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The author explores the clinical and pharmacovigilance challenges involving multidrug interactions. She mentions the challenge posed by the growing prevalence of people with multiple chronic health conditions and taking multiple medications, the importance of systems pharmacology in predicting multidrug interactions and the need to direct attention on the prevention of potential interactions to reduce possible multidrug interactions.

Background: Frailty and medicine‐related problems are common among the elderly and have been associated with an increased risk of adverse outcomes. However, there has been limited research on the association between frailty and medicines use. Aim: To determine the distribution of frailty among older people who used medicines and to examine the difference in frailty scores over time with continuation or discontinuation of specific medicines. Methods: The study population was from the Australian Longitudinal Study of Ageing (ALSA). The data used in the analysis were collected in 1992 (wave 1) and in 1995 (wave 3). Frailty scores were assessed at both waves using a modified version of the Frailty Index. Non‐parametric tests were used to examine the difference in the distribution of frailty scores in relation to medicines used at baseline. Medicine use was categorised into continued or stopped by comparing use at wave 3 to use at baseline. A t‐test was used to compare the mean changes in frailty scores between the two groups, with a p‐value of <0.05 considered to be significant. Results: Data from 2087 participants were included. At baseline, a higher number of medicines used was associated with higher frailty scores (p < 0.0001). Stopping any preventive medicines, as well as beta‐blockers, or potassium‐sparing diuretics, was associated with a higher increase in mean frailty score changes than continuing these medicines, p = 0.01, p = 0.03 and p = 0.004, respectively. Conclusions: There was an association between frailty and medicines use. Further study is needed to assess whether the progression of frailty was due to medicine cessation or vice versa. [ABSTRACT FROM AUTHOR]

Background: Hip fracture impacts on quality of life and may lead to premature death. In Australia, the extent of use of medicines that increase risk of falls or hip fracture in at-risk older people is not known. Aim: To determine the use of medicines associated with falls or hip fracture before hip fracture and whether medicine use changed after hip fracture. Method: Data from the Australian Department of Veterans' Affairs healthcare claims database were used. The cohort included patients aged > 65 years who were hospitalised for hip fracture in 2009. Percentages of patients using medicines associated with falls or hip fracture were calculated in the 6 weeks before hospitalisation for hip fracture. McNemar's test was used to assess changes in medicines used before admission and after discharge from hospital. Results: 2235 patients with a median age of 87 years had hip fractures in 2009. At least 1 medicine that increases risk of falls or hip fracture was used by 84% of patients before admission. Of the drug classes that increase risk of falls or hip fracture, the 4 most commonly dispensed before admission were antihypertensives (63%), antidepressants (29%), benzodiazepines (26%) and opioids (19%). After discharge, the use of antipsychotics (p < 0.0001), opioids (p < 0.0001), benzodiazepines (p = 0.0009) and antidepressants (p = 0.01) increased significantly. Conclusion: Most older patients used at least 1 medicine that increases the risk of falls or hip fracture before and after hip fracture. Antipsychotic, opioid, benzodiazepine and antidepressant use increased significantly after hospital discharge. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We evaluated the impact of quality improvement interventions at different time points on the uptake of collaborative Home Medicines Reviews (HMRs). Methods: National interventions to promote HMRs, comprising patient‐specific prescriber feedback and tailored educational materials for patients and clinicians, were conducted in 2004, 2006 and 2011 through the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) program. Primary care patients taking multiple medicines were targeted in each intervention, while primary care patients taking multiple medicines who did not receive the intervention served as comparisons. Monthly HMR rates among targeted patients and a comparison group in the 9 months post‐intervention were determined using health claims data from the Australian Government Department of Veterans’ Affairs and compared using log binomial regression models. Overall trends in the rate of HMRs between November 2001 and December 2016 were also determined. Results: Over 40 000 patients were targeted in each HMR intervention. Relative increases in HMR uptake were observed among patients targeted in the 2004 intervention (rate ratio (RR) 1.76 (1.39, 2.22), p < 0.0001), the 2006 intervention (RR 1.45 (1.19, 1.76), p = 0.0002) and the 2011 intervention (RR 2.81 (2.34, 3.37), p < 0.0001) compared to the comparison group. Overall, the monthly HMR rate increased from 0.2 per 1000 patients in November 2001 to 2.7 per 1000 patients in December 2012. Conclusion: Regular repetition of quality improvement messages has led to sustained increases in HMR uptake among Australian veterans over the last decade. [ABSTRACT FROM AUTHOR]

