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Chang CB, Lai HY, Hwang SJ, Yang SY, Wu RS, Chang LY, Lee IS, Liu HC, Chan DC. The updated PIM-Taiwan criteria: a list of potentially inappropriate medications in older people. Ther Adv Chronic Dis 2019; 10:2040622319879602. [PMID: 31632624 PMCID: PMC6779000 DOI: 10.1177/2040622319879602] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Explicit criteria for potentially inappropriate medications (PIMs) developed for other countries are difficult to apply to a specific territory. This study aimed to update the PIM-Taiwan criteria from a qualitative review of several published PIM criteria, followed by consensus among regional experts in Taiwan. Methods: After a review of the literature, we selected four sets of published PIM criteria to construct preliminary core PIMs. The Beers criteria, Fit fOR The Aged (FORTA), and Japan criteria were used for PIMs, without consideration of chronic diseases. The Beers criteria, Screening Tool of Older Persons’ Prescriptions (STOPP) criteria, and Japan criteria were used for PIMs with respect to chronic diseases. We asked experts (n = 24) to rate their agreement with each statement, including in the final PIM criteria, after two rounds of modified Delphi methods. The intraclass coefficient (ICC) was used to examine the reliability of the modified Delphi method. Results: Overall, two categories of PIMs were established: 131 individual drugs and 9 drugs with combinations that should generally be avoided; and 9 chronic diseases with their corresponding PIMs that have drug–disease interactions. The ICC estimates for PIMs to be avoided generally were 0.634 and 0.557 (round 1 and 2) and those for PIMs with respect to chronic diseases were 0.866 and 0.775 (round 1 and 2) of the Delphi method, respectively. Conclusions: The 2018 version of PIM-Taiwan criteria was established and several modifications were made to keep the criteria updated and relevant. Clinicians can use them to reduce polypharmacy and PIMs among older patients.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Internal Medicine, National Taiwan University Chu-Tung Branch, Hsin-Chu County
| | - Hsiu-Yun Lai
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veteran General Hospital, Taipei
| | - Shu-Yu Yang
- College of Medicine, Fu Jen Catholic University, Taipei
| | - Ru-Shu Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei
| | - Lo-Yu Chang
- School of Medicine, College of Medicine, National Taiwan University, Taipei
| | - I-Shan Lee
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei
| | | | - Ding-Cheng Chan
- Superintendent, National Taiwan University Hospital Chu-Tung Branch, No. 52, Zhishan Road, Zhudong Township, Hsinchu County, 31064 Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei Department of Internal Medicine, National Taiwan University Hospital, Taipei
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Aldebert G, Faillie JL, Hillaire-Buys D, Mura T, Carrière I, Delcourt C, Creuzot-Garcher C, Villain M, Daien V. Association of Anticholinergic Drug Use With Risk for Late Age-Related Macular Degeneration. JAMA Ophthalmol 2019; 136:770-778. [PMID: 29800005 DOI: 10.1001/jamaophthalmol.2018.1719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Amyloid-β is a major component of retinal drusen, the primary lesions of age-related macular degeneration (AMD), and autopsy and animal models suggested that anticholinergic drug (ACD) use increased brain amyloid-β deposition. Objective To investigate the association between exposure to ACDs and late AMD (features of neovascular AMD or geographic atrophy of the retinal pigment epithelium in at least 1 eye). Design, Setting and Participants A multicenter case-control study in 4 French ophthalmologic centers comprising 200 cases with late AMD and 200 controls enrolled from July 2016 to June 2017. Exposures Exposure to at least 3 months of ACDs started before AMD diagnosis was recorded during a specific interview. A dose-effect association with cumulative exposure duration and Anticholinergic Burden Score was explored. The association between ACD exposure and AMD was assessed by multivariate logistic regression analysis adjusted for age, sex, smoking status, family history of AMD, alcohol consumption, and use of anticoagulant and anti-inflammatory drugs. Odds ratios (ORs) and 95% confidence intervals were estimated. Main Outcomes and Measures Association between exposure to ACDs and late AMD. Results Among case participants, the mean (SD) age was 74.8 (9.2) years, 129 (64.5%) were women, 192 (96%) were white, 65 (32.5%) had geographic atrophy, 135 (67.5%) had neovascular AMD, 116 (58%) had unilateral AMD, and 84 (42%) had bilateral AMD. Among control participants, the mean (SD) age was 75.5 (7.2) years, with 116 (58%) women and 187 (93.5%) white participants. Twenty-six cases (13%) and 10 controls (5%) were exposed to ACDs throughout life for at least 3 months before AMD onset. Risk of AMD was increased with ever exposure to ACDs (adjusted OR [aOR], 2.84; 95% CI, 1.33-6.06; P = .007), high Anticholinergic Burden Score (≥3) (aOR, 6.42; 95% CI, 1.38-29.92; P = .02), and longest cumulative exposure to ACD (≥15 years) (aOR, 5.88; 95% CI, 1.22-28.31; P = .03). Conclusions and Relevance Risk of late AMD may be increased with at least 3 months' use of ACDs. A dose-effect association was suggested by a greater association with prolonged use and high Anticholinergic Burden Score. Further studies, in particular those with longitudinal design, are needed to confirm this association.
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Affiliation(s)
- Gauthier Aldebert
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Jean-Luc Faillie
- Department of Medical Pharmacology and Toxicology, Lapeyronie Hospital, Montpellier, France
| | | | - Thibault Mura
- Department of Epidemiologic and Clinical Reserch, La Colombière Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Isabelle Carrière
- Institut National de la Santé et de la Recherche Médicale, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Cécile Delcourt
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | | | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France
| | - Vincent Daien
- Department of Ophthalmology, Gui De Chauliac Hospital, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
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103
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Trenaman S, Willison M, Robinson B, Andrew M. A collaborative intervention for deprescribing: The role of stakeholder and patient engagement. Res Social Adm Pharm 2019; 16:595-598. [PMID: 31350171 DOI: 10.1016/j.sapharm.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND At a recent World Café Workshop on future deprescribing priorities, Canadian researchers identified that, in addition to implementation evaluation and economic analyses, high quality clinical trials require meaningful patient engagement. OBJECTIVES The aim was to develop a deprescribing intervention for collaborative primary healthcare clinics and long-term care facilities that have pharmacists integrated in these settings. This manuscript aims to provide a summary of the experience with engaging patients in the development of the deprescribing framework. METHODS Sixteen members of the research team met with six patient representatives (identified by the Maritime SPOR SUPPORT Unit) in a facilitated meeting. The event provided a welcoming environment for all participants; discussion groups ensured a mix of clinical, research and patient voice; and facilitators focused on engaging all voices equally. Initial discussions were structured around four topics: 1) identifying and prioritizing potentially inappropriate medications to reduce or stop; 2) identifying patients appropriate for deprescribing; 3) effectively communicating deprescribing with both patients and prescribers; and 4) measuring satisfaction with the framework. Subsequent discussions used group input to draft an intervention. After the event, participants engaged via e-mail, to refine the proposed intervention. RESULTS The facilitated meeting provided helpful insight into patients' interests and changed the shape of the project. For example, patient representatives felt that an age restriction of 65 years of age or older was unfair, as deprescribing may help people younger than 65 years of age. Patient representatives also felt it was crucial to have resources to offer with non-pharmacologic information to increase success of deprescribing. This led to the deprescribing intervention becoming a framework for pharmacist-led deprescribing and a toolbox of supportive patient and healthcare professional resources. CONCLUSIONS Overall, this process allowed for successful and meaningful patient engagement that aligned well with priorities for deprescribing clinical trials.
