Medication review in Parliament. HARM study (2006) Medication review in the Netherlands. HARM study Recommendations. HARM study Risk factors

Transcription

1 HARM study (2006) Medication review in the Netherlands An overview 2,4% of all admissions hospital admissions 46% potentially avoidable 85 million euro Adrianne Faber Eindrapport HARM-onderzoek, Division of Pharmacoepidemiology & Pharmacotherapy, UIPS, 2006 HARM study Risk factors Patient-related 65 years or older non-compliance reduced cognitive function renal failure living in residential or nursing home co-morbidity HARM study Recommendations Intensive monitoring patients with risk factors regular medication review multidisciplinair Drug-related > 4 chronic medications antidiabetic drugs, blood coagulationinhibitors, NSAIDs, corticosteroids Eindrapport HARM-onderzoek, Division of Pharmacoepidemiology & Pharmacotherapy, UIPS, 2006 Eindrapport HARM-onderzoek, Division of Pharmacoepidemiology & Pharmacotherapy, UIPS, 2006 Medication review in Parliament Motion - January 8, 2008 Medication review is useful Avoid unneccesary drug use Improve medication safety Strategy on implementation medication review in The Netherlands 1

2 Health Council Drugs and the elderly (1994) Health Council Drugs and the elderly (1994) Unnecessary drugs Unnecessary side-effects Under treatment this can be avoided by a careful, individual approach when prescribing and a regular evaluation of effectiveness and safety of the prescribed drugs. Prof. A.J. Porsius Quality in pharmacotherapy Drug use profile Pharmaceutical Journal Farmacocasus Mengelingen Van Mil et al. - Pharma Selecta 1995 OMA-project ( ) Analysis of medication in elderly Patients 65 years or older using > 4 medications Intervention by pharmacist Intake and evaluation of drug use Pharmacist-patiënt contact when drugs delivered Half-yearly consultations and evaluation with patient Focus on improving knowledge and adherence 2

3 OMA-project ( ) Analysis of medication in elderly High satisfaction among patients No major effects on knowledge or quality of life after 24 months Low numbers Incomplete documentation QIPC Polypharmacy project 1999 Pilot study in Elburg and Coevorden 2004 Implementation study 14 pharmacies and 31 physicians Financed by Achmea Medication of 839 patients reviewed 36% medication change 44% stopped 23% dose change 20% replaced 13% started reduction costs: 45 euro/patient QIPC Polypharmacy project 2005 Best Practice Polypharmacy intervention (QIPC/DGV) Medication review by pharmacist and physician Joint consultations between pharmacist and physician Monitoring, evaluation and continuity of intervention Coaching by QIPC/DGV during 9 months 2006 Implementation 43 groups of pharmacists &physicians groups intensively coached and 200 groups less intensively SMOG-project ( ) Screening medication in elderly 16 pharmacies (BIRD / Kring) 196 patients of 65 years and older using >5 medications Medication review by pharmacist using pharmacy data + information medical record 3,9 potential DRPs per patient 24% no indication 21% contraindication 18% drug-drug interactions Multimedication check (Kring-apotheken) Vinks THAM et al. Identification of potential drug-related problems in the elderly: the role of the community pharmacist, Pharm World Sci 2006 Improving medication safety in elderly Centre for Quality of Care Research, UMC St.Radboud Nijmegen Development and evaluation of pharmacist-led intervention Randomized controlled trial (2004) 28 pharmacies (Service apotheek) comparing two different strategies/approaches W. Denneboom et al. Treatment review of older people on polypharmacy in primary care: cluster controlled trial comparing two approaches. Br J Gen Pract

4 2004 MedicijnConsult KNMP campaign Brown Bag review Medication review in residential homes (1) DGV ( ) 7 residential homes 278 patients >4 chronic medications Intervention Medication review by pharmacist prescription records written feedback to GP Team conferences: GP, pharmacist, care-manager Follow-up meeting after 3 months Medication review in residential homes (1) DGV ( ) 2.6 medication changes per patiënt 51% stopped 21% started 17% dose change No. medications decreased 8.3 to 7.7 per patient Medication costs declined 190 euro/patiënt/year Nelissen-Vrancken M et al. Aanpak polyfarmacie in verzorgingshuizen. Huisarts & Wetenschap 2007 Nelissen-Vrancken M et al. Aanpak polyfarmacie in verzorgingshuizen. Huisarts & Wetenschap 2007 Medication review in residential homes (2) OLVG Amsterdam ( ) 30 patients, mean age 86 years old Medication review by clinical pharmacist Medical record, prescription record, pharmaceutical record Laboratory values Pharmaceutical care plan Conference meeting with clinical pharmacist, GP, nurse Medication review in residential homes (2) OLVG Amsterdam ( ) Medication Appropriateness Index (MAI) Independent panel of clinical pharmacists 115 DRPs identified, 3.8 per patient 68% DRPs accepted mean summed MAI score decreased (p 0.013) Stuijt et al. Evaluation of a pharmacist s medication review on appropriateness of prescribing among elderly patients in a Dutch residential home. Submitted Stuijt et al. Evaluation of a pharmacist s medication review on appropriateness of prescribing among elderly patients in a Dutch residential home. Submitted 4

5 Medication review in nursing home setting University of Groningen ( ) 5 nursing homes in Meppel and Hoogeveen patients using > 9 medicines 91 patients, mean age 80 years old Medication review by team of hospital pharmacist and nursing home physician Follow-up after 6 weeks Medication review in nursing home setting University of Groningen ( ) 323 DRPs identified, 3.5 per patient 62% classified unclear or not confirmed indication or need for review 51% recommendations accepted No. of drugs decreased from 13.5 to 12.7 (p< ) Finkers et al. A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. J Clin Pharm Therapeutics Finkers et al. A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. J Clin Pharm Therapeutics Medication review in 2008 Medication review in 2008 Pharmacy Pillen & Praten Pill check Medicines Use Review 125 euro per consultation Medication review in 2008 Pharmacy Pillen & Praten Pill check Medicines Use Review 125 euro per consultation Outpatient clinics for polypharmacy Multidisciplinary teams Complex polypharmacy patients referred by GP, specialist, nursing home physician (Screening medication of elderly admitted to hospital) Interest insurance companies 5

6 Randomized clinical trials (1) Homebased Medication Review LLOYDS Pharmacy / SIR Clinical medication review including home visit by pharmacist 65+, polypharmacy, CVD and diabetes Primary end points Number of DRPs No. patients reaching target levels cholesterol, HbA1c, BP 10 pharmacies 200 patients control group ( usual care ) 200 patients intervention group Randomized clinical trials (2) Preventing hospital admissions by reviewing medication (pharm) University of Utrecht / Kring-apotheken Pharmaceutical care plan vs usual care 65+, polypharmacy, multimorbidity Primary endpoint: HARM 100 pharmacies 5000 control group 5000 intervention group Randomized clinical trials (3) VU University Amsterdam IBOM II: Counseling after hospital discharge University Groningen Implementation of Pharmaceutical Care plan Education QIPC Polypharmacy courses DGV Medication analysis New in 2008 PAO Masterclass clinical medication review intensive course 8-10 days during 10 months workshops: expert meetings, laboratory tests, side effects, communication skills, geriatrics, etc.. create portfolio Medication review Where do we stand? Many activities and projects acceleration by HARM study medication review on different levels no overview Increasing interest policy makers insurance companies 6

7 Where do we go from here? 7