Abstract: Background: Delirium is a serious condition in which medications are just one of a number of potential predisposing or precipitating factors. Adequate knowledge of delirium among all healthcare professionals, including pharmacists, may assist in effective prevention and management. However, little is known about the knowledge of pharmacists regarding delirium. Aim: To assess Australian hospital pharmacists' knowledge of risk factors, symptoms, prevention and treatment of delirium in elderly patients. Method: A cross‐sectional survey was conducted via a web‐based questionnaire to collect information on participants' demographics, knowledge of delirium risk factors, symptoms, prevention and treatment. A link to the survey was included in the newsletters of The Society of Hospital Pharmacists of Australia, Australasian Delirium Association and New South Wales Therapeutic Advisory Group and distributed to hospital pharmacists in Australia via email. Results: One‐hundred and six responses from hospital pharmacists were available for analysis. Nine of 11 questions assessing basic knowledge were correctly answered by more than half of respondents. Seven of the eight questions related to delirium prevention strategies were correctly answered by more than half of pharmacists. However, only three of the eight questions about risk factors for delirium were answered correctly by more than half of pharmacists. Conclusion: Pharmacists' basic knowledge about delirium and prevention strategies was good; however, their knowledge of risk factors and symptoms of delirium needs to be improved. Delirium‐specific educational programs for pharmacists should be considered for improving their knowledge and understanding regarding delirium. [ABSTRACT FROM AUTHOR]

Aim: To identify the characteristics of patients who receive home medicines reviews (HMRs). Method: A retrospective analysis was conducted of the Department of Veterans’ Affairs administrative claims data. Veterans living in the community on 30 June 2009 were included if they had ≥ 1 medicines dispensed in the previous 12 months. The main outcome measure was the number of veterans who received an HMR. Log binomial regression analysis compared characteristics of HMR recipients and non-recipients – age and gender; number of medicines, prescribers, dispensing pharmacies and hospitalisations in the previous year; and conditions where medicine use is potentially problematic, e.g. dementia. Results: Of the 175 572 veterans included in the study, 6236 (3.6%) had received an HMR. The likelihood of having an HMR increased with age, number of medicines and number of GP visits. Women were 12% more likely to receive an HMR than men. Veterans who had received an HMR previously were 4 times more likely to have another HMR. Veterans with 1 to 4 hospitalisations were 10% more likely to receive an HMR than those who had not been hospitalised. The likelihood of having an HMR decreased with the number of dispensing pharmacies and specialist visits. Conclusion: Patients who received HMRs had characteristics that placed them at risk of medication-related problems. The uptake of HMRs was appropriate in our study population. [ABSTRACT FROM AUTHOR]

Since 2004, the Department of Veterans' Affairs (DVA) has funded the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program. The main intervention of the program is quarterly targeted patient-specific prescriber feedback. The feedback comprises a list of relevant medications dispensed to each patient and notes about potential medicationrelated problems specific to the intervention. Supportive educational material is provided to assist general practitioners (GPs) resolve these medication-related problems. Veterans identified in the GP mailing are sent an educational brochure highlighting medication issues and encouraging them to speak with their doctor. To enable pharmacists to support this practice change, educational material is also provided to all pharmacies and accredited pharmacists. The most recent of the 28 interventions implemented to date have addressed osteoporosis, opioid-induced constipation and urinary incontinence. Overall, program materials have been mailed to 249 454 veterans, 34 527 GPs and around 8000 pharmacies and accredited pharmacists. Evaluation has demonstrated a doubling of home medicines review (HMR) rates in the veteran population. Analyses of the DVA data have reported a 45% reduction in hospitalisation for heart failure following HMR among veterans with heart failure (adjusted hazard ratio [HR] 0.6; 95% confidence interval [CI] 0.4-0.8), and a 79% reduction in hospitalisation for haemorrhage (HR 0.2; 95%CI 0.05-0.9) 2 to 6 months after an HMR in veterans dispensed warfarin. Veterans' MATES has resulted in clinically significant improvements in medication and health service use. [ABSTRACT FROM AUTHOR]