Long-Term Care medicines formularies: any reasons for pharmacists’ concern?

Authors

DOI:

https://doi.org/10.1590/

Keywords:

Medicines formularies;, Long-Term Care;, Aged;, Pharmacists;, Pharmacy & Therapeutics Committee

Abstract

This study aimed to characterize and compare medicines formularies (MFs) used in Long-Term Care (LTC) facilities in Portugal, and to identify the prevalence of Potentially Inappropriate Medicines (PIMs). A systematic contact with LTC facilities was undertaken in December 2021. MFs were systematized according to the Anatomical Therapeutical Chemical classification system (ATC), followed by descriptive content analysis. A structured comparison between MFs developed by public organizations and private LTC facilities was performed. After duplicate removal and exclusion of medicines not for systemic use, two explicit criteria - the Algorithm of medication review in frail older people and the EU(7)-PIM list - were employed for PIMs identification. Five MFs were obtained and assessed. The three MFs developed by private institutions covered 23% of the national LTC facilities and approximately 34% of the national total of beds. Heterogeneity was particularly high for the Alimentary tract and metabolismBlood and blood-forming organsMusculoskeletal system, and Respiratory system ATC groups. A PIM prevalence of 29,4% was identified. Medicines distribution between the MFs suggests the need to develop national guidelines towards harmonizing medicines usage in LTC. The prevalence of PIMs found highlights the importance of a particular optimized use of this health technology in aged sub-populations.

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References

Baker E, Pryce Roberts A, Wilde K, Walton H, Suri S, Rull G, et al. Development of a core drug list towards improving prescribing education and reducing errors in the UK. Br J Clin Pharmacol. 2011 Feb;71(2):190-8.

Drenth-van Maanen AC, Leendertse AJ, Jansen PAF, Knol W, Keijsers CJPW, Meulendijk MC, et al., The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): Combining implicit and explicit prescribing tools to improve appropriate prescribing. J Eval Clin Pract. 2018 Apr 1;24(2):317-22.

Fenstemacher PA. Long-Term Care Medicine: A Pocket Guide [Internet]. 1st ed. Fenstemacher PA, Winn P, editors. Humana Press; 2010. Available from: http://www.springer.com/series/7633

» http://www.springer.com/series/7633

Godman B, Sakshaug S, Berg C, Wettermark B, Haycox A. Combination of prescribing restrictions and policies to engineer low prices to reduce reimbursement costs. Expert Rev Pharmacoecon Outcomes Res. 2011 Feb;11(1):121-9.

Gonçalves JR, Ramalhinho I, Sleath BL, Lopes MJ, Cavaco AM. Probing pharmacists’ interventions in Long-Term Care: a systematic review. Eur Geriatr Med. 2021a Aug 1;12(4):673-93.

Gonçalves JR, Sleath BL, Lopes MJ, Cavaco AM. Prescribing- Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method. Pharmacy [Internet]. 2021b Dec 3;9(4):194. Available from: https://www.mdpi.com/2226-4787/9/4/194

» https://www.mdpi.com/2226-4787/9/4/194

Hagemann V, Bausewein C, Remi C. Drug use beyond the licence in palliative care: A systematic review and narrative synthesis. Palliat Med. 2019 Jun 24;33(6):650-62.

Jackson SHD, Jansen PAF, Mangoni AA. Off-Label Prescribing in Older Patients. Drugs Aging. 2012 Jun;29(6):427-34.

Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management. J Am Geriatr Soc. 2018 Apr 1;66(4):789-803.

Kapoor A, Field T, Handler S, Fisher K, Saphirak C, Crawford S, et al. Characteristics of Long-Term Care Residents That Predict Adverse Events after Hospitalization. J Am Geriatr Soc . 2020 Nov 1;68(11):2551-7.

Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: A systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014. p. 1-11.

Larsen MD, Schou M, Kristiansen AS, Hallas J. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care. Eur J Clin Pharmacol . 2014;70(7):859-65.

Management Sciences for Health and World Health Organization. Drug and Therapeutics Committee Training Course [Internet]. 2007. Available from: http://www.msh.org/rpmplus

» http://www.msh.org/rpmplus

van Marum RJ. Underrepresentation of the elderly in clinical trials, time for action. Br J Clin Pharmacol . 2020 Oct 1;86(10):2014-6.

McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev. 2004. p. 163-84.

Mekonnen AB, Redley B, de Courten B, Manias E. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis. Br J Clin Pharmacol . 2021 Nov 1;87(11):4150-72.

