Medication Appropriateness in Community Dwelling Older Adults

• Author / Creator

  Abu Fadaleh, Sarah

• Medication appropriateness is a fundamental target for the healthcare system, particularly in relation to older adults. Because polypharmacy and multimorbidity are prevalent in older adults, they are more prone to the risks of having an inappropriate medication. They are also more prone to adverse medication events, such as adverse drugs reactions, falls, morbidity, and mortality. Older adults represent a vulnerable community segment that requires a broad approach to healthcare planning, with intentional and structured follow up. The objective of this thesis was to describe two perspectives that healthcare practitioners can adopt for older adults’ medication management; including the financial aspect of deprescribing inappropriate medications, and the healthcare outcomes of Home Medication Reviews (HMR). Accordingly, the first study objective was to determine the economic impact when deprescribing for older adults. The second study aim was to outline the effect of Home Medication Review (HMR) in older adults in the community on healthcare related outcomes, including clinical, medication, and humanistic outcomes.
  For the first study, we established eight different deprescribing scenarios for a standard case of an average senior in Canada with common comorbidities and polypharmacy, reflecting the financial changes over one-year period in each province with its distinctive government plan. For the second study, we completed a systematic review and a quality appraisal where we screened 3585 studies to include and extract data from 18 relevant articles of HMR.
  The findings of the first study showed a small financial loss impact of deprescribing on the pharmacy’s gross margin but savings in most cases, of patients’ share, with consistent savings to government share. Additionally, we found that that medication regimens varied significantly across the country in terms of coverage and costs to the senior.
  The second study showed minimal HMR role in reducing health services utilization, where only four out of the 18 included studies showed significant reduction of hospitalization readmission rates. On the other hand, HMR had a positive role in improving medication outcomes concerning adjustments of patients’ treatment regimen, with little impact on patients’ quality of life or mortality rates. The findings from this thesis indicated that deprescribing inappropriate medications may create financial burden that restrain the community pharmacy from accepting this approach; and the need for a future decision from policy makers that includes an integrated financial consideration of pharmacy, patients, and government when adopting deprescribing policies. Another finding in this thesis is that HMR is one of the suggested approaches to resolve polypharmacy and inappropriate medications, however, the effect of HMR on healthcare outcomes appears minimal.

• Subjects / Keywords

  • Inappropriate Prescribing
  • Deprescriptions
  • Drug-Use Review
  • Costs and Cost Analysis

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-ne5c-e737

• License

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