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Affiliation(s)
- Shanna Trenaman
- Dalhousie University, Nova Scotia Health Authority, c/o Sherri Fay, 2557, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada.
| | - Marjorie Willison
- Aging Well with Marjorie, c/o Sherri Fay, 2557, Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada.
| | - Bryn Robinson
- Horizon Health Network, Research Engagement Manager, 5DN - Research Services, Saint John Regional Hospital, PO Box 2100, 400 University Avenue, Saint John, NB E2L 4L2, Canada.
| | - Melissa Andrew
- Dalhousie University Department of Medicine (Geriatrics), Nova Scotia Health Authority, Division of Geriatric Medicine, 5955 Veterans' Memorial Lane, Suite 3310 Veterans' Memorial Building, Halifax, NS B3H 2E1, Canada.
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104
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Franchi C, Rossio R, Ardoino I, Mannucci PM, Nobili A. Inappropriate prescription of benzodiazepines in acutely hospitalized older patients. Eur Neuropsychopharmacol 2019; 29:871-879. [PMID: 31221501 DOI: 10.1016/j.euroneuro.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
Benzodiazepines (BDZs) are widely prescribed in older people. The aims of the study are to assess the prevalence of inappropriate prescription of BZDs and the associated factors in acutely hospitalized older patients. Patients aged 65 years or more hospitalized from 2010 to 2017 in more than 100 Italian internal medicine and geriatric wards in the frame of the REPOSI register were included if prescribed with BDZs at hospital admission or discharge. Appropriateness of prescription was assessed according to the 2015 Beers criteria and their modified French and German versions. Among 4681 patients discharged from hospital, 15% (N = 710) were discharged with BDZs, and 62% of them (N = 441, 95% CI: 58.5%-65.6%) were inappropriately prescribed, being prescribed with BDZ to be always avoided in the elderly (45%), at higher doses than recommended (31%) or with no appropriate clinical conditions (19%). From admission to discharge the prevalence of inappropriate BDZ prescription decreased by 4%, but 62% of patients inappropriately prescribed at admission were still inappropriately prescribed at discharge. Among the 179 patients first prescribed at the time of discharge, half were inappropriately prescribed. Being female (OR 1.32, 95%CI 0.95-1.85), enrolled in REPOSI during the years 2016 and 2017 (OR 1.94, 95%CI 1.10-3.39; OR 1.57, 95%CI 0.95-2.58) and living in nursing homes (OR 2.04, 95%CI 0.95-4.37) were associated with an increased risk to be inappropriately prescribed. This study shows a high prevalence of inappropriate use of BDZ in acutely hospitalized older patients both at hospital admission and discharge.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - R Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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105
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Fialová D, Brkić J, Laffon B, Reissigová J, Grešáková S, Dogan S, Doro P, Tasić L, Marinković V, Valdiglesias V, Costa S, Kostřiba J. Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Ther Adv Drug Saf 2019; 10:2042098619854014. [PMID: 31258888 PMCID: PMC6591668 DOI: 10.1177/2042098619854014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. METHODS Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015-November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drug-regulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. RESULTS PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8-21.7% not marketed PIMs) and less than 20% of PIMs were available as over-the-counter medications (except in Turkey, 46.4-48.1%). CONCLUSIONS The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017-2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.
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Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy,
Faculty of Pharmacy in Hradec Králové, Charles University, Heyrovského 1203,
Hradec Králové 500 05, Czech Republic
- Department of Geriatrics and Gerontology, 1st
Faculty of Medicine, Prague, Czech Republic
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy,
Charles University, Czech Republic
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology,
Universidade da Coruña, A Coruña, Spain
| | - Jindra Reissigová
- Department of Statistical Modeling, The Czech
Academy of Sciences, Prague, Czech Republic
| | - Silvia Grešáková
- Department of Social and Clinical Pharmacy,
Charles University, Czech Republic
| | - Soner Dogan
- Department of Medical Biology, Yeditepe
University, Istanbul, Turkey
| | - Peter Doro
- Department of Clinical Pharmacy, University of
Szeged, Szeged, Hungary
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical
Legislation, University of Belgrade, Belgrade, Serbia
| | - Valentina Marinković
- Department of Social Pharmacy and
Pharmaceutical Legislation, University of Belgrade, Belgrade, Serbia
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology,
Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese
National Institute of Health, Porto, Portugal
- EPIUnit, University of Porto, Porto,
Portugal
| | - Jan Kostřiba
- Department of Social and Clinical Pharmacy,
Charles University, Czech Republic
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106
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Khawagi WY, Steinke DT, Nguyen J, Keers RN. Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review. PLoS One 2019; 14:e0217406. [PMID: 31125358 PMCID: PMC6534318 DOI: 10.1371/journal.pone.0217406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prescribing errors and medication related harm may be common in patients with mental illness. However, there has been limited research focusing on the development and application of prescribing safety indicators (PSIs) for this population. OBJECTIVE Identify potential PSIs related to mental health (MH) medications and conditions. METHODS Seven electronic databases were searched (from 1990 to February 2019), including the bibliographies of included studies and of relevant review articles. Studies that developed, validated or updated a set of explicit medication-specific indicators or criteria that measured prescribing safety or quality were included, irrespective of whether they contained MH indicators or not. Studies were screened to extract all MH related indicators before two MH clinical pharmacists screened them to select potential PSIs based on established criteria. All indicators were categorised into prescribing problems and medication categories. RESULTS 79 unique studies were included, 70 of which contained at least one MH related indicator. No studies were identified that focused on development of PSIs for patients with mental illness. A total of 1386 MH indicators were identified (average 20 (SD = 25.1) per study); 245 of these were considered potential PSIs. Among PSIs the most common prescribing problem was 'Potentially inappropriate prescribing considering diagnoses or conditions' (n = 91, 37.1%) and the lowest was 'omission' (n = 5, 2.0%). 'Antidepressant' was the most common PSI medication category (n = 85, 34.7%). CONCLUSION This is the first systematic review to identify a comprehensive list of MH related potential PSIs. This list should undergo further validation and could be used as a foundation for the development of new suites of PSIs applicable to patients with mental illness.
