Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention
dc.check.embargoformat | Not applicable | en |
dc.check.info | No embargo required | en |
dc.check.opt-out | Not applicable | en |
dc.check.reason | No embargo required | en |
dc.check.type | No Embargo Required | |
dc.contributor.advisor | Byrne, Stephen | en |
dc.contributor.advisor | O'Mahony, Denis | |
dc.contributor.author | O'Sullivan, David. | |
dc.contributor.funder | Health Research Board | en |
dc.contributor.funder | Centre for Ageing Research and Development in Ireland | en |
dc.date.accessioned | 2015-08-13T10:55:47Z | |
dc.date.available | 2015-08-13T10:55:47Z | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014 | |
dc.description.abstract | Introduction: Older individuals are particularly vulnerable to potentially inappropriate prescribing (PIP), drug related problems (DRPs) and adverse drug reactions (ADRs). A number of different interventions have been proposed to address these issues. However to-date there is a paucity of well-designed trials examining the impact of such interventions. Therefore the aims of this work were to: (i) establish a baseline PIP prevalence both nationally and internationally using the STOPP, Beers and PRISCUS criteria, (ii) identify the most comprehensive method of assessing PIP in older individuals, (iii) develop a structured pharmacist intervention supported by a computer decisions support system (CDSS) and (iv) examine the impact of this intervention on prescribing and incidence of ADRs. Results: This work identified high rates of PIP across all three healthcare settings in Ireland, 84.7% in the long term care, 70.7% in secondary care and 43.3% in primary care being reported. This work identified that for a comprehensive assessment of prescribing to be undertaken, an amalgamation of all three criteria should be deployed simultaneously. High prevalences of DRPs and PIP in older hospitalised individuals were identified. With 82.0% and 76.3% of patients reported to have at least one DRP or PIP instance respectively. The structured pharmacist intervention demonstrated a positive impact on prescribing, with a significant reduction MAI scores being reported. It also resulted in the intervention patients’ having a reduced risk of experiencing an ADR when compared to the control patients (absolute risk reduction of 6.8 (95% CI 1.5% - 12.3%)) and the number needed to treat = 15 (95% CI 8 - 68). However the intervention was found to have no significant effect on length of stay or mortality rate. Conclusion: This work shows that PIP is highly prevalent in older individuals across three healthcare settings in Ireland. This work also demonstrates that a structured pharmacist intervention support by a dedicated CDSS can significantly improve the appropriateness of prescribing and reduce the incidence of ADRs in older acutely ill hospitalised individuals. | en |
dc.description.status | Not peer reviewed | en |
dc.description.version | Accepted Version | |
dc.format.mimetype | application/pdf | en |
dc.identifier.citation | O'Sullivan, D. 2014. Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention. PhD Thesis, University College Cork. | en |
dc.identifier.endpage | 328 | |
dc.identifier.uri | https://hdl.handle.net/10468/1900 | |
dc.language.iso | en | en |
dc.publisher | University College Cork | en |
dc.rights | © 2013, David O'Sullivan. | en |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/ | en |
dc.subject | Pharmacist | en |
dc.subject | Interventions | en |
dc.subject | Polypharmacy | en |
dc.subject | Elderly | en |
dc.subject | Potentially inappropriate prescribing | en |
dc.subject | Adverse drug reactions | en |
dc.subject | Structured pharmacist interventions | en |
dc.subject | Drug related problems | en |
dc.subject | Secondary care | en |
dc.subject | Potential precribing omission | en |
dc.subject | Medication reconciliation | en |
dc.thesis.opt-out | false | |
dc.title | Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention | en |
dc.type | Doctoral thesis | en |
dc.type.qualificationlevel | Doctoral | en |
dc.type.qualificationname | PhD (Medicine and Health) | en |
ucc.workflow.supervisor | stephen.byrne@ucc.ie |
Files
Original bundle
1 - 4 of 4
Loading...
- Name:
- OSullivanDP_PHD2014_Abstract for thesis_Pharmacotherapy Optimization in Older Patients by a Structured Clinical Pharmacist Assessment and Intervention.pdf
- Size:
- 52.67 KB
- Format:
- Adobe Portable Document Format
- Description:
- Abstract
Loading...
- Name:
- OSullivanDP_PHD2014_Thesis_Pharmacotherapy Optimization in Older Patients by a Structured Clinical Pharmacist Assessment and Intervention.pdf
- Size:
- 3.75 MB
- Format:
- Adobe Portable Document Format
- Description:
- Full Text E-thesis
Loading...
- Name:
- OSullivanDP_PHD2014_Thesis_ Chapter 2-Potentially inappropriate prescribing, 25 years on-Electronic appendix tables.pdf
- Size:
- 1.95 MB
- Format:
- Adobe Portable Document Format
- Description:
- Chapter 2 Appendix Tables
Loading...
- Name:
- OSullivanDP_PHD2014_Thesis_Chapter 3-A Prevalence Study of Potentially Inappropriate Prescribing in Long Term Care Residents An Irish Perspective-Electronic Appendix Tables.pdf
- Size:
- 409.85 KB
- Format:
- Adobe Portable Document Format
- Description:
- Chapter 3 Appendix Tables
License bundle
1 - 1 of 1
Loading...
- Name:
- license.txt
- Size:
- 5.62 KB
- Format:
- Item-specific license agreed upon to submission
- Description: