Includes bibliographical references.

Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital -- Proton Pump Inhibitors in the Elderly Hospitalized Patient: Evaluating Appropriate Use and Deprescribing -- Patient Satisfaction With Diabetes Care in a Student-Run Free Medical Clinic: A Quality Improvement Study -- Impact of a Pharmacy-Driven Transitions of Care Medication Reconciliation Following Hospitalization -- Parallel Assessment of Chemotherapy Adherence and Supportive Therapy Adherence on Occurrence and Minimization of Adverse Drug Reactions Among Cancer Patients: A Clinical-Based Observational Study -- Yosprala: Coordinated Delivery of a Proton Pump Inhibitor and Aspirin.

[Article Title: Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital / Julie B. Cooper, Elizabeth Jeter and Cory John Sessoms, p. 47-53]

Abstract:

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described.

Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center.

Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP.

Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs.

Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

https://doi.org/10.1177/8755122519883642

[Article Title: Proton Pump Inhibitors in the Elderly Hospitalized Patient: Evaluating Appropriate Use and Deprescribing / Nishila Mehta, Fernando Martinez Guasch, Corey Kamen, Sumesh Shah, Lisa D. Burry, Christine Soong and Sangeeta Mehta, p. 54-60]

Abstract:

Background: Proton pump inhibitors (PPIs) are often prescribed for elderly patients without appropriate indication, or for longer durations than recommended.

Objective: To review appropriateness of PPI use prior to and in hospital, and deprescribing rates across different hospital units.

Methods: Retrospective analysis of patients ≥65 years admitted to 5 acute care units: intensive care unit, acute care for elderly, orthopedics, surgery, and medicine. Patients who were “non-naive” (prehospital PPI use) or “naive” (new PPI initiated in hospital) users were included. For both groups, demographics, reason for admission, length of stay, comorbidities, name and number of home medications, PPI name, dose and indication, and PPI discharge instructions were collected. For naive patients, duration of in-hospital use and prescriber specialty was recorded.

Results: Among non-naive patients (n = 377), for 37 patients (10%), the indication for a PPI was not appropriate, and for 92 patients (24%), the indication was unclear. Most patients had their home PPI continued while in hospital (87%) and at discharge (90%). Among naive (n = 93) patients, for 8 patients (9%), the indication for a PPI was not appropriate, and for 25 (27%) patients, the indication was unclear. PPI was prescribed to only 16 (18%) by the gastrointestinal consult service. Most patients had their new PPI continued at discharge (74%); only 7 (9%) were discharged with a plan to reassess PPI indication.

Conclusion: PPIs are infrequently deprescribed during hospital admission, despite inappropriate or unclear indications for use. Thorough medication reconciliation, documentation of PPI indication and duration, and institutional focus on deprescribing are encouraged.

https://doi.org/10.1177/8755122519894953

[Article Title: Patient Satisfaction With Diabetes Care in a Student-Run Free Medical Clinic: A Quality Improvement Study / Michelle N. Schroeder and Maureen O. Hickey, p. 61-67]

Abstract:

Background: Diabetes prevalence continues to be a concern and the management of diabetes is important but costly. The prevalence of diabetes is greater among persons with a low income, including those who are uninsured or underinsured. Student-run free clinics (SRFC) are one resource to these patients who may otherwise lack access to medical care.

Objective: The purpose of this study was to assess patient satisfaction with diabetes care at a SRFC in order to assist in identifying areas of improvement.

Methods: A quality improvement survey was designed to assess patient satisfaction with overall care, as well as with routines and perception of care related to self-management, healthy eating, and exercise.

Results: The survey was completed by 25 patients at a Toledo area SRFC. Established patients who were aged 18 years or older and diagnosed with diabetes, were invited to complete the survey. The majority of patients were satisfied with their diabetes care at the SRFC (88%). Fewer patients, however, reported satisfaction with the treatment for their diabetes (72%) and with their knowledge about diabetes (76%). Subanalyses of survey responses also showed significant differences when comparing sex, age, and length of diabetes diagnosis.

Conclusions: The survey helped identify key areas in which the diabetes care provided at the SRFC could be improved. These areas included education about diabetes in general, as well as in understanding treatment, self-monitoring, and healthy eating and exercise options. Future research could explore survey results after specifying and implementing changes made to the education provided to the patients.

https://doi.org/10.1177/8755122519899084

[Article Title: Impact of a Pharmacy-Driven Transitions of Care Medication Reconciliation Following Hospitalization / Rebecca L. Stauffer and Abigail Yancey, p. 68-71]

Abstract:

Background: Medication changes are common after hospitalizations, and medication reconciliations are one tool to help identify potential medication discrepancies.

Objective: To determine the impact of a pharmacy-driven medication reconciliation service on number of medication discrepancies identified.

