs at 6 months. The most prevalent MRPs at baseline were suboptimal drug (31%), suboptimal dosing (23%), nonadherence (21%), and undertreatment (19%). In comparison, the most prevalent MRP at 6 months was nonadherence (64%), followed by suboptimal drug (14%). At baseline, the most prevalent drugs contributing to overall MRPs were calcium and vitamin D in the category of suboptimal dosing. At 6 months, calcium and vitamin D continued to be the most frequent set of drugs contributing to overall MRPs (32% of the 22 drugs). The second most frequent contributor was antilipidemics, occurring 14% overall. Conclusions: The medication management program was successful in significantly reducing the number and type of MRPS over 6 months. Calcium, vitamin D, and antilipidemics were identified as the most common set of drugs contributing to MRPs. The most common MRP at baseline was suboptimal drug compared to nonadherence at 6 months.Item The impact of medication therapy management on polypharmacy in people living with HIV/AIDS(2020-08) Orimoloye, Helen Tolulope; Suzuki, Sumihiro; Clay, Patrick G.; Rasu, Rafia S.Polypharmacy, defined as the concurrent use of multiple medications simultaneously, is increasingly common in people living with HIV/AIDS (PLWHA) due to the use of antiretroviral and non-antiretroviral drugs for the treatment of multiple chronic diseases. Polypharmacy is a growing concern among PLWHA because of their complex medication regimen, the risk of adverse drug events, drug-drug interactions, medication non-adherence, medication errors, and antiretroviral treatment failure. Medication therapy management (MTM), which are pharmacist-led interventions, have been useful in resolving medication-related problems and optimizing clinical outcomes. However, there are limited studies on the effectiveness of pharmacist-provided MTM services in reducing polypharmacy in HIV/AIDs patients. MTM services should enable the identification and reduction of polypharmacy. Hence, the central goal of this dissertation was to evaluate the impact of MTM services on polypharmacy in PLWHA. A secondary data analysis of a new MTM project by the CDC, UNTHSC, and Walgreens that involved the collaboration of pharmacists and clinicians to provide patient-centered care for HIV patients was done. The study involved 765 participants from 10 states in the United States. Polypharmacy was measured by the number of polyactive substances (pharmacologically active ingredients) in medications used. A paired T-test was used to find the difference between the pill count and the polyactive substances in medicines used by PLWHA. A longitudinal data analysis using a generalized estimating equation was used to assess the impact of MTM intervention on polypharmacy over time by determining the change in polyactive substances in medication pre-post MTM intervention. The relationship between the changes in HIV outcomes CD4 count and HIV RNA count and the change in polyactive substances pre-post MTM intervention was also determined. The results showed a significant average difference between the polyactive substance count and the pill count of about 2.15. Also, the number of polyactive substances in medications used by study participants reduced by an average of 3 from pre- to post- MTM intervention. There was a relationship between the change in HIV outcomes and the change in polyactive substance pre-post MTM intervention. As polyactive substances decrease over time in the study, there is a higher chance that there is viral suppression and improvement in CD4 count at the end of the study. Medication therapy management involving pharmacists and clinicians may be useful in addressing polypharmacy in PLWHA. The MTM program in this study was not designed to address polypharmacy. But the results indicated that the intervention had a positive impact on polypharmacy. Further studies, such as a case-control study or a randomized control trial, are required to assess the effect of MTM on polypharmacy better.