title: Evaluation of drug-related problems in older polypharmacy primary care patients.
abstract: OBJECTIVE
  Targeting older patients with predictive factors for drug-related problems (DRPs) could make clinical medication reviews more cost-effective. The aim of this study was to identify the number, type, and potential predictive factors for DRPs in older polypharmacy patients.
  
  
  METHODS
  Community pharmacists performed clinical medication reviews and documented DRPs, types of interventions, and their implementation in older patients.
  
  
  RESULTS
  Three hundred eighty-eight medication reviews were analyzed, 964 DRPs (average 2.5 ± 1.9), and 1022 interventions (average 2.6 ± 2.0) were identified. The overall implementation rate of interventions was 70.1%, the highest was observed in interventions aiming to resolve the lack of therapy monitoring (86.8%). Patients with ≥12 medications had an increased risk of ≥5 DRPs (P < .001). Asthma was associated with lack of adherence (P = .002), lack of aspirin, statins, and proton pump inhibitors use with additional therapy needed (P = .002-.004). Predictive factors for drug interactions were antihypertensive medications and/or medications with narrow therapeutic index (P < .05). Lack of efficacy was associated with diabetes (P = .006). Nonsteroidal anti-inflammatory drugs were risk factors for inappropriate drug selection (P = .002). Lack of monitoring was associated with hypertension (P = .013), whereas benzodiazepines (P < .001) and aspirin (P = .021) were overused.
  
  
  CONCLUSIONS
  Patients with asthma, hypertension, and diabetes and lack of statin, antithrombotic agent, and/or proton pump inhibitor use were associated with higher risks for DRPs.
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Sandra Vezmar
authors.identifier: http://orcid.org/0000-0002-5791-2145
authors.initials: SV
authors.lastname: Kovačević
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Miljković
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Ćulafić
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Milena
authors.initials: M
authors.lastname: Kovačević
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Bojana
authors.initials: B
authors.lastname: Golubović
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Jovanović
authors.affiliation: Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Vučićević
authors.affiliation: Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, the Netherlands.
authors.forename: Johan J
authors.initials: JJ
authors.lastname: de Gier
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D019338:Polypharmacy; D011446:Prospective Studies; D012307:Risk Factors
keywords: clinical medication review; community pharmacy; drug-related problems; older patients; polypharmacy