Medication reconciliation role and value in Alzheimer's disease treatment

ABSTRACT

Background: With the continuous increase of Alzheimer's disease (AD), it is also imminent to treat patients with AD for medication reconciliation. Objective: To explore the role and value of medication reconciliation in AD treatment. Methods: 100 patients over 65 years of age diagnosed with AD were randomly separated into two groups: conventional treatment and medication reforming. The list of medical orders of all subjects was obtained within 24 hours after admission with Beers criteria, STOPP/START criteria, and Chinese Pharmacopoeia used as the MED intervention criteria. Medication reconciliation was performed at 2 weeks, 1 month, and 2 months after hospital admission. The number of medications prescribed, the quantity of the medication, medication error rate, therapeutic effect, adverse drug reactions, and satisfaction levels of family members and main caregivers were compared between the two groups. Results: After the intervention, the types and amount of medication in the MED group were less compared to the CON group along with a reduced medication deviation rate. The Mini-mental state examination (MMSE) score and the proportion of well-nourished patients in the MED group were higher than those in the CON group. It was also observed that the physical self-care ability score and the proportion of patients with abnormal swallowing were lower when in comparison with the CON group. The incidence of adverse drug reactions in the MED group was lower than that in the CON group. However, the satisfaction rate was higher than that in the CON group.

Conclusion: Medication reconciliation can reduce the medication deviation in AD patients.

Resumo:

Antecedentes: Com o contínuo aumento da prevalência da doença de Alzheimer (DA), a reconciliação medicamentosa no tratamento de pacientes portadores da doença é também iminente. Objetivo: Explorar o papel e a importância da reconciliação medicamentosa no tratamento de DA. Métodos: 100 pacientes com mais de 65 anos de idade com diagnóstico de DA foram divididos aleatoriamente em dois grupos: tratamento convencional (CON) e mudança medicamentosa (MED). A relação das prescrições médicas de todos os indivíduos foi obtida dentro das 24 horas após a admissão, usando-se os critérios Beers, os critérios STOPP / START, e a Farmacopéia Chinesa foi usada como intervenção no grupo MED. A reconciliação medicamentosa foi realizada em 2 semanas, 1 mês e 2 meses após a admissão hospitalar. O número de medicamentos prescritos, a quantidade de medicamentos, a taxa de erro de medicação, o efeito terapêutico, as reações adversas a medicamentos e os níveis de satisfação dos familiares e cuidadores principais foram comparados entre os dois grupos. Resultados: Após a intervenção, os tipos e a quantidade de medicação no grupo MED foram menores em comparação com o grupo CON, juntamente com uma taxa de erro de medicação reduzida. A pontuação do mini-exame do estado mental (MEEM) e a proporção de pacientes bem nutridos no grupo MED foram maiores do que no grupo CON. Observou-se também que o escore da habilidade física de autocuidado e a proporção de pacientes com deglutição alterada foram menores quando comparados ao grupo CON. A incidência de reações adversas a medicamentos no grupo MED foi menor do que no grupo CON. Por outro lado, o índice de satisfação foi superior ao do grupo CON. Conclusão: A reconciliação medicamentosa pode reduzir os erros de medicação em pacientes com DA.

Keywords:

Medication Reconciliation - Alzheimer Disease - Safety - Drug-Related Side Effects and Adverse Reactions

Palavras-chave:

Reconciliação Medicamentosa - Doença de Alzheimer - Segurança - Efeitos Colaterais e Reações Adversas Relacionadas a Medicamentos

Authors’ contributions:

XS, BL: study concept and design; QZ, WS, JS: analysis and interpretation of data; XS, BL: drafting of the manuscript; XS, BL: critical revision of the manuscript for important intellectual content. All authors have read and approved the manuscript.