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Affiliation(s)
- Wael Y. Khawagi
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia
| | - Douglas T. Steinke
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Joanne Nguyen
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Richard N. Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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107
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Gonzalez-Colaço Harmand M, Aldea-Perona AM, Boada-Fernández del Campo C, Areosa-Sastre A, Rodríguez-Jiménez C, García Sánchez-Colomer M, Fernández Quintana E, Plasencia-Nuñez M, Masiero-Aparicio P, Grillo-Grillo C, Orellana-Mobilli A, García Sáiz M, Duarte Diéguez C, Hornillos Calvo M, Avellana Zaragoza JA, Martínez Velilla N, de Guzmán Pérez Hernández D, Ruiz González M, Blanco Reina E, Asensio Ostos C, Peiró A, Cabrera García L, Hortigüela Moro F, Pérez Alayón H, Espárrago García I, Santana Quilez J, Alonso Ramírez J, Fernández Oropesa C, López Varona MJ, Acín Gerico MT, Sanz Alvarez E, Martín de la Sierra MÁ, Peñalver MJ, Falomir Gómez T, Ruiz Salazar J, Rivas GE, Rey Rodríguez E. Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project). Eur J Clin Pharmacol 2019; 75:1161-1176. [DOI: 10.1007/s00228-019-02684-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/15/2019] [Indexed: 12/20/2022]
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108
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Petit-Monéger A, Jouhet V, Thiessard F, Berdaï D, Noize P, Gilleron V, Caridade G, Salmi LR, Saillour-Glénisson F. Appropriateness of psychotropic drug prescriptions in the elderly: structuring tools based on data extracted from the hospital information system to understand physician practices. BMC Health Serv Res 2019; 19:272. [PMID: 31039784 PMCID: PMC6492442 DOI: 10.1186/s12913-019-4064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/05/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The appropriateness of psychotropic prescriptions in the elderly is a major quality-of-care challenge at hospital. Quality indicators have been developed to prevent inappropriate psychotropic prescriptions. We aimed to select and automatically calculate such indicators, from the Bordeaux University Hospital information system, and to analyze the appropriateness of psychotropic prescription practices, in an observational study. METHODS Experts selected indicators of the appropriateness of psychotropic prescriptions in hospitalized elderly patients, according to guidelines from the French High Authority for Health. The indicators were reformulated to focus on psychotropic administrations. The automated calculation of indicators was analyzed by comparing their measure to data collected from a clinical audit. In elderly patients hospitalized between 2014 and 2015, we then analyzed the evolution of the appropriateness of psychotropic prescription practices during hospital stay, using methods of visualization, and described practices by considering patients' characteristics. RESULTS Two indicators were automated to detect overuse and misuse of psychotropic drugs. Indicators identified frequent inappropriate drug administrations, but practices tended to become more appropriate after quality-of-care improvement actions. In the majority of patients (85%), there was no inappropriate administration of psychotropic drugs during hospital stay; for the remaining 15% with at least one inappropriate administration, physicians tended to limit overuse or misuse during hospital stay. Inappropriate administrations were more frequent in patients suffering from psychiatric disorders, dependence and associated complications or morbidities. CONCLUSIONS The automated indicators are structuring tools for the development of a drug prescription monitoring system. Inappropriate psychotropic administrations were limited by physicians during hospital stay; some inappropriate prescriptions might be explained by clinical characteristics of patients.
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Affiliation(s)
- Aurélie Petit-Monéger
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France. .,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - Vianney Jouhet
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - Frantz Thiessard
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Pernelle Noize
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Véronique Gilleron
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Guillaume Caridade
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Louis-Rachid Salmi
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - Florence Saillour-Glénisson
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
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Yang BR, Kwon KE, Kim YJ, Choi NK, Kim MS, Jung SY, Shin JY, Ahn YM, Park BJ, Lee J. The association between antidepressant use and deaths from road traffic accidents: a case-crossover study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:485-495. [PMID: 30474691 DOI: 10.1007/s00127-018-1637-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/17/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents. METHODS We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1 year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case-case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR). RESULTS A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03-1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran. CONCLUSION Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents.
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Affiliation(s)
- Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoung-Eun Kwon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joongyub Lee
- School of Medicine, Inha University, Incheon, Republic of Korea.
- Department of Prevention and Management, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea.
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110
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Laffon de Mazières C, Lapeyre-Mestre M, Vellas B, de Souto Barreto P, Rolland Y. Impact of a geriatric intervention conducted in nursing homes on inappropriate prescriptions of antipsychotics. Eur Geriatr Med 2019; 10:285-293. [PMID: 34652759 DOI: 10.1007/s41999-018-00155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effect of a quality assurance approach in a nursing home, with or without the intervention of a geriatrician, on the potentially inappropriate prescription of antipsychotics (PIPA) at 18 months; and to identify the factors associated with PIPA after 18 months of intervention (T18). METHODS We used data from a multicentre individually tailored controlled trial (IQUARE study). The study population comprised residents included in the IQUARE study with at least one potentially inappropriate prescription of antipsychotics at baseline (T0) who were still in nursing home at T18 (n = 636; nursing homes = 175). The control group received individual feedback from the quality assurance audit performed at baseline. The intervention group also had at least 5 collaborative work meetings with a geriatrician over an 18-month period. We used a multilevel logistic regression model. RESULTS The rates of inappropriate antipsychotic drug prescribing were 66.5% and 45.2% at T0 and T18, respectively. This decrease in the rate of PIPA is significant (p < 0.001). A significant decrease was found within each group: in the intervention arm (68.1% at T0 vs. 44.6% at T18; p < 0.001) and in the control arm (65.2% at T0 vs. 45.6% at T18; p < 0.001). Multivariate analysis did not highlight any statistically significant association between living in a nursing home having received an intervention and PIPA at T18. CONCLUSIONS Collaborative work meetings with a geriatrician does not provide significant added value to a global quality assurance approach towards PIPA. Individual feedback to each nursing home appears to have a substantial impact on decreasing PIPA.
