We commonly encounter patients continuing disease preventative and control medicines at a time of commencing medicines to minimise suffering from common EOL symptoms. The increasing number of medications commonly leads to polypharmacy which has been associated with adverse outcomes (e.g early mortality, falls, adverse drug reactions (ADRs)). Risk of harm increases with increasing number of medications, avoiding harm is critical as any deterioration may lead to some degree of irreversible decline given the frailty of this population. While in some instances polypharmacy may be appropriate, it’s important to identify patients at heightened risk of poor health outcomes.

Medication-Related-Problems (MRPs) has been defined as ‘an event of circumstance involving drug treatment that actually or potentially interferes with the patient experiencing an optimum outcome of medical care’. Other terms include drug-related problem, medication error, ADR and adherence.

Previous studies have examined MRPs occurring in hospital, a gap remains investigating the home experience where the majority of care is delivered. Lack of understanding the patient and carer experience limits health services ability to assess risk, formulate effective and efficient approaches to resolving MRPs.

Aim

Investigate the prevalence and nature of MRPs for palliative people living in their home

Method

Experienced pharmacists embedded within a metro specialist palliative service undertook comprehensive-medication-reviews for patients meeting the inclusion criteria. A validated Australian tool was applied to identify, classify and grade clinical significance of MRPs and recommendations made to GP and/or specialist team.

Findings

Sixty-two patients were included (metro/rural), most frequently in unstable-phase with AKPS 50. On average each patient experienced 5 MRPs with one patient experiencing 19 MRPs. Mean number of Potentially-Inappropriate-Medicines was 1.7.

Eighty-five percent experienced a moderate-high clinically significant MRP. ADRs where identified in 40% of patients, 57% meeting the definition of being preventable.

Overall 469 recommendations were made to GP and/or specialist service to resolve the MRP.

Conclusion

This study provides one of the first insights of the medication experience at home demonstrating MRPs are significantly impacting patient comfort and safety.

We can now begin formulating efficient solutions, which may include greater utilisation of allied health funded commonwealth programs such as Home Medicines Reviews.