Polypharmacy, the use of five or more medications, is a public health epidemic that leads to high health care utilization and costs in older adults globally. Health care organizations and professionals have used interdisciplinary collaboration (IC) interventions to reduce polypharmacy and health care costs with little benefit. There is limited research and integration of IC with an evidence-based practice (EBP) guideline among primary care providers (PCPs) in the primary care setting. The aims of this Doctor of Nursing Practice (DNP) project were to conduct a knowledge and needs assessment via Qualtrics survey to identify PCPs’ current knowledge, practices, and perceptions regarding IC and the American Geriatrics Society (AGS) Beers Criteria on reducing older adult polypharmacy in an urban primary care setting; and to assess PCPs’ interest in participating in IC with a pharmacist using the AGS Beers Criteria. The responses obtained from the Qualtrics survey revealed PCPs were comfortable in communicating to older adults about polypharmacy; however, PCPs with longer practice experiences displayed misconceptions due to lack of familiarity and interest in participating in IC using the AGS Beers Criteria. Overall, 70% of PCPs felt comfortable about participating in IC alone, 50% of PCPs were familiar with IC, and 60% of PCPs used the AGS Beers Criteria. Even though 60% of PCPs felt comfortable about participating in IC based on AGS Beers Criteria with a pharmacist, only 50% of PCPs were interested in participating IC with a pharmacist using AGS Beers Criteria. Barriers and recommendations are discussed further in this DNP Project paper.

Submitted by JUSSEMI BIAZON DALTIN null (jussemidaltin@bauru.sp.gov.br) on 2016-12-07T00:06:46Z No. of bitstreams: 1 Dissertacao de Mestrado - Jussemi.pdf: 2697527 bytes, checksum: a495bff84c4ebd015c2fa73b1fa5fb53 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-12-09T13:03:08Z (GMT) No. of bitstreams: 1 daltin_jb_me_bot.pdf: 2697527 bytes, checksum: a495bff84c4ebd015c2fa73b1fa5fb53 (MD5) / Made available in DSpace on 2016-12-09T13:03:08Z (GMT). No. of bitstreams: 1 daltin_jb_me_bot.pdf: 2697527 bytes, checksum: a495bff84c4ebd015c2fa73b1fa5fb53 (MD5) Previous issue date: 2016-11-08 / Objetivos: Analisar o perfil da prescrição de inibidores da colinesterase e de outros medicamentos em pacientes idosos portadores de demência da doença de Alzheimer (ddA) atendidos em centro de atenção a idosos no município de Bauru/SP. Métodos: Estudo de delineamento transversal, descritivo e analítico, realizado com idosos portadores de demência da doença de Alzheimer (ddA), do Programa Municipal de Atenção ao Idoso (PROMAI), no período de abril de 2015 a agosto de 2015. Participantes: 81 idosos (66 mulheres e 15 homens) que faziam acompanhamento no Programa Municipal de Atenção ao Idoso (PROMAI). Resultados: Dos idosos, 81,5% pertencia ao sexo feminino, 92,6% tinham 75 anos ou mais de idade, 64,2% não eram casados, 58% tinham até 4 anos de escolaridade, 60,5% tinham renda de até um salário mínimo, 60,5% tinham como cuidador principal as filhas e 90,1% residiam com algum familiar. Dentre as comorbidades mais comuns associadas às demências encontramos hipertensão arterial (29,6%), diabetes melitus (13,4%), hipotireoidismo (8,4%) e dislipidemias (7,8%). A capacidade cognitiva expressa pelo MEEM foi em média 14,5 pontos. A polifarmácia esteve presente em 63% dos idosos e, dentre eles, 77,8% faziam uso de algum MPI. A frequência de prescrição dos ICH foi: 54,9% rivastigmina, 33,3% donepezila e 11,8% galantamina. A memantina teve uma prevalência de prescrição de 2,5%. Dos motivos do não uso de tratamento para a ddA, os efeitos colaterais indesejáveis representaram 28% dos casos. Dos idosos estudados, 91% tinha acesso ao tratamento com os ICH através do programa de medicamentos do CEAF. O CDR (Clinical Dementia Rating) não foi encontrado na totalidade dos prontuários analisados. Conclusão: A polifarmácia esteve presente em 63% dos idosos estudados e 77,8% faziam uso de algum MPI. A polifarmácia