Abstract
Introduction: A drug related problem (DRP) is defined as “an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes”1. DRPs are common in mental health where pharmacists play an integral role in recognising and preventing them. However, against a landscape of limited resources and rising demand in mental health care, the need for optimisation of pharmacy services was recognised in Lord Carter’s report to be critical in ensuring these are of high quality2. Prioritising patients for clinical pharmacy services is a relatively new approach that aims to optimise the use of pharmacy expertise and improve patient outcomes. Currently, there are no evidence-based tools to guide prioritisation in mental health inpatient care. The aim of this overall programme of work is to develop an evidence-based pharmaceutical prioritisation tool for use by mental health pharmacy teams. Understanding the risk factors of DRPs in mental health units forms the first step in the process of tool development.
Aims: To characterise the potential risk factors of DRPs in mental health inpatient units.
Objectives:
1. Identify the potential risk factors of DRPs.
2. Understand the relationship between risk factors and DRPs.
Method: A total of six databases (MEDLINE, EMBASE, Web of Science, IPA, PsycINFO, and CINAHL PLUS) were searched between 2000 – 2021. Studies investigating risk factors of DRPs in mental health units using statistical tests were included. Data were extracted by two authors independently and were descriptively synthesised as the heterogeneity of studies precluded a meta-analysis. Study quality assessment was completed using Allan and Barker’s criteria for medication error studies3.
Results: A total of 22 studies met the inclusion criteria and were most frequently conducted in European countries (19/22, 86.4%) such as the UK (7/22, 32%) and Germany (4/22, 18%). Studies focused on potentially inappropriate prescribing (n=8/22), medication errors (n=7/22), adverse drug reactions (n=3/22), medication discrepancies (n=2/22), adverse drug events (n=1/22), with only two studies including a broader range of DRPs. Thirty-nine potential risk factors were identified in included studies. The most investigated factors were patient age (n=14/22), sex (n=14/22), and the number of prescribed medications (n=14/22). Increasing the number of prescribed medications was consistently reported to be significantly associated with the occurrence of most types of DRPs (n=11/14). Increased patient age was found to be a risk factor for medication discrepancies (n=1/14), DRPs (n=1/14), and a protective factor of potentially inappropriate prescribing (n=2/14). Most other risk factors were seldom explored in more than one study.
Discussion and Conclusion: To our knowledge, this is the first systematic review of potential risk factors of DRPs in mental health inpatient units. Several patient, medication, and hospital related risk factors of DRPs in mental health inpatient units were identified. The next step of this project will explore approaches to prioritising pharmacy services in UK mental health organisations via a national survey and interview study as little is known regarding current practice. The results of these two studies will be combined to assist in the development of a consensus-based patient prioritisation tool for acute mental health pharmacy services.
References
1. Pharmaceutical Care Network Europe. The PCNE Classification V 6.2., (2010). https://www.pcne.org/upload/files/11_PCNE_classification_V6-2.pdf. Accessed: 27 Jun 2022.
2. Carter PR. Lord Carter’s review into unwarranted variations in mental health and community health services. An independent report for the department of health by Lord Carter of Coles. Department of Health; 2018.
3. Allan EL, Barker KN. Fundamentals of medication error research. Am J Hosp Pharm, 1990;47(3):555-571.
Aims: To characterise the potential risk factors of DRPs in mental health inpatient units.
Objectives:
1. Identify the potential risk factors of DRPs.
2. Understand the relationship between risk factors and DRPs.
Method: A total of six databases (MEDLINE, EMBASE, Web of Science, IPA, PsycINFO, and CINAHL PLUS) were searched between 2000 – 2021. Studies investigating risk factors of DRPs in mental health units using statistical tests were included. Data were extracted by two authors independently and were descriptively synthesised as the heterogeneity of studies precluded a meta-analysis. Study quality assessment was completed using Allan and Barker’s criteria for medication error studies3.
Results: A total of 22 studies met the inclusion criteria and were most frequently conducted in European countries (19/22, 86.4%) such as the UK (7/22, 32%) and Germany (4/22, 18%). Studies focused on potentially inappropriate prescribing (n=8/22), medication errors (n=7/22), adverse drug reactions (n=3/22), medication discrepancies (n=2/22), adverse drug events (n=1/22), with only two studies including a broader range of DRPs. Thirty-nine potential risk factors were identified in included studies. The most investigated factors were patient age (n=14/22), sex (n=14/22), and the number of prescribed medications (n=14/22). Increasing the number of prescribed medications was consistently reported to be significantly associated with the occurrence of most types of DRPs (n=11/14). Increased patient age was found to be a risk factor for medication discrepancies (n=1/14), DRPs (n=1/14), and a protective factor of potentially inappropriate prescribing (n=2/14). Most other risk factors were seldom explored in more than one study.
Discussion and Conclusion: To our knowledge, this is the first systematic review of potential risk factors of DRPs in mental health inpatient units. Several patient, medication, and hospital related risk factors of DRPs in mental health inpatient units were identified. The next step of this project will explore approaches to prioritising pharmacy services in UK mental health organisations via a national survey and interview study as little is known regarding current practice. The results of these two studies will be combined to assist in the development of a consensus-based patient prioritisation tool for acute mental health pharmacy services.
References
1. Pharmaceutical Care Network Europe. The PCNE Classification V 6.2., (2010). https://www.pcne.org/upload/files/11_PCNE_classification_V6-2.pdf. Accessed: 27 Jun 2022.
2. Carter PR. Lord Carter’s review into unwarranted variations in mental health and community health services. An independent report for the department of health by Lord Carter of Coles. Department of Health; 2018.
3. Allan EL, Barker KN. Fundamentals of medication error research. Am J Hosp Pharm, 1990;47(3):555-571.
| Original language | English |
|---|---|
| Title of host publication | Journal of Psychopharmacology |
| Pages | 3-4 |
| Volume | 36 |
| Edition | 2 |
| DOIs | |
| Publication status | Published - 5 Dec 2022 |
| Event | 12th Annual International College of Mental Health Pharmacy (CMHP) Conference, Northampton, UK - Northampton, United Kingdom Duration: 7 Oct 2022 → 8 Oct 2022 |
Conference
| Conference | 12th Annual International College of Mental Health Pharmacy (CMHP) Conference, Northampton, UK |
|---|---|
| Abbreviated title | College of Mental Health Pharmacy (CMHP) Conference |
| Country/Territory | United Kingdom |
| City | Northampton |
| Period | 7/10/22 → 8/10/22 |