American Journal Geriatric Pharmacotherapy最新文献

{"title":"Medication Adherence Among Geriatric Outpatients Prescribed Multiple Medications","authors":"Kang-Ting Tsai MD ,&nbsp;Jen-Hau Chen MD, MPH ,&nbsp;Chiung-Jung Wen MD, MS ,&nbsp;Hsu-Ko Kuo MD, MPH ,&nbsp;I-Shu Lu MD ,&nbsp;Lee-Shu Chiu BS ,&nbsp;Shwu-Chong Wu PhD ,&nbsp;Ding-Cheng Chan MD, PhD","doi":"10.1016/j.amjopharm.2011.11.005","DOIUrl":"10.1016/j.amjopharm.2011.11.005","url":null,"abstract":"<div><h3>Background</h3><p>Poor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse health outcomes.</p></div><div><h3>Objective</h3><p>We aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy.</p></div><div><h3>Methods</h3><p>Baseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either &lt;80% or &gt;120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (&gt;0 but &lt;25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA.</p></div><div><h3>Results</h3><p>Mean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA.</p></div><div><h3>Conclusions</h3><p>To enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 1","pages":"Pages 61-68"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.11.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30403940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenge of Changing Nursing Home Prescribing Culture","authors":"Jennifer Tjia MD, MSCE,&nbsp;Jerry H. Gurwitz MD,&nbsp;Becky A. Briesacher PhD","doi":"10.1016/j.amjopharm.2011.12.005","DOIUrl":"10.1016/j.amjopharm.2011.12.005","url":null,"abstract":"<div><p>This article described a framework for improving prescribing in nursing homes (NH) by focusing on the whole facility as a system that has created a “prescribing culture.” We offered this paradigm as an alternative to focused interventions that target prescribers only. We used the example of atypical antipsychotics to illustrate the approach. We also highlighted elements of the NH culture change movement that are germane to medication prescribing, and illustrated which elements of NH culture were shown to be associated with suboptimal quality of care. We concluded by describing current models, including our study funded by the Agency for Healthcare Research and Quality, to identify the best methods of disseminating evidence-based medication use guides in NHs.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 1","pages":"Pages 37-46"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.12.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30402938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Efficacy and Tolerability Profile of Liraglutide, a Once-Daily Human GLP-1 Analog, in Patients With Type 2 Diabetes ≥65 and <65 Years of Age: A Pooled Analysis from Phase III Studies","authors":"Bruce W. Bode MD ,&nbsp;Jason Brett MD ,&nbsp;Ali Falahati PhD ,&nbsp;Richard E. Pratley MD","doi":"10.1016/j.amjopharm.2011.09.007","DOIUrl":"10.1016/j.amjopharm.2011.09.007","url":null,"abstract":"<div><h3>Background</h3><p>Managing elderly patients with type 2 diabetes poses particular challenges, so it is important to evaluate the efficacy and tolerability profile of antidiabetic therapies specifically in this patient population.</p></div><div><h3>Objective</h3><p>The aim of our study was to compare the efficacy and tolerability profile of liraglutide, a GLP-1 analog, in elderly (≥65 years) and younger (&lt;65 years) patients with type 2 diabetes.</p></div><div><h3>Methods</h3><p>A pooled analysis of 6 randomized, placebo-controlled, multinational trials included data from 3967 patients aged18 to 80 years with type 2 diabetes and glycosylated hemoglobin (HbA_1c) of 7% to 11%. Of these, 552 patients ≥65 years received liraglutide 1.8 mg, liraglutide 1.2 mg, or placebo; 2231 patients &lt;65 years received liraglutide 1.8 mg, liraglutide 1.2 mg, or placebo for 26 weeks. End points were: change in HbA_1c, fasting plasma glucose, body weight, and blood pressure: as marked to identify elements tracked for change from baseline; hypoglycemic episodes; and adverse events.</p></div><div><h3>Results</h3><p>Reduction in HbA_1c from baseline was significantly greater with liraglutide 1.8 mg versus placebo (least squares mean difference: ≥65 years, 0.91% [95% CI, 0.69–1.12]; &lt;65 years, 1.17% [95% CI, 1.06–1.28]; both, <em>P</em> &lt; 0.0001) and with liraglutide 1.2 mg versus placebo (≥65 years, 0.87% [95% CI, 0.64–1.11]; &lt;65 years, 1.10% [95% CI, 0.98–1.22]; both, <em>P</em> &lt; 0.0001). For fasting plasma glucose, comparable results were observed between liraglutide 1.8 mg or 1.2 mg and placebo for both age groups (<em>P</em> &lt; 0.0001). No statistically significant difference in body weight change was seen with liraglutide between the age groups. The proportion of patients reporting minor hypoglycemia was low and appeared comparable between the ≥65-year-old (4.3%–15.2%) and &lt;65-year-old (8%–13.2%) groups. Likewise, adverse events appeared comparable in nature and frequency.