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Optimising Drug Prescribing and Improving Medication Management: What Can We Do?

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 26154

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Special Issue Editors

Dr. Caitriona Cahir

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Guest Editor

Epidemiology & Modelling Research Group (EMeRGe), Division of Population Health Sciences, Royal College of Surgeons in Ireland, Mercer Street, D02 YN77 Dublin, Ireland
Interests: drug utilization research; medication adherence; prescribing quality indicators; pharmacoepidemiology; health services research and behavioural interventions

Prof. Dr. Enrica Menditto

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Guest Editor

Department of Pharmacy, University of Naples Federico II, 80138 Naples, NA, Italy
Interests: medication adherence; drug utilization research; pharmaceutical policies; prescribing quality indicators
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The World Health Organisation (WHO) has referred to non-adherence to medication as “a worldwide problem of striking magnitude” and “one of the two largest unsolved gaps in health care” (the other being “suboptimal prescription of medication”). Medication-related morbidity and mortality is a major public health care concern and a significant burden on health care resources. In recent years, there has been an increase in the development and availability of new and efficacious medications with positive benefit-to-risk profiles, but there has also been an increase in the use of unnecessary and non-clinically-indicated drugs, drug interactions, adherence problems, drug costs and adverse drug events.

Optimizing prescribing is essential to ensure medicines are taken as intended and that significant clinical and economic costs of drug-related illness are minimized through the effective management of chronic conditions, multimorbidity and polypharmacy. A number of criteria and screening tools have been developed to measure and assist prescribers in detecting potentially inappropriate prescribing (PIP). These measures consist of drugs to be avoided independent of diagnosis or in the context of certain diagnoses. A taxonomy of adherence has also been developed to promote scientific studies of adherence. The taxonomy defines medication adherence “as the process by which patients take their medication as prescribed” and includes three components: (i) initiation (taking the first dose of prescribed medication); (ii) implementation (taking medication as prescribed); and (iii) discontinuation (stopping treatment).

This Special Issue aims to publish high-quality research and reviews that focus on medication adherence and the identification and prevention of adverse health outcomes and address prescribing quality, safety and effective medication management. Research may be based on any age group, context or setting; including a disease-specific clinical setting or the broader area of population health and health services research. Investigators who have conducted research on these topics are invited to submit manuscripts for consideration for this Special Issue of IJERPH.

Dr. Caitriona Cahir
Prof. Enrica Menditto
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

optimizing prescribing
medication management
adherence
potentially inappropriate prescribing
suboptimal prescribing
health outcomes
adverse events
chronic disease
polypharmacy
multimorbidity
population health
drug utilization research

Published Papers (9 papers)

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Research

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13 pages, 635 KiB

Open AccessArticle

Over-the-Counter Medicine Attitudes and Knowledge among University and College Students in Brunei Darussalam: Findings from the First National Survey

by Ishpa Shapiah Abdullah, Li Ling Chaw, David Koh, Zahid Hussain, Khang Wen Goh, Asma A’tiyah Abdul Hamid and Long Chiau Ming

Int. J. Environ. Res. Public Health 2022, 19(5), 2658; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052658 - 24 Feb 2022

Cited by 10 | Viewed by 5508

Abstract

Over-the-counter (OTC) medicine is defined as safe and effective for the general public to use, without seeking therapy from a health professional. As primary social media and internet users, university and college students are more likely to be exposed to unverified sources of health information. This study aims to assess the knowledge, attitudes, and behaviour of students at institutions of higher learning in Brunei with regard to the safe use of OTC medicines. A cross-sectional study was performed using a self-administered online questionnaire, adapted from the literature with additional information from the United States Food and Drug Administration (FDA) on the educational resources in understanding OTC medicine for consumers. The questionnaire consisted of 4 sections: demographic information, knowledge of OTC medicines, attitudes, and practice. Descriptive and inferential statistics were used for data analysis. A total of 335 students returned a completed questionnaire. The students had a mean knowledge score of 7.1 out of 9, with more than half (53.4%) having good knowledge (knowledge score > 7), and only a small percentage (5.7%) with poor knowledge. Almost all of the students (99.7%) had a positive attitude toward OTC medicine use. Few of the students practiced improper habits in terms of OTC medicine use, such as not reading the instructions or taking more than the recommended dose. Awareness of proper OTC medicine use among students in institutions of higher learning is necessary to prevent the rise of inappropriate user practices. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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14 pages, 1828 KiB

Open AccessArticle

The Prescription of Drug Ontology 2.0 (PDRO): More Than the Sum of Its Parts

by Jean-François Ethier, François Goyer, Paul Fabry and Adrien Barton

Int. J. Environ. Res. Public Health 2021, 18(22), 12025; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182212025 - 16 Nov 2021

