engleski

Drug therapy problems in nursing home residents: opportunities for pharmacist intervention

Introduction: Older people are more susceptible to experiencing drug therapy problems (DTPs) due to their age-related changes in pharmacodynamics and pharmacokinetics, multiple comorbidities and polypharmacy 1. With the lack of data on DTP profile of the elderly living in Croatian nursing homes, identification and resolution of DTPs could be crucial in improving health care of the elderly. Aim: To determine the prevalence of DTPs, identify their type and the medications most frequently related with the DTPs of the nursing home residents. Materials and methods: A prospective observational study was conducted during the 5-month period in the nursing home “Sv. Kamilo de Lellis” (Vrbovec, Croatia). Home residents with at least two regular prescription medications and signed informed consent were included in the study. Residents’ data were retrieved by a careful review of their medical records, and through the interview with the resident, their caregiver or health care professionals. DTPs were classified according to the Pharmacotherapy Workup method proposed by Cipolle et al. 2, with DTPs being grouped into indication, effectiveness, safety and adherence. Results: Seventy-three residents were included in the study with a median age (range) of 80 (57-96) years. On average, residents used 7 (2-16) medications and had 5 (1-10) comorbidities. The total number of 310 DTPs was identified (4.3 ± 1.9 per resident). The most prevalent DTP was the ‘‘Needs additional drug therapy’’ (N = 74 ; 23.9%), followed by the ‘‘Adverse drug reaction’’ (N = 57 ; 18.4%) and ‘‘Dosage too high“ (N = 53 ; 17.1%). A significant correlation was found between the number of comorbidities (p < 0.001) and the number of used medications (p < 0.001) with the proportion of identified DTPs. Lactulose and potassium were the most frequently used medications related with DTPs. Potassium was the most involved medicine in the DTP “Dosage too low” (N = 18 ; 5.8%) due to incorrect administration, while tramadol was most frequently related to the DTP “Adverse drug reaction” (n = 25 ; 8.1%) for causing constipation. Conclusion: High prevalence of DTPs among nursing home residents highlights the irrational drug use in a clinical setting of a nursing home, thus implying an important role of pharmacists in the care of polymedicated elderly patients with multiple comorbidities. In that context, the pharmacist intervention could improve therapeutic safety and efficacy, clinical outcomes and lead to cost reduction. References: 1 Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003 ; 38(8):843-53. 2 Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient-centered approach to medication management. Third edit. New York:The McGraw-Hill Companies ; 2012.

drug therapy problem, nursing home, pharmacist

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