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      Optimising Medicines Use by South Asian and Middle Eastern Groups in a Primary Care Setting in the UK: Validation of a Tool to identify Medicine-Related Problems

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          Abstract

          The ethnic minority groups (EMGs) are perceived to be more prone to medicine-related problems (MRPs) than the general population in United Kingdom. There is, therefore, a need for improved detection and prevention of MRPs in EMGs, such as South Asians (SA) and Middle Eastern (ME) populations, to avoid unnecessary GP visits and potential hospital admissions. In this cross-sectional study, the data were collected in 80 face-to-face semi-structured interviews using Gordon’s MRPs tool from seven pharmacies in London. The study involved patients aged over 18 from SA/ME origins who were prescribed three or more medicines. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon’s coding frame and Nvivo 10. All issues under each of the main themes were explored and compared in an attempt to systematically adapt the Gordon’s MRPs tool for SA/ME populations. Some modifications were made to the original Gordon’s MRPs questionnaire to capture patients’ views regarding the use of medicines and the access to services. This also helped in identifying MRPs specific to SA/ME populations and proposing recommendations to address them. This included targeted medication use reviews (MURs), and tailored interventions to patients’ needs in improving medication use and access to services.

          Most cited references22

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          Is inappropriate medication use a major cause of adverse drug reactions in the elderly?

          To study the occurrence of adverse drug reactions (ADRs) linked to inappropriate medication (IM) use in elderly people admitted to an acute medical geriatric unit. All the elderly people aged > or = 70 years admitted to the acute medical geriatric unit of Limoges University hospital (France) over a 49-month period were included, whatever their medical condition. For all the patients, clinical pharmacologists listed the medications given before admission and identified the possible ADRs. The appropriateness of these medications and the causal relationship between drugs (either appropriate or not) and ADRs were evaluated. Two thousand and eighteen patients were included. The number of drugs taken was 7.3 +/- 3.0 in the patients with ADRs and 6.0 +/- 3.0 in those without ADRs (P < 0.0001). Sixty-six percent of the patients were given at least one IM prior to admission. ADR prevalence was 20.4% among the 1331 patients using IMs and 16.4% among those using only appropriate drugs (P < 0.03). In only 79 of the 1331 IM users (5.9%) were ADRs directly attributable to IMs. The IMs most often involved in patients with ADRs were: anticholinergic antidepressants, cerebral vasodilators, long-acting benzodiazepines and concomitant use of two or more psychotropic drugs from the same therapeutic class. Using multivariate analysis, after adjusting for confounding factors, IM use was not associated with a significant increased risk of ADRs (odds ratio 1.0, 95% confidence interval 0.8, 1.3). Besides a reduction in the number of drugs given to the elderly, a good prescription should involve a reduction in the proportion of IMs and should take into consideration the frailty of these patients.
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            Drug-related problem classification systems.

            To provide an overview of and critically appraise classifications of drug-related problems (DRPs) for use during the pharmaceutical care process and research in pharmacy. A literature search was conducted using MEDLINE and Yahoo (January 2003) and manually. The search terms included DRP, drug-related problem, drug-therapy problem, and medicine-related problem. English- and German-language articles on pharmaceutical care and DRPs were reviewed. Most classifications of DRPs were identified through searching publications on pharmaceutical care and DRPs. Fourteen classifications with different focuses were found. Some classifications were hierarchical, categorized into main groups and subgroups. Various terminologies and definitions for DRPs were revealed, as well as guidelines for an optimal DRP classification. Classifications were assessed according to a clear definition, published validation method, and results reflecting process and outcomes, usability in pharmaceutical care practice, and a hierarchical structure with main groups and subgroups. Finding DRP classifications by computerized search of the biomedical literature with the help of PubMed proved to be difficult. No classification could be found that met all of our criteria for an optimal system. Few classifications have been validated. Three have been tested as to their usability in practice and internal consistency. The Pharmaceutical Care Network Europe system Version 4 comes closest to the defined requirements.
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              Effective chronic disease management: patients' perspectives on medication-related problems.

              To examine medication-related problems from the perspective of patients with a chronic condition and to identify how they may be supported in managing their medication. Patients prescribed medication for cardiovascular disease were recruited through five general medical surgeries and four community pharmacies in south London. Data were collected in 98 face-to-face interviews in participants' own homes. Interviews were designed to enable a detailed and holistic exploration of medication-related problems from participants' perspectives. Data were audio-recorded and transcribed verbatim to allow qualitative analysis. Five broad categories of medication-related problem emerged which were examined in the context of patients' perspectives on, and experiences of, the use of medicines and health services. These were concerns about and management of side effects; differing views regarding the use of medicines; cognitive, practical and sensory problems; lack of information or understanding; and problems with access to, and organisation of, services. All categories of problem had potential implications for the success of therapy in that they created barriers to adherence, access to medication or informed decision-making. The study demonstrated how patients actively engage in decision-making about their medicines in the home, if not in the consultation. The five categories of problem provide a focus for interventions by health professionals to support patients in achieving optimal theory outcomes. They demonstrate the need for a comprehensive approach, spanning patient education to the systems of delivery of care. Within the NHS in Britain, policy and practice initiatives are being designed to achieve this end. Further research should focus on the evaluation of professional practices and service developments in supporting patients in the self-management of their medicines.
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                Author and article information

                Journal
                BJPharm
                British Journal of Pharmacy
                University of Huddersfield Press
                2058-8356
                14 November 2016
                : 1
                : 1
                : 90-99
                Affiliations
                [a ]Department of Clinical and Pharmacy Practice, College of Clinical Pharmacy, University of Dammam, Dammam, Saudi Arabia
                [b ]Department of Pharmacy, Pharmacology and Postgraduate Medicine
                [c ]School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, United Kingdom.
                [d ]Department of Practice and Policy, UCL School of Pharmacy, University College London, London, United Kingdom.
                Author notes
                *Corresponding author. Tel.: + 966133335547 E-mail: f.k.alhomoud@ 123456gmail.com
                Article
                10.5920/bjpharm.2016.13
                5ebc736c-495e-4bf8-af36-ee2b8209330d
                © 2016, Faten Alhomoud, Soraya Dhillon, Zoe Aslanpour, Felicity Smith

                This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/.

                History
                : 01 September 2016
                : 24 September 2016
                : 10 October 2016
                Categories
                Research Article

                Medicine,Pharmacology & Pharmaceutical medicine,Health & Social care
                Medicine optimization,Ethnic minority groups,Medicine adherence,Drug-related problems,Medication errors

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