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Affiliation(s)
- Clarisse Laffon de Mazières
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France. .,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France.,Department of Medical and Clinical Pharmacology, CIc 1436, CHU de Toulouse, 37 Allées Jules Guesde, Toulouse, France
| | - Bruno Vellas
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France.,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France
| | - Philipe de Souto Barreto
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France.,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France
| | - Yves Rolland
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France.,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France
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111
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Abstract
RÉSUMÉLa réduction des médicaments potentiellement inappropriés (MPI) chez les personnes âgées est un enjeu important selon de nombreux cliniciens et chercheurs à travers le monde, car ces médicaments accroissent significativement la morbidité et la mortalité dans la population plus âgée. La prévalence des MPI est un problème répandu malgré l’existence de plusieurs critères explicites et implicites de réduction des MPI chez les personnes âgées, les plus courants étant les critères de Beers, les critères STOPP/START et plusieurs critères nationaux spécifiques. Cette revue non systématique visait à examiner les critères de référence pour la réduction des MPI et à clarifier le rôle de certaines mesures, dont la déprescription, pour optimiser la prescription des médicaments chez les personnes âgées. Des recherches par mots-clés et termes MeSH ont été menées dans des bases de données électroniques. Les nombreux critères disponibles ont chacun leurs avantages et inconvénients. La déprescription, qui vise à réduire l’utilisation des MPI, a considérablement gagné en importance dans les initiatives associées à l’amélioration des pratiques de prescription. La déprescription est une approche méthodique qui implique l’arrêt graduel, éclairé et individualisé des médicaments inappropriés, avec un suivi rigoureux des patients pour assurer la détection d’événements indésirables ou de symptômes de rebond. Une approche combinée centrée sur le patient et le soignant favorise la collaboration entre les prescripteurs et les pharmaciens afin de réduire le nombre de MPI chez les personnes âgées.
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112
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Assessing Potentially Inappropriate Medications in Nursing Home Residents by NORGEP-NH Criteria. PHARMACY 2019; 7:pharmacy7010026. [PMID: 30841495 PMCID: PMC6473407 DOI: 10.3390/pharmacy7010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Nursing home residents often have several conditions that necessitate the use of multiple medicines. This study investigates the prevalence of potentially inappropriate medications (PIMs) and its associations with sex, age, number of medicines, and study location (rural/urban). Methods: A cross-sectional study of long-term care residents from six nursing homes. Data was collected from medical records. We identified PIMs by applying the NORGEP-NH criteria. We conducted a Poisson regression analysis to investigate the association between the number of PIMs and sex, age, number of medicines, and study location. Results: We included 103 (18.4%) of 559 residents (68.0% women; mean age 83.2 years, mean number of daily used medicines 7.2 (SD = 3.6)). We identified PIMs in 56% of the residents (mean number = 1.10, SD = 1.26). In adjusted analyses, residents ≥80 years had 0.43 fewer PIMs compared to residents <80 years (p < 0.05). Residents using 4–6, 7–9, and 10+ medicines had on average 0.73, 1.06, and 2.11 more PIMs compared to residents using 0–3 medicines (p < 0.001), respectively. Conclusion: PIM use is prevalent among nursing home residents and is significantly associated with age and number of medicines. Our findings suggest a modest decrease in residents using PIMs compared to previous studies. Nevertheless, prescribing quality in nursing home residents in both urban and rural areas is still of great concern.
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113
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Aguiar JP, Brito AM, Martins AP, Leufkens HGM, Alves da Costa F. Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly: A systematic review of tools addressing inappropriate prescribing. J Clin Pharm Ther 2019; 44:349-360. [DOI: 10.1111/jcpt.12811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/25/2023]
Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia Universidade de Lisboa Lisboa Portugal
| | - Ana Mafalda Brito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM) Instituto Universitário Egas Moniz Caparica Portugal
| | - Ana Paula Martins
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia Universidade de Lisboa Lisboa Portugal
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology and Clinical PharmacyUtrecht Institute for Pharmaceutical SciencesUtrecht University Utrecht the Netherlands
| | - Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM) Instituto Universitário Egas Moniz Caparica Portugal
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114
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Laroche ML, Sirois C, Reeve E, Gnjidic D, Morin L. Pharmacoepidemiology in older people: Purposes and future directions. Therapie 2019; 74:325-332. [PMID: 30773343 DOI: 10.1016/j.therap.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022]
Abstract
Knowledge of the benefit/risk ratio of drugs in older adults is essential to optimise medication use. While randomised controlled trials are fundamental to the process of drug development and bringing new drugs to the market, they often exclude older adults, especially those suffering from frailty, multimorbidity and/or receiving polypharmacy. Therefore, it is generally unknown whether the benefits and harms of drugs established through pre-marketing clinical trials are translatable to the real-word population of older adults. Pharmacoepidemiology can provide real-world data on drug utilisation and drug effects in older people with multiple comorbidities and polypharmacy and can greatly contribute towards the goal of high quality use of drugs and well-being in older adults. A wide variety of pharmacoepidemiology studies can be used and exciting progress is being made with the use of novel and advanced statistical methods to improve the robustness of data. Coordinated and strategic initiatives are required internationally in order for this field to reach its full potential of optimising drug use in older adults so as to improve health care outcomes.