Methods: This was a retrospective cohort, chart-review study conducted at an internal medicine outpatient clinic. Patients at least 18 years of age were eligible for inclusion if they presented for a hospital follow-up appointment within 14 days of discharge between September 1, 2015, and May 31, 2016, from a system hospital. The 2 cohorts were patients with a pharmacist-completed medication reconciliation note written in the electronic health record on the date of their hospital follow-up appointment and those without. The primary outcome was number of medication discrepancies identified during medication reconciliation. Secondary outcomes included types of discrepancies, 30-day hospital readmission, and 30-day emergency department visits. This study was approved by the facility institutional review board.

Results: Seventy-nine patients were included, and 38 patients had a pharmacist-completed medication reconciliation (48%). A total of 64 medication discrepancies were identified in 26 patients; of these, 49 discrepancies were resolved during the appointment (77%). There was an average of 2.46 medication discrepancies (±2.34) per patient. The most common discrepancy was missing medications. Thirty-day readmission rate was 5.3% in the intervention group and 19.5% in the control group (P = .054).

Conclusions: A pharmacist-completed medication reconciliation identified many medication discrepancies that were then resolved. From this study, pharmacist-led medication reconciliations following hospital discharge appear valuable.

https://doi.org/10.1177/8755122519900507

[Article Title: Parallel Assessment of Chemotherapy Adherence and Supportive Therapy Adherence on Occurrence and Minimization of Adverse Drug Reactions Among Cancer Patients: A Clinical-Based Observational Study / Jyoti Kumar, Manjula Gudhoor and Madiwalayya Shivakantayya Ganachari,p. 72-77]

Abstract:

Background: Cancer is a disease that is inevitably treated using chemotherapy, but the cytotoxic drugs used in the treatment have the potency to cause adverse drug reactions (ADRs). Thus, supportive therapy plays an essential role in managing the untoward effects of the cancer drugs in patients. This highlights the importance of medication adherence in managing the disease, mitigating and preventing the occurrence of chemotherapy-induced ADR without compromising the health status of the cancer population.

Objective: To assess the adherence to chemotherapy and supportive therapy and to evaluate type and degree of causality of ADRs observed in cancer patients.

Methods: On ethics committee approval, a 6-month observational study was conducted among recruited cancer patients undergoing chemotherapy in a tertiary care hospital. Morisky Medication Adherence Measurement Scale–8 was employed to assess the medication adherence, and ADR causality was determined using Naranjo ADR Probability Scale.

Results: Ninety cancer patients participated in the study, out of which females were 61.11%. Chemotherapy adherence in comparison to supportive drugs was observed to be more (21.11%). Twelve different combination of ADR were reported in the subjects with variability in the degree of causality assessment.

Conclusion and Relevance: The distinction of adherence to the medication used in cancer management with marked level of ADR was well depicted in the study, implicating the necessity of prudent symbiotic practice of an oncology pharmacist, patient, and physician relationship in optimizing the quality of life of cancer patients by imparting vigilant efforts in medication adherence.

https://doi.org/10.1177/8755122520901739

[Article Title: Yosprala: Coordinated Delivery of a Proton Pump Inhibitor and Aspirin / Courtney A. Ingram, Gracie Giang, Katie McCrory and Terri M. Wensel, p. 78-83]

Abstract:

Objective: Review the pharmacology, pharmacokinetics, efficacy, and safety of Yosprala (aspirin and omeprazole).

Data Sources: A literature search was conducted using PubMed with the terms “Yosprala,” “PA8140,” and “PA32540” from the initial year through May, 2019. Additional sources were gathered through bibliographies. Aralez Pharmaceuticals Inc was contacted for manufacturer information.

Study Selection and Data Extraction: The sources were narrowed to studies done in English language between 1990 and 2019. All viable clinical trials for the use of Yosprala in the secondary prevention of cardiovascular events were included.

Data Synthesis: Yosprala is a coordinated delivery system of immediate-release omeprazole 40 mg and enteric-coated aspirin (325 mg or 81 mg). In 2016, the Food and Drug Administration approved Yosprala for the secondary prevention of cardiovascular or cerebrovascular events (ie, stroke or myocardial infarction). While it is recommended that patients take low-dose aspirin for secondary prevention of these events, many patients cannot tolerate the gastrointestinal (GI) adverse effect profile of the drug. Phase 3 clinical trials have proven that Yosprala significantly lowers the occurrence of GI bleeds and ulcers versus aspirin alone (3.2% and 8.6%, respectively; P ≤ .001). The most common adverse effects include infection, diarrhea, and dyspepsia.

Conclusion: Yosprala significantly reduces the occurrence of GI ulcers and seems to be a safe and effective option for the secondary prevention of cardiovascular events.

https://doi.org/10.1177/8755122519867906