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The American Journal of Medicine Apr 2021Nonoptimized medication regimens cost patients and payors in the United States more than $528 billion in additional health care expenses each year. Comprehensive... (Review)
Review
Nonoptimized medication regimens cost patients and payors in the United States more than $528 billion in additional health care expenses each year. Comprehensive medication management is a patient-centered approach to medication optimization delivered by a clinical pharmacist working with the patient, physicians, and other members of the health care team. Comprehensive medication management ensures medications are assessed for appropriateness, effectiveness, and safety given the patient's clinical status, comorbidities, and other medications, as well as the patient's ability to take the medications as intended and adhere to the regimen. This article reviews the growing body of literature demonstrating the value of comprehensive medication management in achieving the quadruple aim of health care: better care, reduced health care costs, an improved patient experience, and provider well-being.
Topics: Drug Prescriptions; Humans; Medication Therapy Management; Pharmaceutical Preparations; Pharmacists; United States
PubMed: 33472055
DOI: 10.1016/j.amjmed.2020.12.008 -
British Journal of Clinical Pharmacology May 2012Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed... (Review)
Review
Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications', 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.
Topics: Databases, Factual; Disease Management; Drug Monitoring; Humans; Medication Adherence; Patient Care Management; Pharmaceutical Preparations
PubMed: 22486599
DOI: 10.1111/j.1365-2125.2012.04167.x -
Geriatric Nursing (New York, N.Y.) 2016GRACE targets home-based, geriatrics team management, primary care collaboration, and protocols for common conditions. GRACE can improve outcomes and reduce acute-care...
GRACE targets home-based, geriatrics team management, primary care collaboration, and protocols for common conditions. GRACE can improve outcomes and reduce acute-care utilization. We aimed to characterize medication-related GRACE recommendations. Medical record review of Indiana University Health Physicians GRACE patients (June 2012 to September 2013), with six months' follow-up was conducted. Demographics, clinical characteristics, and recommendations were summarized. Mean age (N = 156) was 82 years; 71% were women, 24% black, and 34% living alone, with a mean of 12 medications. Medication management was activated in 99%. Implementation occurred in 96% of 924 recommendations, including reviewing medication lists (N = 153) and purposes (N = 109) with patients, and providing medication lists to providers (N = 119). GRACE recommended and implemented medication-related interventions, facilitating medication reconciliation, education, communication, and coordination of care. Medication management, a key GRACE component, may contribute to reducing hospitalization rates.
Topics: Aged, 80 and over; Disease Management; Female; Geriatric Assessment; Home Care Services; Humans; Indiana; Male; Medication Reconciliation; Patient Care Team; Primary Health Care; Retrospective Studies
PubMed: 27344943
DOI: 10.1016/j.gerinurse.2016.05.001 -
Life Sciences Jul 2021Alzheimer's disease (AD) is a multifactorial neurodegenerative disease which is mainly characterized by progressive impairment in cognition, emotion, language and memory... (Review)
Review
Alzheimer's disease (AD) is a multifactorial neurodegenerative disease which is mainly characterized by progressive impairment in cognition, emotion, language and memory in older population. Considering the impact of AD, formulations of pharmaceutical drugs and cholinesterase inhibitors have been widely propagated, receiving endorsement by FDA as a form of AD treatment. However, these medications were gradually discovered to be ineffective in removing the root of AD pathogenesis but merely targeting the symptoms so as to improve a patient's cognitive outcome. Hence, a search for better disease-modifying alternatives is put into motion. Having a clear understanding of the neuroprotective mechanisms and diverse properties undertaken by specific genes, antibodies and nanoparticles is central towards designing novel therapeutic agents. In this review, we provide a brief introduction on the background of Alzheimer's disease, the biology of blood-brain barrier, along with the potentials and drawbacks associated with current therapeutic treatment avenues pertaining to gene therapy, immunotherapy and nanotherapy for better diagnosis and management of Alzheimer's disease.
Topics: Alzheimer Disease; Animals; Disease Management; Genetic Therapy; Humans; Immunotherapy; Pharmaceutical Preparations; Theranostic Nanomedicine
PubMed: 33515559
DOI: 10.1016/j.lfs.2021.119129 -
The New England Journal of Medicine May 2010Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has... (Clinical Trial)
Clinical Trial
BACKGROUND
Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).
METHODS
We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.
RESULTS
We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.
CONCLUSIONS
Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)
Topics: Academic Medical Centers; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Electronic Data Processing; Humans; Medical Order Entry Systems; Medication Errors; Medication Systems, Hospital; Organizational Case Studies; Organizational Innovation; Pharmaceutical Preparations; United States
PubMed: 20445181
DOI: 10.1056/NEJMsa0907115 -
Journal of Managed Care & Specialty... Feb 2020To explore how healthcare management has evolved from managing separate components to disease management. Recent published atricles and the authors' experiences. Not...
