Medication management among home-dwelling older patients with chronic diseases: possible roles for community pharmacists.
OBJECTIVE
To describe medication management among home-dwelling older adults. These data should allow us to identify potential problems and to indicate target areas for community pharmacist intervention.


METHODS
Cross-sectional observational study.


METHODS
Community pharmacies (n=86) in Belgium.


METHODS
Home-dwelling older adults using at least one chronic medicine (n=338).


METHODS
Data on drug use were taken from the electronic pharmacy databases, while drug adherence was measured by pill count, self-report and estimation by GP and pharmacist. Drug knowledge and practical drug management capacity were assessed by patient interview and questionnaire, respectively.


RESULTS
The study population (n=338) used a median of 5 chronic drugs per patient. Half of our sample (n=169) used psychotropic medication chronically, mainly benzodiazepines. In 100 patients (29.6%) at least one drug-drug interaction of potential clinical significance was observed. The overall mean adherence per patient was very high (98.1%), but 39.6% of individuals was underadherent with at least one medication. Seventy-six % of patients had an acceptable knowledge of the indication for at least 75% of their medication. In nearly 15 % of the study population cognitive impairment was suspected by the mini-cog test. The participants reported several practical problems with drug taking: difficulties with vision (32.0%), blister opening (12.1%), tablet swallowing (14.8%), tablet splitting (29.7% [represents % of patients who have to split tablets]) and distinction between different drug packages (23.4%).


CONCLUSIONS
This study identified the following aspects of medication management by home-dwelling older adults that could be improved by pharmaceutical care services: (i) assistance of cognitively impaired patients, (ii) management of practical drug taking problems, (iii) DDI screening, (iv) drug adherence, and (v) chronic benzodiazepine use.
Pharmaceutical Care Unit, Ghent University, Harelbekestraat 72, B-9000 Ghent, Belgium. els.mehuys@ugent.be
E
E
Mehuys
L
L
Dupond
M
M
Petrovic
T
T
Christiaens
L
L
Van Bortel
E
E
Adriaens
L
L
De Bolle
I
I
Van Tongelen
J-P
JP
Remon
K
K
Boussery
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D001530:Belgium / Q000453:epidemiology; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D004347:Drug Interactions; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D054539:Medication Therapy Management; D020380:Needs Assessment; D010594:Pharmacies; D010595:Pharmacists; D019338:Polypharmacy; D024382:Professional Role; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000078329:Workforce
D011619:Psychotropic Drugs