</p></div><div><h3>Conclusion</h3><p>Liraglutide provides effective glycemic control and is well tolerated in patients ≥65 and &lt;65 years of age with type 2 diabetes. These data suggest that liraglutide may be a suitable treatment option for older patients who may have additional age-related complications.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 423-433"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40128779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Use and Functional Status Decline in Older Adults: A Narrative Review","authors":"Emily P. Peron PharmD ,&nbsp;Shelly L. Gray PharmD, MS ,&nbsp;Joseph T. Hanlon PharmD, MS","doi":"10.1016/j.amjopharm.2011.10.002","DOIUrl":"10.1016/j.amjopharm.2011.10.002","url":null,"abstract":"<div><h3>Background</h3><p>Functional status is the cornerstone of geriatric care and serves as an indicator of general well-being. A decline in function can increase health care use, worsen quality of life, threaten independence, and increase the risk of mortality. One of several risk factors for decline in functional status is medication use.</p></div><div><h3>Objective</h3><p>Our aim was to critically review published articles that have examined the relationship between medication use and functional status decline in the elderly.</p></div><div><h3>Methods</h3><p>The MEDLINE and EMBASE databases were searched for English-language articles published from January 1986 to June 2011. Search terms included <em>aged</em>, <em>humans</em>, <em>drug utilization</em>, <em>polypharmacy</em>, <em>inappropriate prescribing</em>, <em>anticholinergics</em>, <em>psychotropics</em>, <em>antihypertensives</em>, <em>drug burden index</em>, <em>functional status</em>, <em>function change or decline</em>, <em>activities of daily living</em>, <em>gait</em>, <em>mobility limitation</em>, and <em>disability</em>. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to retrieve additional publications. Only articles that used rigorous observational or interventional designs were included. Cross-sectional studies and case series were excluded from this review.</p></div><div><h3>Results</h3><p>Nineteen studies met the inclusion criteria. Five studies addressed the impact of suboptimal prescribing on function, 3 of which found an increased risk of worse function in community-dwelling subjects receiving polypharmacy. Three of the 4 studies that assessed benzodiazepine use and functional status decline found a statistically significant association. One cohort study identified no relationship between antidepressant use and functional status, whereas a randomized trial found that amitriptyline, but not desipramine or paroxetine, impaired certain measures of gait. Two studies found that increasing anticholinergic burden was associated with worse functional status. In a study of hospitalized rehabilitation patients, users of hypnotics/anxiolytics (eg, phenobarbital, zolpidem) had lower relative Functional Independence Measure motor gains than nonusers. Use of multiple central nervous system (CNS) drugs (using different definitions) was linked to greater declines in self-reported mobility and Short Physical Performance Battery (SPPB) scores in 2 community-based studies. Another study of nursing home patients did not report a significant decrease in SPPB scores in those taking multiple CNS drugs. Finally, 2 studies found mixed effects between antihypertensive use and functional status in the elderly.</p></div><div><h3>Conclusions</h3><p>Benzodiazepines and anticholinergics have been consistently associated with impairments in functional status in the elderly. The relationships between su","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 378-391"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40132009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric Pharmacotherapy Updates","authors":"David R.P. Guay PharmD","doi":"10.1016/j.amjopharm.2011.11.001","DOIUrl":"https://doi.org/10.1016/j.amjopharm.2011.11.001","url":null,"abstract":"","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 495-502"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137392833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valproic Acid–Induced Parkinsonism in the Elderly: A Comprehensive Review of the Literature","authors":"Fade Mahmoud MD ,&nbsp;Rajesh R. Tampi MD, MS","doi":"10.1016/j.amjopharm.2011.09.002","DOIUrl":"10.1016/j.amjopharm.2011.09.002","url":null,"abstract":"<div><h3>Background</h3><p>Valproic acid (VPA) is commonly used to treat many psychiatric conditions in the elderly. VPA-induced parkinsonism is a less common but important adverse effect of this drug.</p></div><div><h3>Objectives</h3><p>The purpose of our study was to conduct a literature review to assess VPA-induced parkinsonism in the elderly.</p></div><div><h3>Methods</h3><p>We searched Ovid Medline, PubMed, and Cochrane Database (January 1970 to December 2010) using the key words <em>divalproate</em>, <em>divalproex sodium</em>, <em>valproate</em>, <em>depakote</em>, <em>valproic acid</em>, <em>elderly</em>, <em>aged</em>, <em>Parkinson's disease</em>, and <em>parkinsonism</em>. The Naranjo algorithm was used to assess whether a change in clinical status was the result of an adverse drug reaction.