Browsing by Subject "comprehensive medication review"
Now showing items 1-2 of 2
-
(2013)With advancing age the kidneys undergo anatomical and physiological changes. The most significant physiological changes are decreased renal blood flow and glomerular filtration rate (GFR). GFR is declined approximately in two thirds of the aged. Dosages of drugs eliminated mainly by the kidney should be adjusted carefully in patients with renal insufficiency. Nevertheless, according to earlier studies renal insufficiency among elderly patients is underdiagnosed and renal function is often overlooked when prescribing. Serum creatinine level is used as a screening test for renal dysfunction. However, it is a poor measure among elderly patients. Instead, calculated GFR should be the preferred method in estimating kidney function among this patient group. The aim of this study was to assess if comprehensive medication review can improve the quality of drug therapy among aged nursing home residents with impaired renal function. The data consisted of 153 comprehensive medication reviews (CMRs) conducted by Farenta Oy. CMR case reports were used to assess intervention recommendations made by pharmacists because of renal insufficiency, other kidney-related findings and resulting medication-related interventions. In addition, the prevalence of renal insufficiency, degree of renal insufficiency diagnoses and relationship between serum creatinine and estimated GFR were assessed. Clinical significance of the interventions was not assessed. The mean age of patients was 82,4 years. The estimated GFR was available for 145 patients (94,8%). 86,9% (n=126) had declined renal function (GFR<80 ml/min). Of these, serum creatinine levels were within normal range or under in 73,8% of all patients with renal insufficiency. Physicians had documented 4,8% of renal insufficiency cases in clinical patient files. Pharmacists identified inappropriate drugs due to renal function in 34,9% (n=44) of the patients with renal insufficiency. In total, pharmacists made 71 intervention recommendations. Physicians approved 60,6% of the pharmacists' recommendations as made. At least one intervention recommendation was approved as made in nearly one fourth (23,0%) of the patients with renal insufficiency. The most common drug-related intervention was changing the drug (25,4 %). Cardiovascular drugs accounted for 33,8% of the intervention recommendations, nervous system drugs 19,7 %. According to this study renal insufficiency among aged nursing home residents is common but underdiagnosed. Approximately one third of patients with renal insufficiency are using inappropriate medicines or dosages. These drug-related problems can be indentified and resolved during the comprehensive medication review procedure.
-
(2015)Different kind of medication reviews have been developed in different countries. In Finland comprehensive medication review was developed in the late 2000th. Only few researches of medication review exist in Finland. In other countries more studies on the subject have been done. This Master's thesis's aim in the literature review was to examine what kind of outcome measurements were used in medication review studies and what kind of results were obtained from these measurements. In many medication review studies different kind of drug related parameters were used to evaluate the effectiveness of medication review. These parameters are Drug Related Problems (DRP), Medication Appropriateness Index (MAI) and different kind of criteria's for potentially inappropriate medication for elderly. Medication reviews have showed a positive effect on these parameters. To the health-related quality of life medication reviews have not shown any statistical effect. Physical performance meters have not been used a lot in medication review studies. And results have been controversial. Omahoitosuunnitelma 2100 (OMA21) research project, that examines the effectiveness of the comprehensive medication review in Finnish health care, could potentially due to its long follow-up time produce results also from the quality of life and physical performance instruments. In the Master's thesis's experimental part the aim was to evaluate unity of the medication reviews in OMA21 research project. For four intervention patients in the OMA21 research project parallel medication reviews were done. From these reviews were examined how many of the problems found in the reviews were the same with different reviewers. There was a lot of dispersion in the problems found in the reviews. Only 17.5 % of the 40 different problems found in the reviews were the same with all the reviewers. From 12 patients medication reviews drug related problems were categorized by PCNE classification V6.2. 69 drug related problems were found from the medication reviews. Most common problem was the treatment effectiveness (P1) (37.7 %). For the problems 92 potential causes were found and the most common of them was drug selection (C1) (39.1 %). The aim was also examine whether Evidence-Based Medicine electronic Decision Support (EBMeDS) tool, developed by Duodecim Medical Publications Ltd, could be useful in the OMA21 research project. It was shown that EBMeDS have limited advantage if patients' information has not been reported right in the electronic health records. Only 30 % of the examined drugs had indication. In the future if the patients' information was reported right in the electronic health records the EBMeDS tools could be useful help in medication reviews, because EBMeDS contains many electronic databases that are often used in medication reviews.P50O48
Now showing items 1-2 of 2