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Affiliation(s)
- Marie-Laure Laroche
- Centre de pharmacovigilance, de pharmacoépidemiologie et d'information sur les médicaments, CHU de Limoges, 97042 Limoges, France; Inserm 1248, faculté de médecine de Limoges, 87042 Limoges, France.
| | - Caroline Sirois
- Centre d'excellence sur le vieillissement de Québec, centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, G1S 4L8 Québec, Canada; Département de médecine sociale et préventive, université Laval, G1V 0A6 Québec, Canada
| | - Emily Reeve
- NHMRC-Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Sydney Medical School, University of Sydney, NSW 2065 Saint-Leonard, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, NS B3H 2Y9 Halifax, Canada; College of Pharmacy, Faculty of Health, Dalhousie University, B3H 4R2 Nova Scotia, Canada; College of Medicine, University of Saskatchewan, SK S7N 5C9 Saskatoon, Canada
| | - Danijela Gnjidic
- Sydney Pharmacy School and Charles Perkins Centre, University of Sydney, NSW 2006 Sydney, Australia
| | - Lucas Morin
- Aging Research Center, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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115
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de Germay S, Rueter M, Montastruc F, Rousseau V, Lapeyre-Mestre M, Montastruc JL. Trends of atropinic (anticholinergic) exposure in the elderly: a 10-year analysis in the French EGB database. Fundam Clin Pharmacol 2019; 33:471-478. [PMID: 30687946 DOI: 10.1111/fcp.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Abstract
Atropinic drugs are known to potentially induce physical and/or mental impairments in the elderly. The aim of this study was to investigate trends of atropinic exposure in patients ≥65 years in France between 2006 and 2015. A repeated cross-sectional study was performed quarterly from January 1, 2006 to December 31, 2015, in the 'Echantillon Généraliste des Bénéficiaires (EGB)', a representative sample of the French population. Exposed patients were identified using the Anticholinergic Durán's list. Outcomes were rate of patients exposed to at least one atropinic drug (atropinic prevalence rate) and atropinic burden per patient (sum of atropinic burden scores). Interrupted time series were used to analyze the impact of market withdrawal of some drugs with atropinic properties during the period of the study. The number of patients ≥65 years registered in the EGB ranged from 75 611 in 2006 to 95 389 in 2015. Atropinic prevalence rate decreased significantly from 45.6% in 2006 to 33.2% in 2015 (-12.4%, slope significance P < 0.05). Subjects aged ≥85 years were the most exposed. Total atropinic burden decreased significantly between 2006 and 2015 (2.2 ± 1.7 in 2006; 2.0 ± 1.5 in 2015; slope significance P < 0.05), especially in patients ≥85 years. Market withdrawals for safety reasons of some atropinic drugs were significantly associated with a decrease in the atropinic prevalence rate (P < 0.05) and atropinic burden per patient (P < 0.05). In conclusion, atropinic drug exposure in the elderly significantly decreased in France between 2006 and 2015. This decrease can be partly explained by regulatory measures against some atropinic drugs.
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Affiliation(s)
- Sibylle de Germay
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Manuela Rueter
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre d'Evaluation et d'Information sur la PharmacoDépendance et d'AddictoVigilance (CEIP-A), 37 allées Jules Guesde, 31000, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.,UMR INSERM 1027, Faculté de Médecine, Université Paul-Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.,Centre de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC INSERM 1436, Université et Centre Hospitalier Universitaire, 37 allées Jules Guesde, 31000, Toulouse, France
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116
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Mangin D, Bahat G, Golomb BA, Mallery LH, Moorhouse P, Onder G, Petrovic M, Garfinkel D. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action. Drugs Aging 2019; 35:575-587. [PMID: 30006810 PMCID: PMC6061397 DOI: 10.1007/s40266-018-0554-2] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Globally, the number of drug prescriptions is increasing causing more adverse drug events, which is now a significant cause of mortality, morbidity, and disability that has reached epidemic proportions. The risk of adverse drug events is correlated to very old age, multiple co-morbidities, dementia, frailty, and limited life expectancy, with the major contributor being polypharmacy. Each characteristic alters the risk-benefit balance of medications, typically reducing anticipated benefits and amplifying risk. Current clinical guidelines are based on evidence proven in younger/healthier adult populations using a single disease model and their application to older adults with multimorbidity, in whom testing has not been conducted, yields a different risk-benefit prospect and makes inappropriate medication use and polypharmacy inevitable. Applying inappropriate clinical practice guidelines to older adults is antithetical to good healthcare, is likely to increase health inequity, and is associated with substantial negative clinical, economic, and social implications for health systems. The casualties are on the scale of a war or epidemic, yet are usually invisible in measures of healthcare quality and formal recommendations. Radical and rapid action is required to achieve a better quality of life for older populations and to remain true to the principles of medical professionalism and evidence-based medicine that place patients' interests and autonomy at the fore. This first International Group for Reducing Inappropriate Medication Use & Polypharmacy position statement briefly details the causes, consequences, and extent of inappropriate medication use and polypharmacy. This article outlines current strategies to reduce inappropriate medication use, provides evidence for their effect, and then proposes recommendations for moving forward with 10 recommendations for action and 12 recommendations for research. We conclude that an urgent integrated effort to reduce inappropriate medication use and polypharmacy should be a leading global target of the highest priority. The cornerstone of this position statement from the International Group for Reducing Inappropriate Medication Use & Polypharmacy is the understanding that without evidence of definite relevant benefit, when it comes to prescribing, for many older patients 'less is more'. This approach differs from most other current recommendations and guidance in medical care, as the focus is on what, when, and how to stop, rather than on when to start medications/interventions. Disrupting the framework that indiscriminately applies standard guidelines to older adults requires a new approach that better serves patients with multimorbidity. This transition requires a shift in medical education, research, and diagnostic frameworks, and re-examination of the measures used as quality indicators. In achieving this objective, we promote a return to some of the original concepts of evidence-based medicine: which considers scientific data (where it exists), clinical judgment, patient/family preference, and context. A shift is needed: from the current model that focuses on single conditions to one that simultaneously considers multiple conditions and patient priorities. This approach reframes the clinician's role as a professional providing care, rather than a disease technician.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main Street West, Hamilton, ON, Canada. .,Department of General Practice, University of Otago, Christchurch, New Zealand.
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Beatrice A Golomb
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Laurie Herzig Mallery
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paige Moorhouse
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Graziano Onder
- Department of Geriatrics, Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Doron Garfinkel
- Wolfson Medical Center, Holon, Israel.,Homecare Hospice Israel Cancer Association, Holon, Israel
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117
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Niehoff KM, Mecca MC, Fried TR. Medication appropriateness criteria for older adults: a narrative review of criteria and supporting studies. Ther Adv Drug Saf 2019; 10:2042098618815431. [PMID: 30719279 PMCID: PMC6348576 DOI: 10.1177/2042098618815431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/04/2018] [Indexed: 01/05/2023] Open
Abstract
Polypharmacy is common among older adults and is associated with adverse outcomes. Polypharmacy increases the likelihood of receiving a potentially inappropriate medication (PIM). PIMs have traditionally been defined as medications that have either no benefit (e.g. therapeutic duplication) or increased risk (e.g. altered pharmacodynamics/kinetics with aging). A growing literature supports the notion that these represent only a subset of the potential risks of medications prescribed to older adults. Different authors have proposed new sets of criteria for evaluating medication appropriateness. This narrative review had two objectives: 1) to summarize the contents of these criteria in order to obtain preliminary information about where clinical consensus exists regarding appropriateness; 2) The second was to describe studies examining the risks and benefits of medications identified by the criteria to determine the strength of the evidence supporting the derivation of these criteria. We identified 13 articles sharing overlapping criteria for evaluating appropriateness including: (1) delayed time to benefit; (2) altered benefit-harm ratios in the face of competing risks; (3) effects that do not match patients' goals; and (4) nonadherence. The similarities across the articles suggested strong clinical consensus; however, the articles presented little data directly supporting these criteria. Additional studies provide evidence for the proof of concept that average estimates of benefit and harm derived from randomized controlled trials may differ from the benefits and harms experienced by older persons. However, more data are required to characterize the benefits and harms of medications in the context of the regimen as a whole and the individual's health status.