</p></div><div><h3>Results</h3><p>We identified 13 case reports. Available evidence indicated that there was a variable time interval for the development of parkinsonism after VPA therapy. Most cases showed improvement with the withdrawal of the drug, but the rate and extent of improvement was unpredictable. The calculated Naranjo adverse drug reaction scores, for most cases, were between 5 and 6, meaning it was probable that parkinsonism was due to VPA therapy.</p></div><div><h3>Conclusions</h3><p>High clinical awareness is required in diagnosing VPA-induced parkinsonism in the elderly due the presence of comorbid neurodegenerative conditions and the usage of antipsychotics in these patients.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 405-412"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30201570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Important Are Drug–Drug Interactions to the Health of Older Adults?","authors":"Joseph T. Hanlon PharmD, MS (Co-Editor-in-Chief),&nbsp;Kenneth E. Schmader MD (Co-Editor-in-Chief)","doi":"10.1016/j.amjopharm.2011.10.007","DOIUrl":"10.1016/j.amjopharm.2011.10.007","url":null,"abstract":"","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 361-363"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30257513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection and Prevention of Drug–Drug Interactions in the Hospitalized Elderly: Utility of New Cytochrome P450–Based Software","authors":"Hubert Zakrzewski-Jakubiak BPharm, MSc ,&nbsp;Julie Doan BPharm, MSc ,&nbsp;Pamela Lamoureux BPharm ,&nbsp;Dharmender Singh BPharm, MSc ,&nbsp;Jacques Turgeon PhD ,&nbsp;Cara Tannenbaum MD, MSc","doi":"10.1016/j.amjopharm.2011.09.006","DOIUrl":"10.1016/j.amjopharm.2011.09.006","url":null,"abstract":"<div><h3>Background</h3><p>Polypharmacy increases the risk of cytochrome P450–based drug–drug interactions (CYP450-DDIs), leading to decreased therapeutic efficacy or increased drug toxicity.</p></div><div><h3>Objective</h3><p>The aims of this study were to investigate the utility of a new CYP450-DDI software, InterMED-Rx, in aiding pharmacists in detecting CYP450-DDIs in hospitalized elderly patients and to ascertain pharmacists' agreement on how to intervene for each CYP450-DDI.</p></div><div><h3>Methods</h3><p>A consensus panel of geriatric pharmacists first established guidelines for managing clinically relevant pharmacokinetic CYP450-DDIs. A prospective study was then conducted of patients newly admitted to a geriatric hospital whose pharmaceutical profile underwent analysis with InterMED-Rx. Rates and types of interventions were recorded.</p></div><div><h3>Results</h3><p>Pharmacists' interrater agreement on how to manage CYP450-DDIs was initially only moderate (Cohen's κ, 0.51; 95% CI, 0.39–0.62), but improved subsequent to deliberation (Cohen's κ, 0.79; 95% CI, 0.70–0.88). Persistent disagreement involved interactions between 2 drugs with similar affinities for the same cytochrome. One hundred patients with polypharmacy (≥5 medications) aged 82.3 years (range, 65–96), with a mean (SD) of 12.2 (4.1) drugs (range, 5–27) were recruited for the prospective study. Eighty percent of patients had at least 1 CYP450 DDI detected with InterMED-Rx. A total of 238 CYP450-DDIs were identified involving CYP3A4 (70.2%), CYP2D6 (22.7%), and CYP2C9 (3.4%) substrates or inhibitors. Nineteen percent of patients received immediate medication adjustment, and 39% required follow-up of clinical signs, symptoms, and laboratory tests to determine whether future modification was needed. More than one half (56%) of all patients who required clinical follow-up had further medication adjustment prior to discharge.</p></div><div><h3>Conclusions</h3><p>Use of the InterMED-Rx software identified elderly patients at risk for pharmacokinetic interactions and facilitated interventions aimed at reducing adverse drug events. Although consensus can be reached among pharmacists on how to intervene for many CYP450-DDI scenarios, certain situations allow for multiple intervention strategies.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 461-470"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30226100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Multidisciplinary Intervention on Antibiotic Use for Nursing Home–Acquired Pneumonia","authors":"Sunny A. Linnebur PharmD ,&nbsp;Douglas N. Fish PharmD ,&nbsp;J. Mark Ruscin PharmD ,&nbsp;Tiffany A. Radcliff PhD ,&nbsp;Kathy S. Oman RN, PhD ,&nbsp;Regina Fink RN, PhD ,&nbsp;Brent Van Dorsten PhD ,&nbsp;Debra Liebrecht RN ,&nbsp;Ron Fish MBA ,&nbsp;Monica McNulty MS ,&nbsp;Evelyn Hutt MD","doi":"10.1016/j.amjopharm.2011.09.009","DOIUrl":"10.1016/j.amjopharm.2011.09.009","url":null,"abstract":"<div><h3>Background</h3><p>Academic detailing in nursing homes (NHs) has been shown to improve drug use patterns and adherence to guidelines.