Cited by 6 | Viewed by 1981

Abstract

While drugs and related products have profoundly changed the lives of people around the world, ongoing challenges remain, including inappropriate use of a drug product. Inappropriate uses can be explained in part by ambiguous or incomplete information, for example, missing reasons for treatments, ambiguous information on how to take a medication, or lack of information on medication-related events outside the health care system. In order to fully assess the situation, data from multiple systems (electronic medical records, pharmacy and radiology information systems, laboratory management systems, etc.) from multiple organizations (outpatient clinics, hospitals, long-term care facilities, laboratories, pharmacies, registries, governments) on a large geographical scale is needed. Formal knowledge models like ontologies can help address such an information integration challenge. Existing approaches like the Observational Medical Outcomes Partnership are discussed and contrasted with the use of ontologies and systems using them for data integration. The PRescription Drug Ontology 2.0 (PDRO 2.0) is then presented and entities that are paramount in addressing this problematic are described. Finally, the benefits of using PDRO are discussed through a series of exemplar situation. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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14 pages, 1913 KiB

Open AccessArticle

How Physicians Renew Electronic Prescriptions in Primary Care: Therapeutic Decision or Technical Task?

by Taina Oravainen, Marja Airaksinen, Kaija Hannula and Kirsi Kvarnström

Int. J. Environ. Res. Public Health 2021, 18(20), 10937; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182010937 - 18 Oct 2021

Cited by 3 | Viewed by 2773

Abstract

In long-term pharmacotherapies, the renewal of prescriptions is part of the medication use process. Although the majority of medicines are used with renewed prescriptions, little research has focused on renewal practices. The aim of this study was to explore current renewal practices from a primary care physician’s perspective to identify system-based challenges and development needs related to the renewal practices. This qualitative study was conducted in two phases in public primary health care centres of Kirkkonummi, Finland. First, five physicians were shadowed on-site while they renewed prescriptions. The findings of the shadowing phase were further discussed in two focus group discussions with seven other physicians than in the shadowing phase. Inductive content analysis was used for data analysis utilizing Reason’s risk management theory as a theoretical framework. Due to problems in the renewal process, including impractical information systems, a lack of reconciled medication lists, and a lack of time allocated for renewing prescriptions, physicians felt that monitoring and reviewing each patients’ medications for renewal was complicated. Therefore, they felt that renewing, at times, became a technical task rather than a therapeutic decision. The physicians suggested information system improvements, enhanced interprofessional cooperation, and patient involvement as strategies to ensure rational pharmacotherapy and patient safety in the renewal of prescription medicines. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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7 pages, 604 KiB

Open AccessArticle

Interventions to Increase Leukocyte Testing during Treatment with Dimethyl Fumarate

by Paul A. Heidenreich, Shoutzu Lin, Parisa Gholami, Von R. Moore, Muriel L. Burk, Peter A. Glassman, Francesca E. Cunningham and Anju Sahay

Int. J. Environ. Res. Public Health 2021, 18(19), 10312; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910312 - 30 Sep 2021

Viewed by 1519

Abstract

Dimethyl fumarate (DMF), a treatment for multiple sclerosis, may cause leukopenia and infection. Accordingly, periodic white blood cell (WBC) monitoring is recommended. We sought to evaluate the US Department of Veteran Affairs’ safety program which provides facilities with a list of patients prescribed DMF therapy without a documented white blood cell count (WBC). We identified 118 sites with patients treated with DMF from 1 January 2016 through 30 September 2016. Each site was asked if any of seven interventions were used to improve WBC monitoring (academic detailing, provider education without academic detailing, electronic clinical reminders, request for provider action plan, draft orders for WBC monitoring, patient mailings, and patient calls). The survey response rate was 78%. For the 92 responding sites (78%) included sites (1115 patients) the mean rate of WBC monitoring was 54%. In multivariate analysis, academic detailing increased the rate by 17% (95% CI 4 to 30%, p = 0.011) and provider education increased the rate by 9% (95% CI 0.6 to 18%, p = 0.037). The WBC monitoring rate increased by 3.8% for each additional intervention used (95% CI 1.2–6.4%, p = 0.005). Interventions focused on the physician, including academic detailing, were associated with improved WBC monitoring for patients at risk for leukopenia from DMF treatment. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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10 pages, 1511 KiB

Open AccessArticle

Communicating Electronic Adherence Data to Physicians—Consensus-Based Development of a Compact Reporting Form

by Fine Dietrich, Andreas Zeller, Melanie Haag, Kurt E. Hersberger and Isabelle Arnet

Int. J. Environ. Res. Public Health 2021, 18(19), 10264; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910264 - 29 Sep 2021

Cited by 3 | Viewed by 1562

Abstract

Information on medication adherence is missing in patient files, although it might be helpful to optimize treatment. An adherence report that presents data from electronic adherence monitoring and provides recommendations regarding pharmacological treatment could close this gap. We aimed to develop an adherence reporting form that combines suitable calculations and graphical representations to facilitate the physicians’ interpretation of (non-)adherence. Two consensus development panels were conducted. First, pharmacists with expertise in adherence monitoring debated the items needed to calculate and illustrate electronic adherence data. Second, physicians discussed the items they would need for an adherence report and were encouraged to propose new items. Preference was indicated by raising a green or red card. Voting was repeated until consensus was obtained. Third, first drafts of the adherence reporting form were created by two pharmacists. Seven pharmacists agreed on four metrics to express medication adherence and three graphical representations. Five physicians approved the four metrics and rated the dot chart as the most useful illustration for judging the patient’s adherence patterns. Additionally, they required a clinical–pharmaceutical evaluation of the adherence estimates considering drug-related properties. We developed an adherence reporting form for the first time in a compact format and based on the recommendations of experts. In addition, we considered the preferences of physicians, who appreciated the clarity of the reporting form. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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14 pages, 680 KiB