To explore how healthcare management has evolved from managing separate components to disease management. Recent published atricles and the authors' experiences. Not applicable. Not applicable. Disease state management integrates services from all areas of healthcare. To evaluate whether a disease is being treated effectively, clinical, physical, and quality of life, indicators need to be measured. Protocols and intervention strategies need to be developed at minimal cost without compromising patient care. Patient and physician satisfaction need to be evaluated to measure the success of the disease management process. The old paradigm of component management of medical care is losing ground and being replaced by systems focused on patient outcomes as the best way to deal with the issues of access, quality, and cost. Disease state management, Outcomes, Costs.
Topics: Attitude of Health Personnel; Delivery of Health Care; Disease Management; Humans; Patient Satisfaction; Physicians; Quality of Life
PubMed: 32011963
DOI: 10.18553/jmcp.2020.26.2.85a -
American Journal of Hospital Pharmacy Aug 1994Automated devices for managing medication distribution are described. Shrinking operating budgets are causing many departments of pharmacy to consider automation to... (Comparative Study)
Comparative Study
Automated devices for managing medication distribution are described. Shrinking operating budgets are causing many departments of pharmacy to consider automation to maximize the cost-effective use of professional personnel. Many devices and systems that are currently available or under development can help with (1) distribution of medication to and from the patient care area, (2) distribution of medication directly to the patient, (3) inventory control, (4) management of controlled substances, or (5) documentation of medication administration. Medication-management devices based in the patient care unit (Lionville CDModule, Access, Meditrol, Argus, MedStation, Sure-Med, and SelecTrac-Rx) are designed to replace manual filling of unit dose carts or to increase control over floor-stock medications and controlled substances. They provide immediate access to medications but can take extra time to fill. Centrally located medication-management systems (Automated Pharmacy Station, ATC-212, and Medispense) are designed to replace or improve a manual system for filling unit dose carts. They may have financial and practical advantages over systems based in the patient care unit because they avoid redundant inventories. However, a manual system is still needed for some medications, particularly those that need refrigeration. Several point-of-care information systems also have medication-management components (MedTake, CliniCare, Automated Medication Administration Tracking, and MedLynk). They provide rapid access to patient information and facilitate documentation. Many incorporate bar-code technology and radio-frequency transmission of data. An automated management system can combine increased efficiency with decreased risk of error. Descriptions of available systems may help pharmacists choose a system that meets their needs.
Topics: Automation; Drug Industry; Equipment Design; Humans; Medication Systems, Hospital; Pharmaceutical Preparations; Pharmacy Service, Hospital; Robotics; United States
PubMed: 7942923
DOI: No ID Found -
Journal of the American College of... Apr 2017
Topics: Cardiology; Cardiovascular Diseases; Delivery of Health Care; Disease Management; Humans; Leadership; Patient Care Team; Societies, Medical; United States
PubMed: 28385316
DOI: 10.1016/j.jacc.2017.03.007 -
Expert Opinion on Drug Delivery May 2020: Recent technological progress in pain management includes patient´s stratification depending on their disease subtype, prognosis, risk, or treatment response using... (Review)
Review
: Recent technological progress in pain management includes patient´s stratification depending on their disease subtype, prognosis, risk, or treatment response using data analysis and genetic testing in order to select the most appropriate drug for each group. A spatiotemporal control on the release of the selected anesthetic drug is also desirable in order to minimize side effects and to provide the patient with the appropriate dose above the therapeutic threshold and below the maximum desirable concentration. Light can be used non-invasively as an exogenous trigger to allow multiple drug administrations with precise spatiotemporal control. By controlling light fluence/irradiance, pulse structure, and duration of the irradiation drug release kinetics can be controlled in a pulsatile manner to release totally or partially the drug loaded into particulate carriers.: Recent advances in the field of light-triggered nanoparticles used in pain management specially those studies which include preclinical models are reviewed.: Two decades later after the first light-sensitive drug delivery systems reported still several limitations hinder their clinical translation. Additional efforts should be undertaken to understand the nanoparticles biological fate, to satisfy their large-scale production, and to facilitate the technology to apply this therapeutic approach at a low cost.
Topics: Drug Delivery Systems; Drug Liberation; Humans; Nanoparticles; Pain; Pain Management; Pharmaceutical Preparations
PubMed: 32116072
DOI: 10.1080/17425247.2020.1737670 -
Pediatric Emergency Medicine Practice Apr 2016Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments... (Review)
Review
Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments with concern for unintentional medication exposure, and nearly half of all calls to poison centers are for children aged less than 6 years. Ingestion of magnetic objects and button batteries has also become an increasing source of morbidity and mortality. Although fatal pediatric ingestions are rare, the prescription medications most responsible for injury and fatality in children include opioids, sedative/hypnotics, and cardiovascular drugs. Evidence regarding the evaluation and management of common pediatric ingestions is comprised largely of case reports and retrospective studies. This issue provides a review of these studies as well as consensus guidelines addressing the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination, administration of antidotes for specific toxins, and management of ingested foreign bodies.
Topics: Antidotes; Chemically-Induced Disorders; Child; Child, Preschool; Disease Management; Emergency Medical Services; Evidence-Based Emergency Medicine; Foreign Bodies; Humans; Outcome Assessment, Health Care; Pharmaceutical Preparations; Poison Control Centers; Practice Guidelines as Topic
PubMed: 27104813
DOI: No ID Found