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Development and Piloting of an Algorithm to Select Older Patients for Different Types of Medication Review
Stijn Crutzen1, Jan Schuling2, Jacqueline G Hugtenburg3
1Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Frontiers in Pharmacology
|April 4, 2019
Summary
An algorithm was developed to identify older adults needing medication reviews based on case complexity. It uses medication count, prescriber number, falls, and medication collection habits, but needs further validation.
Area of Science:
- Gerontology
- Pharmaceutical Sciences
- Health Services Research
Background:
- Medication reviews are crucial for older adults.
- Selecting patients for medication reviews based on complexity is challenging.
- A systematic approach is needed to optimize medication review allocation.
Purpose of the Study:
- To develop and pilot a criteria-based algorithm for selecting older adults for medication reviews.
- To assess the algorithm's ability to differentiate between high and low case complexity.
- To evaluate the feasibility of the algorithm in community pharmacy settings.
Main Methods:
- Expert consensus (Delphi method) to identify complexity criteria.
- Regression modeling to develop a weighted algorithm based on case characteristics.
- Pilot testing in community pharmacies with 38 patients.
- Assessment of medication review time, interventions, and pharmacist feedback.
Main Results:
- An algorithm was developed using number of medications, prescribers, recent falls, and medication collection.
- The algorithm showed slight to moderate agreement with pharmacist complexity ratings (Kappa 0.16-0.42).
- Medication review time did not significantly differ between high and low complexity cases.
Conclusions:
- An algorithm with four criteria was developed to stratify patient complexity for medication reviews.
- Pharmacist feedback indicated mixed feasibility, particularly regarding the 'fall incidents' criterion.
- Further validation is required before widespread implementation of the algorithm.
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