teve associação estatisticamente positiva com o número de comorbidades (p=0,0018), escolaridade (p=0,0017), hipertensão arterial (p=0,0013) e diabetes melittus (p<0,01) e o uso de MPI apresentou associação estatisticamente positiva com a polifarmácia (p<0,01). Dos medicamentos para tratar a ddA a rivastigmina aparece com a maior prevalência de uso, 34,6%, e 30,9% não faziam uso de nenhum tratamento para a ddA. Efeitos colaterais indesejáveis e doença em estado avançado, 28%, aparecem como os principais motivos de não uso de medicamentos. / Objectives: To analyze the profile of prescribing cholinesterase inhibitors and other medications in elderly patients with Dementia of Alzheimer's disease (DAD) met in Center of attention for the elderly in the city of Bauru/SP. Methods: Study of transverse, descriptive and analytical design, conducted with elderly patients with Dementia of Alzheimer's disease (DAD), in the Municipal Program of Attention to the older persons (PROMAI), from April to August 2015. Participants: 81 elderly (66 women and 15 men) who were monitoring the Municipal program of Attention to the Elderly (PROMAI). Results: Of the elderly 81.5% belonged to the female, 92.6% were 75 years or older, 64.2% were unmarried, 58% had up to 4 years of schooling, 60.5% had incomes up to 1 minimum salary, 60.5% had as main caregiver daughters and 90.1% lived with a family member. Among the most prevalent comorbid associated with dementias found Hypertension (29.6%), Diabetes mellitus (13.4%), Hypothyroidism (8.4%) and dyslipidemias (7.8%). Cognitive ability expressed by the MMSE was an average of 14.5 points. The polypharmacy was present in 63% of the elderly and among the elderly 77.8% made use of some MPI. The frequency of prescription of (the) ICH was: 54.9% rivastigmine, 33.3% Donepezil and 11.8% galantamina. Memantine had a prevalence of prescription of 2.5%. The reasons of the non-use of treatment for DAD, the undesirable side effects accounted for 28% of the cases. The elderly studied 91% had access to treatment with the ICH trough medication program CEAF. The CDR (Clinical Dementia Rating) was not found in all the analyzed records. Conclusion: Polypharmacy was present in 63% of the elderly studied and 77.8% made use of some MPI. The polypharmacy had statistically positive association with the number of comorbid (p<0.01), education (p < 0.01), hypertension (p<0.01) and melittus diabetes (p<0.01) and the use of MPI presented statistically positive association with polypharmacy (p < 0.01). Of the medications to treatment DAD the rivastigmine appears with the higher prevalence of use, 34.6% and 30.9% did not use any treatment for DAD. Undesirable side effects and advanced-stage disease, 28%, appear as the main reasons for non-use of medicines

Candidate: Zuzana Očovská1 Supervisor: prof. RNDr. Jiří Vlček, CSc.1 Consultant: PharmDr. Martina Maříková2 1 Department Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University 2 University Hospital Hradec Králové, Hospital Pharmacy, Head of the Division of Clinical Pharmacy Title of the master thesis: The analysis of drug-related problems potentially leading to hospitalization among geriatric patients Hospital admissions due to drug-related problems (DRPs) represent a relevant clinical issue with significant economic consequences. Polypharmacy and age-related pharmacokinetic and pharmacodynamic changes make elderly patients particularly prone to develop DRP. The aim of the theoretical part of this thesis was to introduce the issue of drug-related problems and to outline the results of previous studies concerning drug-related hospitalizations among geriatric patients. The aim of the practical part was to determine the prevalence of DRP potentially leading to hospitalization and to identify the most common medication classes involved in these DRPs. Over the period of six months 200 admissions to geriatric ward of III. Internal Gerontometabolic Clinic of University Hospital Hradec Králové have been retrospectively evaluated in order to determine whether the...