Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method.

João R Gonçalves, Betsy L Sleath, Manuel J Lopes, Afonso M Cavaco
Author Information
  1. João R Gonçalves: iMed.ULisboa, Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal.
  2. Betsy L Sleath: Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
  3. Manuel J Lopes: College of Nursing S. João de Deus, University of Évora, 7000-811 Évora, Portugal. ORCID
  4. Afonso M Cavaco: iMed.ULisboa, Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal. ORCID

Abstract

Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as 'appropriate', 'uncertain', or 'inappropriate' a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as 'appropriate' for pharmacy practice targeted to long-term care patients, while 3 were classified as 'inappropriate'. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.

Keywords

References

  1. Clin Interv Aging. 2016 Jun 23;11:857-66 [PMID: 27382268]
  2. Pharmacol Rev. 2004 Jun;56(2):163-84 [PMID: 15169926]
  3. Arch Gerontol Geriatr. 2016 Nov-Dec;67:130-8 [PMID: 27500661]
  4. CMAJ. 1997 Feb 1;156(3):385-91 [PMID: 9033421]
  5. Eur J Gen Pract. 2017 Dec;23(1):69-77 [PMID: 28271916]
  6. Ann Pharmacother. 2004 Sep;38(9):1369-76 [PMID: 15266038]
  7. Drugs Aging. 2012 Jun 1;29(6):437-52 [PMID: 22642779]
  8. Dement Geriatr Cogn Disord. 2015;40(3-4):166-77 [PMID: 26138271]
  9. Cochrane Database Syst Rev. 2018 Sep 03;9:CD008165 [PMID: 30175841]
  10. Am Heart J. 2006 Mar;151(3):713-9 [PMID: 16504638]
  11. Acad Med. 2017 Oct;92(10):1491-1498 [PMID: 28678098]
  12. Arch Intern Med. 2008 Mar 10;168(5):508-13 [PMID: 18332297]
  13. Br J Clin Pharmacol. 2014 Jan;77(1):201-10 [PMID: 23711082]
  14. Lancet. 2007 Jul 14;370(9582):173-184 [PMID: 17630041]
  15. Clin Interv Aging. 2018 May 18;13:975-986 [PMID: 29844664]
  16. BMC Geriatr. 2004 Oct 15;4:9 [PMID: 15488143]
  17. BMC Geriatr. 2011 Nov 30;11:79 [PMID: 22129458]
  18. Drugs Aging. 2010 Dec 1;27(12):947-57 [PMID: 21087065]
  19. Drugs Aging. 2014 Feb;31(2):131-40 [PMID: 24353033]
  20. Eur J Clin Pharmacol. 2007 Aug;63(8):725-31 [PMID: 17554532]
  21. Gut. 2020 Oct;69(10):1769-1777 [PMID: 32513653]
  22. Age Ageing. 2015 Mar;44(2):213-8 [PMID: 25324330]
  23. Arch Intern Med. 2007 Apr 23;167(8):781-7 [PMID: 17452540]
  24. J Am Geriatr Soc. 2009 Feb;57(2):266-72 [PMID: 19170782]
  25. Pharm World Sci. 2005 Oct;27(5):407-13 [PMID: 16341749]
  26. Chest. 2010 Nov;138(5):1093-100 [PMID: 20299623]
  27. Geriatr Gerontol Int. 2016 Sep;16(9):1002-13 [PMID: 26338275]
  28. Health Policy. 2018 Mar;122(3):210-216 [PMID: 29395541]
  29. J Am Geriatr Soc. 2019 Apr;67(4):674-694 [PMID: 30693946]
  30. Scand J Prim Health Care. 2009;27(3):153-9 [PMID: 19462339]
  31. J Clin Pharm Ther. 2001 Feb;26(1):5-14 [PMID: 11286603]
  32. J Comorb. 2011 Dec 27;1:28-44 [PMID: 29090134]
  33. BMC Pharmacol Toxicol. 2017 Jul 25;18(1):59 [PMID: 28743294]
  34. J Clin Epidemiol. 1992 Oct;45(10):1045-51 [PMID: 1474400]
  35. J Am Med Dir Assoc. 2015 Mar;16(3):181-4 [PMID: 25704126]
  36. J Am Med Dir Assoc. 2015 Jul 1;16(7):629.e1-17 [PMID: 25979776]
  37. Eur Geriatr Med. 2021 Aug;12(4):673-693 [PMID: 33743169]
  38. J Am Geriatr Soc. 2008 Jul;56(7):1306-11 [PMID: 18482301]
  39. Ther Adv Drug Saf. 2019 Feb 13;10:2042098619829431 [PMID: 30800270]
  40. Arq Bras Cardiol. 2007 Oct;89(4):210-8 [PMID: 17992376]
  41. J Am Coll Cardiol. 2011 Jul 19;58(4):395-401 [PMID: 21757117]
  42. Ther Adv Drug Saf. 2020 Jun 12;11:2042098620933741 [PMID: 32587680]
  43. Arch Gerontol Geriatr. 2008 Jul-Aug;47(1):35-51 [PMID: 17675177]
  44. Pharmacy (Basel). 2020 Jul 30;8(3): [PMID: 32751644]
  45. Drugs Aging. 2018 Jan;35(1):43-60 [PMID: 29350335]
  46. Infect Control Hosp Epidemiol. 2001 Feb;22(2):120-4 [PMID: 11232875]
  47. Chest. 2010 Feb;137(2):263-72 [PMID: 19762550]
  48. Integr Pharm Res Pract. 2017 May 12;6:121-129 [PMID: 29354558]
  49. Dtsch Med Wochenschr. 2008 Oct;133(44):2289-91 [PMID: 18946857]
  50. J Clin Epidemiol. 2015 Aug;68(8):903-12 [PMID: 25910910]
  51. J Am Geriatr Soc. 2018 Dec;66(12):2254-2258 [PMID: 30423194]
  52. Eur J Clin Pharmacol. 2014 Jan;70(1):1-11 [PMID: 24019054]
  53. Drugs Aging. 2008;25(9):777-93 [PMID: 18729548]

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