Ministério da Saúde, ACSS. Monitorização da Rede Nacional de Cuidados Continuados Integrados (RNCCI) - 2020 [Internet]. 2020. Available from: http://www.acss.min-saude.pt/2016/07/22/documentacao/

» http://www.acss.min-saude.pt/2016/07/22/documentacao/

Ministério da Saúde, ACSS. Relatório de monitorizacao da RNCCI - 1o semestre 2021 [Internet]. 2021. Available from: https://www.acss.min-saude.pt/category/cuidados-de-saude/continuados/?lang=pt

» https://www.acss.min-saude.pt/category/cuidados-de-saude/continuados/?lang=pt

Ministério da Saúde, Ministério do Trabalho Solidariedade e Segurança Social. Decreto-Lei 101/2006. 101/2006 Portugal: Diário da República; Jun 6, 2006.

Nobili A, Garattini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorb. 2011;1:28-44.

Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2016 Nov 1;67:130-8.

O’connor MN, Gallagher P, O’mahony D. Inappropriate Prescribing Criteria, Detection and Prevention. Drugs Aging . 2012;29(6):437-52.

Onder G, van der cammen TJM, Petrovic M, Somers A, Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013. p. 284-91.

Parrish R. What Is a Formulary, Anyway? Part 2. Pharmacy (Basel). 2018 Jul 23;6(3):72.

Poudel A, Ballokova A, Hubbard RE, Gray LC, Mitchell CA, Nissen LM, et al. Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications. Geriatr Gerontol Int. 2016 Sep 1;16(9):1002-13.

Puigventós Latorre F, Santos-Ramos B, Ortega Eslava A, Durán-García ME. Variability in Activity and Results From Drug Assessments by Pharmacy and Therapeutics Committees in Spanish Hospitals. Farmacia Hospitalaria (English Edition). 2011 Nov;35(6):305-14.

Rankin A, Cadogan CA, Patterson SM, Kerse N, Cardwell CR, Bradley MC, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews. 2018 Sep 3;2018(9).

Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: A list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol . 2015 Jul 13;71(7):861-75.

Rodrigues DA, Herdeiro MT, Thurmann PA, Figueiras A, Coutinho P, Roque F. Operationalisation for portugal of the EU(7)-PIM list for identification of potentially inappropriate medicines in older adults. Acta Med Port. 2020;33(13).

Schiff GD, Galanter WL, Duhig J, Koronkowski MJ, Lodolce AE, Pontikes P, et al. A prescription for improving drug formulary decision making. PLoS Med. 2012 May;9(5).

Sofat R, Cremers S, Ferner RE. Drug and therapeutics committees as guardians of safe and rational medicines use. Br J Clin Pharmacol . 2020 Jan 1;86(1):10-2.

Tyler LS, Cole SW, May JR, Miliares M, Valentino MA, Vermeulen LC, et al. ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System. Am J Health-Syst Pharm. 2008 Jul 1;65(13):1272-83.

de Vries TPGM, Daniels JMA, Mulder CW, Groot OA, Wewerinke L, Barnes KI, et al. Should medical students learn to develop a personal formulary? An international, multicentre, randomised controlled study. Eur J Clin Pharmacol . 2008 Jun;64(6):641-6.

de Vries TPGM, Henning RH, Hogerzeil HV, Fresle DA, Haaijer-Ruskamp M, van Gilst RM. Guide to good prescribing - a practical manual [Internet]. Geneva; 1994. Available from: https://apps.who.int/iris/handle/10665/59001

» https://apps.who.int/iris/handle/10665/59001

Wang KN, Bell JS, Chen EYH, Gilmartin-Thomas JFM, Ilomäki J. Medications and Prescribing Patterns as Factors Associated with Hospitalizations from Long-Term Care Facilities: A Systematic Review. Drugs Aging . 2018 May 1;35(5):423-57.

World Health Organization. Towards an international consensus on policy for long-term care of the ageing [Internet]. WHO. 2000. Available from: https://apps.who.int/iris/handle/10665/66339

» https://apps.who.int/iris/handle/10665/66339

World Health Organization. World Health Organization Model List of Essential Medicines - 22nd List [Internet]. Wordl Health Organization. 2021. Available from: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02

» https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02

World Health Organization. WHOCC - ATC/DDD Index. 2022.

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Published

2023-08-28

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Long-Term Care medicines formularies: any reasons for pharmacists’ concern?. (2023). Brazilian Journal of Pharmaceutical Sciences, 59, e22802. https://doi.org/10.1590/