Medication care : databases, drug use and outcomes

King, Michelle Annette. (2003). Medication care : databases, drug use and outcomes PhD Thesis, School of Medicine, The University of Queensland.

       
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Author King, Michelle Annette.
Thesis Title Medication care : databases, drug use and outcomes
School, Centre or Institute School of Medicine
Institution The University of Queensland
Publication date 2003
Thesis type PhD Thesis
Supervisor Michael Roberts
Darrel Doessel
Total pages 285
Collection year 2003
Language eng
Subjects 320000 Medical and Health Sciences
L
321106 Aged Care Nursing
Formatted abstract

Sub-optimal medication use risks increased morbidity, mortality and health-care costs. The annual cost of adverse drug events alone has been estimated at $350 million in Australia. The elderly are particularly vulnerable to adverse drug events; 54% of nursing home patients experienced one.  

Clinical pharmacists can improve medication use, but multidisciplinary involvement is necessary for optimum medicines management. The concept of medication care was developed to highlight the paradigm shift of pharmaceutical care from a role that focuses on pharmacists to one that focuses on the health care team.   

This thesis evaluates the impact of medication care on medication use and patient outcomes through three trials. The first randomised controlled trial, the Nursing Home Study, randomly selected 52 nursing homes (3230 residents) from South-East Queensland and Northern New South Wales. The intervention was a combination of nurse education and medication review for selected residents. The second randomised controlled trial, the Veterans Study, used ten nursing homes (374 residents), with large proportions of war veterans among their residents, in South-East Queensland. The intervention was a combination of nurse liaison, nurse education, direct contact with general practitioners, and medication review for all residents. The third study, of multidisciplinary case conference reviews, was a controlled trial, undertaken in and around Canberra, that used a convenience sample of three nursing homes (245 residents).   

A database was designed to capture, code and analyse the data. Its uniqueness was in the breadth and level of detail it could capture on medication use. It facilitated the study of medication use and the validation of Australian prescription claims data. This validation showed that between 48% and 78% of the data from nursing home records and prescription claims matched. A major contributor to the lack of matching was the lack of a unique patient identifier.  

The majority (61 to 71%) of residents studied were female. The average resident was aged 80 to 84 years, had resided in the nursing home for 2.6 to 3.1 years, and was ordered 6.6 to 8.4 medications from which she was administered 4.8 to 6.2 medications with a total cost of $17.21 per week. Compliance was high, a median of 97% of doses per resident were taken. The highest levels of compliance were associated with lower numbers of medications, dispersible tablets, tablets, capsules and transdermal patches that were subsidised by the government and administered once daily.  

The most commonly used drugs and drug groups were laxatives, psycholeptics especially thioridazine and benzodiazepines, analgesics especially paracetamol, digoxin, frusemide and low-dose aspirin.

Medication care can reduce the numbers of medications ordered for and administered to nursing home residents. Medications influenced by the education and review interventions were laxatives, oral hypoglycaemics, steroid creams, analgesics containing dextropropoxyphene, psychotropics including benzodiazepines, antipsychotics and antidepressants, non-steroidal antiinflanmiatory drugs, antiinfectives (systemic, urinary and eye drops), and angiotensin converting enzyme inhibitors.

The results from all but one survival analysis showed trends towards increased survival. The results from patient outcome measures, i.e. Resident Classification Index and Modified Barthel Index, were difficult to interpret or mixed. These results highlight the need to develop patient outcome measures sensitive to medication care interventions.  

Other obstacles to measuring outcomes were identified, these included the need for large sample sizes, clustered designs and detailed studies which place heavy demands on limited resources, variation in record quality, and a population that cannot be interviewed due to a high prevalence of dementia and communication difficulties.

To sum up, medication care facilitated by pharmacists alters medication use and may improve patient outcomes. All models of medication care studied produced changes in medication use however increasing interaction between health professionals appears to be associated with better outcomes and increased satisfaction for the health professionals involved. This research contributed to changes supported by the professions and government, including payments to pharmacists and doctors to facilitate medication review and case conferences; the Medicare number, a unique patient identifier, is now on the prescription.

Keyword Older people -- Drug use
Older people -- Medical care

Document type: Thesis
Collection: UQ Theses (RHD) - UQ staff and students only
 
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Created: Tue, 06 Dec 2011, 09:09:48 EST by Bekti Mulatiningsih on behalf of The University of Queensland Library