Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

• Published in: Journal of international medical research Vol. 48; no. 6; p. 300060520928791
• Main Authors: Šola, Katarina Fehir, Mucalo, Iva, Brajković, Andrea, Jukić, Ivona, Verbanac, Donatella, Vladimir Knežević, Sanda
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-06-2020; Sage Publications Ltd; SAGE Publishing
• Subjects: Aged; Aged, 80 and over; Croatia - epidemiology; Cross-Sectional Studies; Drug therapy; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - prevention & control; Female; Health Services Needs and Demand; Humans; Institutionalization; Male; Medication Therapy Management - organization & administration; Nursing homes; Nursing Homes - organization & administration; Nursing Homes - statistics & numerical data; Pharmacists - organization & administration; Polypharmacy; Prevalence; Prospective Clinical Research Report; Prospective Studies; Quality Improvement; Croatia; older adults; comprehensive medication management services; pharmaceutical care; polymedication; drug therapy problems; Nursing home
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060520928791

Objective
The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults.
Method
We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs.
Results
Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs.
Conclusion
The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.