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Affiliation(s)
- Kristina M. Niehoff
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcia C. Mecca
- Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Terri R. Fried
- VA Connecticut Healthcare System, CERC 151B, 950 Campbell Avenue, West Haven, CT 06516, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT USA
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118
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Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. Eur J Clin Pharmacol 2019; 75:467-481. [PMID: 30610274 DOI: 10.1007/s00228-018-02612-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Older people with dementia are at risk of adverse events associated with potentially inappropriate prescribing. AIM to describe (1) how international tools designed to identify potentially inappropriate prescribing have been used in studies of older people with dementia, (2) the prevalence of potentially inappropriate prescribing in this cohort and (3) advantages/disadvantages of tools METHODS: Systematic literature review, designed and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, PsychInfo, CINAHL, the Cochrane Library, the Social Science Citation Index, OpenGrey, Base, GreyLit, Mednar and the National Database of Ageing Research were searched in April 2016 for studies describing the use of a tool or criteria to identify potentially inappropriate prescribing in older people with dementia. RESULTS Three thousand three hundred twenty-six unique papers were identified; 26 were included in the review. Eight studies used more than one tool to identify potentially inappropriate prescribing. There were variations in how the tools were applied. The Beers criteria were the most commonly used tool. Thirteen of the 15 studies using the Beers criteria did not use the full tool. The prevalence of potentially inappropriate prescribing ranged from 14 to 74% in older people with dementia. Benzodiazepines, hypnotics and anticholinergics were the most common potentially inappropriately prescribed medications. CONCLUSIONS Variations in tool application may at least in part explain variations in potentially inappropriate prescribing across studies. Recommendations include a more standardised tool usage and ensuring the tools are comprehensive enough to identify all potentially inappropriate medications and are kept up to date.
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119
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Potentially Inappropriate Medications in the Elderly: IFAsPIAM List by Argentinian Consensus Panel. Value Health Reg Issues 2018; 17:38-55. [DOI: 10.1016/j.vhri.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/01/2017] [Accepted: 10/03/2017] [Indexed: 11/22/2022]
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120
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Association Between Potentially Inappropriate Medications and Frailty in the Early Old Age: A Longitudinal Study in the GAZEL Cohort. J Am Med Dir Assoc 2018; 19:967-973.e3. [DOI: 10.1016/j.jamda.2018.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 01/01/2023]
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121
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Benevent J, Hurault-Delarue C, Araujo M, Montastruc F, Montastruc JL, Lacroix I, Damase-Michel C. Higher intake of medications for digestive disorders in children prenatally exposed to drugs with atropinic properties. Fundam Clin Pharmacol 2018; 33:314-326. [PMID: 30365180 DOI: 10.1111/fcp.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/15/2022]
Abstract
Childhood digestive disorders are a common occurrence and are sometimes unexplained. Maternal medication during the development of the foetus' digestive system may contribute to the increase in childhood digestive disorders, especially with drugs acting on the cholinergic system. This study investigated the association between prenatal exposure to drugs with atropinic properties and the use of digestive disorder medications in childhood (0-3 years). Children from POMME (PrescriptiOn Médicaments Mères Enfants), a French database of reimbursed drugs for pregnant women and their children, were included (N = 8 372). Each drug prescribed during antenatal life was assigned an atropinic score (0 = null, 1 = low, 3 = strong). The prenatal atropinic burden was calculated as the sum of atropinic scores of drugs prescribed. More than 30% (N = 2 652) of the children were prenatally exposed to atropinic drugs. They used significantly more digestive disorder medications than unexposed children (RRa = 1.11 [1.06; 1.16]). The strength of the association increased with the prenatal atropinic burden. Our results suggest long-term digestive effects after prenatal exposure to atropinic drugs.
