Magazine article Drug Topics

Are Consultant R.Ph.S Doing a Good Job with DURs?

Magazine article Drug Topics

Are Consultant R.Ph.S Doing a Good Job with DURs?

Article excerpt


David Morris made some waves when he began seeing patients at the Hebrew Home for the Aged in New York City last summer. His faux pas was reviewing drug regimens and cutting back on the number of drugs patients were taking. Most patients applauded but demanded he be taken off their case. Hebrew's administrator backed Morris, while the home's medical chief chastised him for being overzealous.

It's a familiar story for consultant pharmacists, said Tom Clark, director of professional affairs for the American Society of Consultant Pharmacists (ASCP). Between 80% and 90% of consultant pharmacist recommendations are accepted by nursing home physicians, Clark said. But objections can be vocal, bitter, and highly personal.

What makes Hebrew different is that the recommendations to cut back on medication usage didn't come from a consultant pharmacist. Morris is a physician. "We're dealing with medication on top of medication in nursing homes," he said. "If patients are getting long-term meds, the prescription may be for a problem that no longer exists. Treatment must be changed as the patients and their conditions change."

Physicians should evaluate patient drug regimens regularly, agreed gerontologist Jerry Avorn, M.D., but few do. That makes overmedication a significant problem in many nursing homes. Avorn is associate professor of medicine at Harvard Medical School and chief of pharmacoepidemiology and pharmacoeconomics at Brigham & Women's Hospital in Boston.

"The elderly are more susceptible to adverse drug events and much more likely to be on multiple drugs. A regular drug utilization review [DUR] may be the most important intervention you can do for an elderly patient," Avorn said. Reviewing drug regimens is more than simply reducing the number of drugs. Many patients are overmedicated, he said, but there's also a significant population who are undermedicated. Patients with osteoporosis, glaucoma, atherosclerosis, and chronic pain are commonly undertreated. They typically need more drugs, he said, not fewer.

The problem, Morris and Avorn concurred, is pharmacist focus. Consultant R.Ph.s are skilled at screening for clinical interactions and contraindications. But too few evaluate the appropriateness of therapy or the lack of appropriate therapy.

Does that mean consultant pharmacists are not doing their jobs? No, said Stephen Feldman, ASCP vp. and president/CEO of The ICPS Group in Boston. It means the consultant pharmacist doesn't have solid information. …

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