Effect of care transfer model led by the hospital clinical pharmacist on reduction of hospital readmissions in the elderly.

Transfer of care is a critical point for patient safety and requires an optimal care transfer model in order to ensure safe pharmacotherapy transfer. Polypharmacy among elderly is associated with adverse health consequences such as hospital readmissions. Hospital readmissions represent priorities in health care research and are one of the measures for assessing patient safety. Medication-related problems among elderly are associated with polypharmacy. The aim of the study was to show the impact of a developed model of care transfer led by a hospital clinical pharmacist on the number of hospital readmissions in the 12-months period in the elderly. A randomized controlled study of patients aged 65 or more was conducted at Dubrava University Hospital, Community Health Centre Zagreb - East and community pharmacies in the City of Zagreb and Zagreb County, Croatia. An intervention group received specially designed care transfer led by the hospital clinical pharmacist. Model included high-intensity pharmacotherapy interventions delivered at admission, during hospital stay and discharge, transition to primary care and post-discharge and cooperation between all healthcare professionals. In all, 182 patients in the intervention and 171 in the control group were analysed. The total number of hospital readmissions and emergency readmissions, within one year from the hospital discharge, was lower in the intervention group than in the control group (41.7% vs. 58.3%, p=0.005; 40.8% vs. 59.2%, p=0.008). The model of the health care transfer applied in this research thus significantly reduced hospital readmissions in the 1-year period in elderly patients. Therefore, the hospital clinical pharmacists should design and coordinate the transfer between hospital and primary care.

Potential clinically significant drug-drug interactions in prescribed pharmacotherapy in an outpatient setting.

The aim of this study was to determine the most common potential clinically significant drug-drug unteractions (DDIs) in prescribed pharmacotherapy in an outpatient setting in Croatia. Twelve community pharmacies were randomly selected in this research. Retrospective pharmacotherapy record data analysis was conducted on consecutive eligible patients. Potential DDIs were detected using Lexicomp software that categorizes DDIs according to clinical significance. Categories C (monitor drug therapy), D (consider therapy modification) and X (avoid combination) are of clinical concern. In total, 1211 patients were enrolled in this study. The results showed that 84% of patients had at least one clinically significant interaction. The average number of interactions per patient was 4. Overall, 4798 potentially clinically significant DDIs were identified; 3945 (82.2%) required therapy monitoring, while other interactions (D and X category) required specific therapy modification. According to the level of clinical significance the most common clinical consequences of identified potential drug interactions were increased risk of hypotension, impaired renal function, central nervous system depression, gastrointestinal toxicity and QTc prolongation. Research indicates the high exposure to potential clinically significant DDIs in the prescribed pharmacotherapy in an outpatient setting and imposes the need for standardised models of pharmacist interventions.

Incidence of statin-drug interactions in Croatian community pharmacy.

Statins are among the most frequently issued drugs that patients usually need to take for a lifetime. They are often an integral part of a polytherapeutic approach in preventing and treating cardiovascular diseases. As such, they might often interact with drugs prescribed for treating acute and chronic conditions. A pharmacist is the final professional control before a drug reaches the patient and his role in preventing drug-drug interactions is crucial. The objective of this research was to analyse the incidence and relevance of potential drug interactions with statins in community pharmacy. We retrospectively analysed the prescribed pharmacotherapy of 153 patients who were taking statins. Lexicomp® Lexi-Interact™ Online (Lexi-Comp, Inc., Hudson, USA) was used to identify interactions. The mean age of study patients was 65.5 (52.3% women). The most frequently used statin was atorvastatin and the least used was fluvastatin. The average number of coprescribed drugs was 4. The highest number of interactions which required enhanced patient surveillance were registered with atorvastatin, while interactions which might need specific therapy modification were mostly seen with simvastatin. Systematic and regular control of potential clinically significant drug-drug interactions in the prescribed pharmacotherapy is important for therapy outcomes and appropriate pharmaceutical surveillance in issuing pharmacotherapy.

Incidence of potential drug-drug interactions with antidiabetic drugs.

In an effort to achieve normoglycemia more than one antidiabetic agent is usually needed. Diabetes is associated with several comorbidities and patients with diabetes are often treated with multiple medications. Therefore, patients with diabetes are especially exposed to drug-drug interactions (DDIs). The aim of this study was to analyse the incidence and type of potential DDIs of antidiabetic drugs in patients with diabetes. This retrospective study analyzed pharmacy record data of 225 patients with diabetes mellitus. Both type 1 and type 2 diabetic patients who were taking at least one antidiabetic agent during the period of six months were included. We investigated associated therapy in that period in order to identify potential DDIs with antidiabetic therapy. Potential interactions were identified by Lexicomp Lexi-Interat Online (Lexi-Comp, Inc., Hudson, USA) software which categorizes potential DDIs according to clinical significance in five types (A, B, C, D and X). Categories C, D and X are of clinical concern and always require medical attention (therapy monitoring, therapy modification or avoiding combination). We found that 80.9% of patients had at least one potential category C interaction while there were no D and X interactions. Most frequently encountered potential DDI (n = 176) included antidiabetic drugs and thiazide or thiazide like diuretics. Patients with diabetes are exposed to a large number of potential clinically significant DDIs that may require appropriate monitoring. Using databases of DDIs could be helpful in reducing the risk of potential clinically significant DDIs.