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Affiliation(s)
- Justine Benevent
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Caroline Hurault-Delarue
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Mélanie Araujo
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - François Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Centre Hospitalier Universitaire de Toulouse, CHU Purpan - Hôpital Pierre Paul Riquet, Place du Dr Baylac, TSA40031 31059, Toulouse Cedex 9, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Centre Hospitalier Universitaire de Toulouse, CHU Purpan - Hôpital Pierre Paul Riquet, Place du Dr Baylac, TSA40031 31059, Toulouse Cedex 9, France
| | - Isabelle Lacroix
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Christine Damase-Michel
- Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de Pharmaco Vigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine de Toulouse, INSERM UMR 1027, 37 allées Jules Guesde, 31000, Toulouse, France
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Chang CB, Lai HY, Hwang SJ, Yang SY, Wu RS, Liu HC, Chan DC. The application of updating PIM-Taiwan criteria in clinic-visiting older patients with polypharmacy. Ther Adv Drug Saf 2018; 9:699-709. [PMID: 30546864 DOI: 10.1177/2042098618804493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/20/2018] [Indexed: 11/15/2022] Open
Abstract
Background PIM-Taiwan criteria were first established in 2010 for potentially inappropriate medications (PIMs). Currently, updating of PIM criteria is mandatory because of newly established evidence and newly developed medications. This study aims to evaluate the prevalence of PIM based on country-specific PIM criteria and factors associated with PIM use by applying 2010 version and newly updating PIM-Taiwan criteria in a cohort with polypharmacy. Methods The baseline data of Medication Safety Review Clinic Taiwan (MSRC-Taiwan) study were used to investigate the prevalence of PIMs. Older patients (aged ⩾65 years) who were either having polypharmacy or visited ⩾3 different physicians were enrolled between August and October 2007. Bivariate analysis and multivariate logistic regressions were used to evaluate the factors associated with PIM use. Results The prevalence of having at least one PIM was 46.1% for 2010 version and increased to 74.6% for 2018 version. The average number of PIMs generally to be avoided per patient also increased for 2018 version (0.2 versus 1.2, p < 0.0001). In contrast, the average number of PIMs considering chronic conditions per patient decreased (0.6 versus 0.3, p < 0.001). The associated chronic conditions of PIM users were distinct between 2010 and 2018 version. The major leading PIMs were benzodiazepines (BZDs) in both versions of criteria. Conclusions As there were significant differences in medication lists between PIM-Taiwan version 2010 and 2018, the prevalence of PIM and factors associated with PIM users varied accordingly. Physicians should pay special attention before prescribing BZDs which keep being the major leading PIM.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Internal Medicine, National Taiwan University Chu-Tung Branch, Hsin-Chu County, Taiwan
| | - Hsiu-Yun Lai
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Yu Yang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ru-Shu Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
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123
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Park MJ, Kim MH, Shin SM, Chung SY. Effect of providing drug utilization review information on tricyclic antidepressant prescription in the elderly. J Med Syst 2018; 42:198. [PMID: 30215150 PMCID: PMC6153773 DOI: 10.1007/s10916-018-1061-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
Tricyclic antidepressants are known as potentially inappropriate medications in the elderly. A notification issued in July 2015 in South Korea recommended caution while prescribing tricyclic antidepressants to the elderly. Further, since October 2015, the nationwide computerized drug utilization review monitoring system provides a pop-up window, on a real-time basis, whenever tricyclic antidepressants are prescribed to elderly outpatients. Therefore, we evaluated whether providing drug utilization review information was effective in reducing tricyclic antidepressant prescription to elderly outpatients. We used the Health Insurance Review and Assessment Service-Adult Patient Sample data from 2014 to 2016. Data related to the prescription of tricyclic antidepressants to outpatients aged 65 years or more were extracted. We determined the number of prescriptions per day per 100,000 elderly patients in each month, compared the average number of prescriptions before and after the drug utilization review information was provided, and evaluated the changes in the number of prescriptions by using an interrupted time series analysis. The average number of tricyclic antidepressant prescriptions per day per 100,000 elderly patients decreased from 76.6 (75.5 to 77.6) to 65.7 (64.5 to 66.9), a 14.2% reduction after the provision of drug utilization review information started. Following initiation of provision of drug utilization review information, there was an immediate drop of 9.2 tricyclic antidepressant prescriptions per day per 100,000 elderly patients, whereas there was no statistically significant change in trends. Providing the drug utilization review information on tricyclic antidepressant prescription for the elderly contributed to the reduction in tricyclic antidepressant prescriptions.
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Affiliation(s)
- Mi-Ju Park
- Korea Institute of Drug Safety and Risk Management, 30, Burim-ro, 169beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, South Korea
| | - Mi-Hee Kim
- Korea Institute of Drug Safety and Risk Management, 30, Burim-ro, 169beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, South Korea
| | - Sun Mi Shin
- Korea Institute of Drug Safety and Risk Management, 30, Burim-ro, 169beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, South Korea.
| | - Soo Youn Chung
- Korea Institute of Drug Safety and Risk Management, 30, Burim-ro, 169beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, South Korea
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Martsevich SY, Kutishenko NP, Lukina YV, Komkova NA, Dmitrieva NA, Drapkina OA. Main Approaches to Assessing the Quality of Drug Therapy in Cardiology. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-4-558-566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A competent choice of drug therapy in a specific clinical situation is a difficult and important task that a practical doctor must regularly solve in everyday practice, and the consequences of errors in this decision can be quite serious. Therefore, evaluation of the quality of the prescribed therapy is extremely important.In the treatment of cardiovascular diseases, medicines that have a proven effect on the outcomes of the disease, primarily on mortality rates (so-called "life-saving drugs") acquire special significance. There are several classes of such drugs, and in different situations, their positive impact on the prognosis of the disease may be different. On the other hand, one should remember the so-called "drug-related problems" (DRP), which include contraindications to the prescription of certain drugs in a particular patient, the possibility of developing side effects of drug therapy, aggravated by polypharmacy, inter-drug interaction, improper dosage of drugs, etc.In this publication, an attempt is made to identify the main components by which the quality of the prescribed therapy can be evaluated in the treatment of cardiovascular diseases: compliance of prescriptions with official instructions for preparations, modern clinical guidelines, adequate selection of a specific drug within the class, drug formulation, salt of the drug, evaluation of important safety parameters and efficacy of the prescribed drug. In addition, a review of the methods and scales of the composite evaluation of the quality of drug therapy developed to date has been conducted, as well as attempts to improve them and create new ones that continue to the present day. Nevertheless, none of the currently known methods for assessing the quality of therapy is not universal or devoid of shortcomings.Most likely, a universal method of assessing the quality of the prescribed treatment may not exist. In its most general form, it can be said that treatment should be based on modern evidence-based medicine, which is usually reflected in the clinical guidelines, without contradicting the official instruction on the use of the drug, considering the presence of concomitant diseases, that are often the reasons of contraindications to prescribing those or other medicines.
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125
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Sharif SI, Al-Harbi AB, Al-Shihabi AM, Al-Daour DS, Sharif RS. Falls in the elderly: assessment of prevalence and risk factors. Pharm Pract (Granada) 2018; 16:1206. [PMID: 30416623 PMCID: PMC6207352 DOI: 10.18549/pharmpract.2018.03.1206] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 07/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Falls in elderly people can lead to serious health problems. There is limited knowledge about the prevalence of falls, risk factors and causes of falls in the United Arab Emirates. Objective: To assess the prevalence of falls among older adults aged 60 years and above and to determine the risk factors associated with falls. Methods: This cross-sectional study was conducted using an anonymous, 20-item questionnaire which was developed in English and Arabic to be delivered as a semi-structured interview. The pre-piloted questionnaire was distributed to 510 families with at least one elderly person. The study was conducted in Sharjah and Dubai, United Arab Emirates, from September to November 2017. Results: Participants were Arabs (368; 99.5%), living with family (339; 91.6%), females (256; 69.2%), married (240; 64.9%), holders of a university Bachelor’s degree (110; 29.7%), and unemployed (154; 41.6%). Almost half of the participants (188; 50.8%) had a fall in the past two years, and three quarters (141; 75%) of those claimed that their illness was the reason for their fall. The results indicate that female and 70 years and above old participants are more likely to experience falls than males and younger counterparts respectively. A larger proportion of elderly participants not taking medications did not experience falls, while those on 1-4 medications fallers were less than non-fallers. However as the number of medications increased to 5-8 and more than 8 the number of those experiencing falls was significantly higher than non-fallers. Conclusions: Falls are prevalent among the elderly population studied and efforts should be made to decrease the incidence of falls, identify those at risk and increase awareness about falls and their health consequences among the elderly and the general public.