Publication History

Received: 18 April 2021

Accepted: 01 July 2021

Article published online:
30 January 2023

• Reference

• 1 Li ZZ, Li W, Zhang DS. Pathogenesis and drug therapy of Alzheimer's disease. Chinese J Pharmacol Toxicol 2019; 33: 76
• 2 Rappaport R, Arinzon Z, Feldman J, Lotan S, Heffez-Aizenfeld R, Berner Y. The Need for Medication Reconciliation Increases with Age. Isr Med Assoc J 2017; 19 (10) 625-630
• 3 Xu SS, Zhao HY, Li L, Wang JW. Effects and practice of medication reconciliation in preventing medication errors by clinical pharmacists. Pract Pharm Clin Remedies 2015; 18: 709-711
• 4 Dai TT, Wang CH, Wang XX, Yan XL, Zhang WT. Code of practice for pharmaceutical care in medical institutions - part 3 - drug restructuring. Chin Pharm 2019; 665: 15-17
• 5 Ho TK. The promise of international patient safety solutions: the work of the WHO collaborating centre for patient safety solutions. Chin Hosp 2007; 11: 6-8
• 6 Speding RA, Montine TJ, Park DC. et al. National Institute on Aging and Alzheimer's Association diagnostic guidelines writing group: definition of the preclinical phase of Alzheimer's disease. Chin J Neurol 2012; 45: 336-344
• 7 Li C, Chen ML. Evaluation of potential inappropriate medication in hospitalized elderly patients based on Beers and STOPP/START criteria. Academic J Chin Pla Med School 2019; 40: 201-206
• 8 Wang Y. Pharmacopoeia of the People's Republic of China. China Standardization 2015; 4: 132-135
• 9 Katzman R, Zhang MY, Ouang Y-Q, Wang ZY, Liu WT, Yu E. et al. A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol 1988; 41 (10) P971-P978 https://doi.org/10.1016/0895-4356(88)90034-0
• 10 Xiao TY, Wang HQ, Li YF. To analyse the factors affecting the decline in the level of activities of daily living in patients with Alzheimer's disease. China J Alzheimer Dis Relat Disord 2020; 3: 37-41
• 11 Kubota T, Mishima H, Hanada M, Minami I, Kojima Y. Paralytic dysphagia in cerebrovas-cular disorder - screening tests and their clinical application. Sogo Rehabilitation 1982; 10: 271-276
• 12 Cuong TQ, Banks M, Hannan-Jones M, Diep DTN, Gallegos D. Validity, reliability and feasibility of nutrition screening tools NRS-2002 and MST administered by trained medical doctors in routine practice. Hosp Pract (1995) 2019; 47 (05) 259-266
• 13 Zhang M. Treatment Emergent Symptom Scale (TESS). Shanghai Arch Psychiatry 1984; 2: 77-80
• 14 Hang J, Qin-Yuan LI, Ling YU. et al. Pharmaceutical practice of medication reconciliation service on a patient with severe drug-induced liver injury. Pract Pharm Clin Remed 2016; 19: 1413-1416
• 15 Yang N, General DO. Benefits and thinking of medication reconciliation carried out by general practitioners. Clin Med J 2017; 15: 52-55
• 16 Digiantonio N, Lund J, Bastow S. Impact of a Pharmacy-Led Medication Reconciliation Program. P T 2018; 43 (02) 105-110
• 17 Yu A-C, Wang G-Y, Fu M-Y, Mu Y, Xu Y-G, Li X-X. et al. Investigation on medication discrepancies and related factors in elderly patients with chronic diseases. Chin J Hosp Pharm 2020; 40 (19) 2059-2063 https://doi.org/10.13286/j.1001-5213.2020.19.11
• 18 Nie XJ, Cheng LF, Bai HH. et al. Observation on the effect of medication reconciliation implementation for patients with type 2 diabetes. Chin J Clin Pharm 2019; 28: 34-38
• 19 Nuzzo A, Brown JR. The microbiome factor in drug discovery and development. Chem Res Toxicol 2020; 33 (01) 119-124 https://doi.org/10.1021/acs.chemrestox.9b00333
• 20 Liu Y, Cui XL, Liu LH. Brief analysis of medication reconciliation between domestic and foreign. Chin Pharm J 2015; 50 (24) 2099-2102
• 21 Zhao LY, Zhao ZP, Cheng YQ. Research progress on inappropriate medication use in the elderly. China Med Herald 2019; 16: 47-50