سامانه همایش های دانشگاه آزاد اسلامی واحد نجف آباد

صفحه اصلی / اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

Medication Therapy Management and Prevention of Drug Interactions: Clinical Value, Evidence Limits, and Implementation Priorities

نویسندگان :

Mahdi Karimi Boroujeni¹ Samira Shariati Najafabadi²

1- دانشگاه آزاد اسلامی واحد نجف آباد 2- دانشگاه آزاد اسلامی واحد نجف آباد

کلمات کلیدی :

medication therapy management،drug-drug interactions،adverse drug events،pharmacist-led care،polypharmacy،deprescribing،medication reconciliation،clinical decision support

چکیده :

Inroduction: Medication regimens are becoming increasingly complex leading to treatment problems such as polypharmacy and potentially dangerous drug interactions, which are becoming an increasing concern in older adults and patients with multimorbidity.(1) Medication therapy management has come into fruition as a viable safety measure, but its efficacy in clinically relevant drug-drug interactions is still unknown.(2) The purpose of this review was to clarify the evidence that medication therapy management is associated with interaction prevention and to determine which components are likely to have the greatest impact to minimize risk in routine care. Methods: Systematic reviews, meta-analyses, observational studies and implementation-related evidence pertaining to medication therapy management in outpatient or transitional care settings were synthesized as a narrative review. The review highlighted pharmacist-led medication review and reconciliation, deprescribing, patient counselling and clinical decision support, and focussed on medication safety and drug-interaction prevention outcomes. Results: Medication therapy management was shown to be associated with better medication appropriateness and the risk of adverse drug reactions was reduced, with some studies also reporting reductions in potentially inappropriate medication use, safer prescribing and dispensing and fewer adverse reactions.(2,4,5) The primary pathway identified for hidden or mismatched medicines was through medication reconciliation,(3) and comprehensive medication review, deprescribing, pharmacist-prescriber interaction, and counseling were all pathways that contributed to interaction risk reduction.(2,3,4,5) The detection sensitivity was enhanced with clinical decision support, but it was not shown to be beneficial if given alone due to alert fatigue and workflow mismatch. Very few studies evaluated clinically relevant drug-drug interactions as primary endpoints and results of the studies were variable depending on the setting and population. Discussion: Medication therapy management is a potentially viable approach to preventing medication-related harm in people with polypharmacy, the evidence does support, though the impact on clinically significant drug-drug interactions is less clear.(2,4,5) The review recommends that MTM is most effective when interprofessional workflows include reconciliation, deprescribing, counselling and/or the context-aware pharmacist review, rather than relying on automated alerts.(2,3,4,5) More specific clinical endpoints are needed to better quantify the benefit in future research.