Pharmacists' and Pharmacy Students' Ability to Identify Drug-Related Problems Using TIMER (Tool to Improve Medications in the Elderly Via Review)

By Lee, Sarah Snyder; Schwemm, Ann K. et al. | American Journal of Pharmaceutical Education, June 2009 | Go to article overview

Pharmacists' and Pharmacy Students' Ability to Identify Drug-Related Problems Using TIMER (Tool to Improve Medications in the Elderly Via Review)


Lee, Sarah Snyder, Schwemm, Ann K., Reist, Jeffrey, Cantrell, Matthew, Andreski, Michael, Doucette, William R., Chrischilles, Elizabeth A., Farris, Karen B., American Journal of Pharmaceutical Education


INTRODUCTION

Medicare Part D requires MTM for enrollees who use a high proportion of financial resources in the program. (1) Pharmacists are challenged to find ways to effectively and efficiently provide MTM services, given the high volume of prescriptions that they dispense. While there are MTM plans that assist pharmacists, these services are not always available. (2-3) Community pharmacists, who fill the vast majority of prescriptions, are in a unique position to provide important medication reviews. (4-6) An MTM tool may provide pharmacists with a systematic approach for conducting medication reviews and improve efficiency.

MTM services can be especially valuable to older adults. (7-8) The presence of polypharmacy and age-related physiological changes cause this population to experience more drug-related problems (DRPs). (9) Medication errors consist of overuse, underuse, and misuse, and lead to more than 5% of hospital admissions in older adults. (9-11) Between 14% and 23% of older adults receive a medication that should not have been prescribed for them, (12-14) and 10% to 25% of patients have an adverse drug reaction or adverse drug event. (15,16) However, some medications, such as statins and angiotensin-converting enzyme (ACE) inhibitors, are under prescribed among older adults. (17-21)

In order to simplify medication reviews, screening tools have been developed. Available tools include Beer's list, Assessing Care of Vulnerable Elders guidelines, and the Medication Appropriateness Index. (22-28) These tools can rarely accommodate patients with multiple chronic diseases, multiple drug interactions, and/or organ-system insufficiency that may cause patient-specific medication problems. Medication reviews need to be done in a way that encompasses the whole patient, not just a particular disease, medication, or drug interaction. This complexity makes it nearly impossible to create a tool that is sufficiently specific and sensitive to identify drug therapy problems. (28)

In addition to practicing pharmacists, pharmacy students are trained to provide MTM, (29,30) but there is currently no standardized approach used to provide MTM services or to identify DRPs. (31,32) A tool may make the task of learning how to provide these services easier for pharmacy students and practicing pharmacists who are new to MTM. Having such a tool may also facilitate and improve the efficiency of identifying DRPs.

The objective of this study was to evaluate the Tool to Improve Medications in Elderly via Review (TIMER), a systematic approach to conducting medication reviews and improving pharmacists' ability to identify important drug-related problems among older adults. The specific aim of this 2-part study was to compare the number and types of drug-related problems identified by practicing pharmacists (part 1) and pharmacy students (part 2) with and without using the TIMER.

METHODS

Development of the TIMER

TIMER is a guide for pharmacists and pharmacy students to follow when conducting medication reviews. TIMER was developed by 2 of the authors (KF and EC), with input from a consensus panel of 4 regional experts who reviewed the tool and provided feedback. Using a scale ranging from strongly agree to strongly disagree, reviewers rated each section of the TIMER on whether the content was evidence-based, important, helpful/useful, and understandable. Feedback from reviewers resulted in several improvements to TIMER, for example, including drug-drug interactions based on both prevalence and severity rather than just on severity, and reducing the symptom timeframe to several months.

An important assumption made in developing TIMER was that its users have conducted a patient medication history so that a complete medication list is avail able. TIMER has 4 sections including cost-effective drug selection, adherence, medication safety, and attaining therapeutic goals, and covers the most common medication issues that affect older adults. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Pharmacists' and Pharmacy Students' Ability to Identify Drug-Related Problems Using TIMER (Tool to Improve Medications in the Elderly Via Review)
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.