Medication Management Among Home-Dwelling Older Patients With Chronic Diseases: Possible Roles for Community Pharmacists

J Nutr Health Aging. 2012 Aug;16(8):721-6. doi: 10.1007/s12603-012-0028-x.

Abstract

Objective: To describe medication management among home-dwelling older adults. These data should allow us to identify potential problems and to indicate target areas for community pharmacist intervention.

Design: Cross-sectional observational study.

Setting: Community pharmacies (n=86) in Belgium.

Participants: Home-dwelling older adults using at least one chronic medicine (n=338).

Measurements: Data on drug use were taken from the electronic pharmacy databases, while drug adherence was measured by pill count, self-report and estimation by GP and pharmacist. Drug knowledge and practical drug management capacity were assessed by patient interview and questionnaire, respectively.

Results: The study population (n=338) used a median of 5 chronic drugs per patient. Half of our sample (n=169) used psychotropic medication chronically, mainly benzodiazepines. In 100 patients (29.6%) at least one drug-drug interaction of potential clinical significance was observed. The overall mean adherence per patient was very high (98.1%), but 39.6% of individuals was underadherent with at least one medication. Seventy-six % of patients had an acceptable knowledge of the indication for at least 75% of their medication. In nearly 15 % of the study population cognitive impairment was suspected by the mini-cog test. The participants reported several practical problems with drug taking: difficulties with vision (32.0%), blister opening (12.1%), tablet swallowing (14.8%), tablet splitting (29.7% [represents % of patients who have to split tablets]) and distinction between different drug packages (23.4%).

Conclusion: This study identified the following aspects of medication management by home-dwelling older adults that could be improved by pharmaceutical care services: (i) assistance of cognitively impaired patients, (ii) management of practical drug taking problems, (iii) DDI screening, (iv) drug adherence, and (v) chronic benzodiazepine use.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Aging* / psychology
  • Belgium / epidemiology
  • Cognitive Dysfunction / epidemiology
  • Cognitive Dysfunction / psychology*
  • Cross-Sectional Studies
  • Drug Interactions
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Medication Adherence
  • Medication Therapy Management*
  • Needs Assessment
  • Pharmacies*
  • Pharmacists*
  • Polypharmacy
  • Professional Role
  • Psychotropic Drugs / administration & dosage
  • Psychotropic Drugs / adverse effects
  • Psychotropic Drugs / therapeutic use
  • Workforce

Substances

  • Psychotropic Drugs