</p></div><div><h3>Objective</h3><p>The purpose of this study was to evaluate the impact of a multidisciplinary intervention that included academic detailing on adherence to national nursing home–acquired pneumonia (NHAP) guidelines related to use of antibiotics.</p></div><div><h3>Methods</h3><p>This quasi-experimental study evaluated the effects of a 2-year multifaceted and multidisciplinary intervention targeting implementation of national evidence-based guidelines for NHAP. Interventions took place in 8 NHs in Colorado; 8 NHs in Kansas and Missouri served as controls. Interventions included (1) educational sessions for nurses to improve recognition and timely treatment of NHAP symptoms and (2) academic detailing to clinicians by pharmacists regarding diagnostic and prescribing practices. Differences in antibiotic use between groups were compared after 2 intervention years relative to baseline.</p></div><div><h3>Results</h3><p>A total of 549 episodes of NHAP were evaluated in the intervention group and 574 in the control group. Compared with baseline, 1 facility in the intervention group significantly improved in guideline adherence for optimal antibiotic use (<em>P</em> = 0.007), whereas no facilities in the control group improved. The mean adherence score for optimal antibiotic use in intervention NHs increased from 60% to 66%, whereas the control NHs increased from 32% to 39% (<em>P</em> = 0.3). Mean adherence to guidelines recommending antibiotic use within 4 hours of NHAP diagnosis increased from 57% to 75% in intervention NHs but decreased from 38% to 31% in control NHs (<em>P</em> = 0.0003 for difference). There was no difference between intervention and control NHs for guideline adherence regarding optimal duration of antibiotic use.</p></div><div><h3>Conclusions</h3><p>The ability of this multifaceted study to repeatedly remind nursing staff of the importance of timely antibiotic administration contrasts with its limited academic detailing interaction with clinicians. This difference within the intervention may explain the differential impact of the intervention on antibiotic guideline adherence.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 442-450.e1"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40128777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Testing of a Tool for Assessing and Resolving Medication-Related Problems in Older Adults in an Ambulatory Care Setting: The Individualized Medication Assessment and Planning (iMAP) Tool","authors":"Ginny D. Crisp PharmD ,&nbsp;Jena Ivey Burkhart PharmD ,&nbsp;Denise A. Esserman PhD ,&nbsp;Morris Weinberger PhD ,&nbsp;Mary T. Roth PharmD","doi":"10.1016/j.amjopharm.2011.10.003","DOIUrl":"10.1016/j.amjopharm.2011.10.003","url":null,"abstract":"<div><h3>Background</h3><p>Medication is one of the most important interventions for improving the health of older adults, yet it has great potential for causing harm. Clinical pharmacists are well positioned to engage in medication assessment and planning. The Individualized Medication Assessment and Planning (iMAP) tool was developed to aid clinical pharmacists in documenting medication-related problems (MRPs) and associated recommendations.</p></div><div><h3>Objective</h3><p>The purpose of our study was to assess the reliability and usability of the iMAP tool in classifying MRPs and associated recommendations in older adults in the ambulatory care setting.</p></div><div><h3>Methods</h3><p>Three cases, representative of older adults seen in an outpatient setting, were developed. Pilot testing was conducted and a “gold standard” key developed. Eight eligible pharmacists consented to participate in the study. They were instructed to read each case, make an assessment of MRPs, formulate a plan, and document the information using the iMAP tool. Inter-rater reliability was assessed for each case, comparing the pharmacists' identified MRPs and recommendations to the gold standard. Consistency of categorization across reviewers was assessed using the κ statistic or percent agreement.</p></div><div><h3>Results</h3><p>The mean κ across the 8 pharmacists in classifying MRPs compared with the gold standard was 0.74 (range, 0.54–1.00) for case 1 and 0.68 (range, 0.36–1.00) for case 2, indicating substantial agreement. For case 3, percent agreement was 63% (range, 40%–100%). The mean κ across the 8 pharmacists when classifying recommendations compared with the gold standard was 0.87 (range, 0.58–1.00) for case 1 and 0.88 (range, 0.75–1.00) for case 2, indicating almost perfect agreement. For case 3, percent agreement was 68% (range, 40%–100%). Clinical pharmacists found the iMAP tool easy to use.</p></div><div><h3>Conclusions</h3><p>The iMAP tool provides a reliable and standardized approach for clinical pharmacists to use in the ambulatory care setting to classify MRPs and associated recommendations. Future studies will explore the predictive validity of the tool on clinical outcomes such as health care utilization.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 451-460"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40128778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}