Open AccessArticle

Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center

by Javier González-Bueno, Daniel Sevilla-Sánchez, Emma Puigoriol-Juvanteny, Núria Molist-Brunet, Carles Codina-Jané and Joan Espaulella-Panicot

Int. J. Environ. Res. Public Health 2021, 18(18), 9606; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189606 - 12 Sep 2021

Cited by 12 | Viewed by 3598

Abstract

Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients’ multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80–28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95–15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients’ experiences related to medication management. Thus, the relationship between patients’ self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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20 pages, 8879 KiB

Open AccessArticle

A Network Approach for the Study of Drug Prescriptions: Analysis of Administrative Records from a Local Health Unit (ASL TO4, Regione Piemonte, Italy)

by Gianluca Miglio, Lara Basso, Lucrezia G. Armando, Sara Traina, Elisa Benetti, Abdoulaye Diarassouba, Raffaella Baroetto Parisi, Mariangela Esiliato, Cristina Rolando, Elisa Remani and Clara Cena

Int. J. Environ. Res. Public Health 2021, 18(9), 4859; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094859 - 02 May 2021

Cited by 3 | Viewed by 2045

Abstract

In a Drug Prescription Network (DPN), each drug is represented as a node and two drugs co-prescribed to the same patient are represented as an edge linking the nodes. The use of DPNs is a novel approach that has been proposed as a means to study the complexity of drug prescription. The aim of this study is to demonstrate the analytical power of the DPN-based approach when it is applied to the analysis of administrative data. Drug prescription data that were collected at a local health unit (ASL TO4, Regione Piemonte, Italy), over a 12-month period (July 2018–June 2019), were used to create several DPNs that correspond to the five levels of the Anatomical Therapeutic Chemical classification system. A total of 5,431,335 drugs prescribed to 361,574 patients (age 0–100 years; 54.7% females) were analysed. As indicated by our results, the DPNs were dense networks, with giant components that contain all nodes. The disassortative mixing of node degrees was observed, which implies that non-random connectivity exists in the networks. Network-based methods have proven to be a flexible and efficient approach to the analysis of administrative data on drug prescription. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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11 pages, 820 KiB

Open AccessArticle

Primary Care Records of Chronic-Disease Patient Adherence to Treatment

by Mireia Massot Mesquida, Josep Anton de la Fuente, Anna María Andrés Lorca, Ingrid Arteaga Pillasagua, Edelmiro Balboa Blanco, Sonia Gracia Vidal, Sara Pablo Reyes, Paula Gómez Iparraguirre, Gemma Seda Gombau and Pere Torán-Monserrat

Int. J. Environ. Res. Public Health 2021, 18(7), 3710; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073710 - 02 Apr 2021

Cited by 3 | Viewed by 2222

Abstract

The goal of managing adherence (AD) is to achieve better medication use by patients in order to maximize benefits and reduce risks. With the aim of improving treatment adherence by patients, we carried out a descriptive study to obtain information related to adherence management in primary care. Inclusion criteria were as follows: patients that had at least one record of any treatment adherence assessment variable. For those that had more than one recorded variable, we analyzed consistency across test results. For the comparative analysis of adherence records, patients were categorized into three groups on the basis of the healthcare unit that recorded the data: case management (CM), home care (HC), and primary care team (PCT). A total of 32,137 subjects met inclusion criteria; 79.56% of subjects were older than 65. As for the analysis of assessment records across care units, 69.73% of CM patients, 67.17% of HC patients, and 2.33% of PCT patients had adherence assessment records. CM units made a significantly greater number of records than HC units. We observed low adherence at a rate of 49.3% in the CM group, 31.91% in the HC group, and 17.58% in the PCT group. When more than one adherence variable was recorded, analysis revealed inconsistent test results or recorded variables in 9.06% of PCT cases, 14.83% of HC cases, and 20.47% of CM cases. The inconsistencies observed in records of adherence assessment and management across different care units reveal the huge variability that exists in managing and selecting a tool to assess adherence. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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Other

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9 pages, 594 KiB

Open AccessPerspective

Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance

by Enrica Menditto, Caitriona Cahir, Sara Malo, Isabel Aguilar-Palacio, Marta Almada, Elisio Costa, Anna Giardini, María Gil Peinado, Mireia Massot Mesquida, Sara Mucherino, Valentina Orlando, Carlos Luis Parra-Calderón, Enrique Pepiol Salom, Przemyslaw Kardas and Bernard Vrijens

Int. J. Environ. Res. Public Health 2021, 18(9), 4872; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094872 - 03 May 2021

Cited by 11 | Viewed by 3569

Abstract

Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients’ medication-taking patterns, as well as clinical and health outcomes. Full article

(This article belongs to the Special Issue Optimising Drug Prescribing and Improving Medication Management: What Can We Do?)

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