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Affiliation(s)
- Suleiman I Sharif
- Department of Pharmacy Practice & Pharmacotherapeutics. College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
| | - Alaa B Al-Harbi
- Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
| | - Alaa M Al-Shihabi
- Department of Pharmacy Practice & Pharmacotherapeutics, College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
| | - Dana S Al-Daour
- Department of Pharmacy Practice & Pharmacotherapeutics. College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
| | - Rubian S Sharif
- Department of Pharmacy Practice & Pharmacotherapeutics. College of Pharmacy, University of Sharjah. Sharjah (United Arab Emirates).
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018; 35:43-60. [PMID: 29350335 DOI: 10.1007/s40266-018-0516-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice. OBJECTIVES The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity). METHODS A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting. RESULTS After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%). CONCLUSION The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia.
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
| | - Gillian E Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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127
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Heider D, Matschinger H, Meid AD, Quinzler R, Adler JB, Günster C, Haefeli WE, König HH. The impact of potentially inappropriate medication on the development of health care costs and its moderation by the number of prescribed substances. Results of a retrospective matched cohort study. PLoS One 2018; 13:e0198004. [PMID: 30063697 PMCID: PMC6067698 DOI: 10.1371/journal.pone.0198004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background In the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase health care costs. Objective Using data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and health care costs applying a longitudinal perspective. Methods An initial number of 6,849,622 insurants aged 65+ of a large German health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on health care costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period. Results After successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total health care costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total health care costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total health care costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2–4 of the post-period, the differences between both study groups tended to decrease sequentially. Conclusions PIM use has an increasing effect on the development of health care costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.
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Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cool C, Cestac P, McCambridge C, Rouch L, de Souto Barreto P, Rolland Y, Lapeyre‐Mestre M. Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention. Br J Clin Pharmacol 2018; 84:1598-1610. [PMID: 29607568 PMCID: PMC6005629 DOI: 10.1111/bcp.13598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/12/2018] [Accepted: 03/02/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Potentially inappropriate drug prescribing (PIDP) is frequent in nursing home (NH) residents. We aimed to investigate whether a geriatric intervention on quality of care reduced PIDP. METHODS We performed an ancillary study within a multicentric individually-tailored controlled trial (IQUARE trial). All NH received a baseline and 18-month audit regarding drug prescriptions and other quality of care indicators. After the initial audit, NHs of the intervention group benefited of an in-site intervention (geriatric education for NH staff) provided by a geriatrician from the closest hospital. The analysis included 629 residents of 159 NHs. The main outcome was PIDP, defined as the presence of at least one of the following criteria: (i) drug with an unfavourable benefit-to-risk ratio; (ii) with questionable efficacy; (iii) absolute contraindication; (iv) significant drug-drug interaction. Multivariable multilevel logistic regression models were performed including residents and NH factors as confounders. RESULTS PIDP was 65.2% (-3.6% from baseline) in the intervention group (n = 339) and 69.9% (-2.3%) in the control group (n = 290). The intervention significantly decreased PIDP [odds ratio (OR) = 0.63; 95% confidence interval 0.40-0.99], as a special care unit in NH (OR = 0.60; (0.42 to 0.85)), and a fall in the last 12 months (OR = 0.63; 0.44-0.90). Charlson Comorbidity Index [ORCCI = 1 vs. 0 = 1.38; 0.87-2.19, ORCCI ≥ 2 vs. 0 = 2.01; (1.31-3.08)] and psychiatric advice and/or hospitalization in a psychiatric unit (OR = 1.53; 1.07-2.18) increased the likelihood of PIDP. CONCLUSION This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient level.
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Affiliation(s)
- Charlène Cool
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philippe Cestac
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Cécile McCambridge
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Laure Rouch
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
- UMR 7268 Aix‐Marseille, Laboratoire d'Anthropologie bioculturelle, droit, éthique et santéFrance
| | - Yves Rolland
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
| | - Maryse Lapeyre‐Mestre
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Service de Pharmacologie Médicale et Clinique, CIC Inserm 1436CHU de Toulouse37 Allées Jules GuesdeF 31000ToulouseFrance
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Tommelein E, Mehuys E, Van Tongelen I, Petrovic M, Somers A, Colin P, Demarche S, Van Hees T, Christiaens T, Boussery K. Community pharmacists' evaluation of potentially inappropriate prescribing in older community-dwelling patients with polypharmacy: observational research based on the GheOP³S tool. J Public Health (Oxf) 2018; 39:583-592. [PMID: 27698269 DOI: 10.1093/pubmed/fdw108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 08/30/2016] [Indexed: 01/08/2023] Open
Abstract
Background In this study, we aimed to (i) determine the prevalence of potentially inappropriate prescribing (PIP) in community-dwelling older polypharmacy patients using the Ghent Older People's Prescriptions community-Pharmacy Screening (GheOP³S) tool, (ii) identify the items that account for the highest proportion of PIP and (iii) identify the patient variables that may influence the occurrence of PIP. Additionally, pharmacist-physician contacts emerging from PIP screening with the GheOP³S tool and feasibility of the GheOP³S tool in daily practice were evaluated. Methods A prospective observational study was carried out between December 2013 and July 2014 in 204 community pharmacies in Belgium. Patients were eligible if they were (i) ≥70 years, (ii) community-dwelling, (iii) using ≥5 chronic drugs, (iv) a regular visitor of the pharmacy and (v) understanding Dutch or French. Community pharmacists used a structured interview to obtain demographic data and medication use and subsequently screened for PIP using the GheOP³S tool. A Poisson regression was used to investigate the association between different covariates and the number of PIP. Results In 987 (97%) of 1016 included patients, 3721 PIP items were detected (median of 3 per patient; inter quartile range: 2-5). Most frequently involved with PIP are drugs for the central nervous system such as hypnosedatives, antipsychotics and antidepressants. Risk factors for a higher PIP prevalence appeared to be a higher number of drugs (30% extra PIPs per 5 extra drugs), female gender (20% extra PIPs), higher body mass index (BMI, 20% extra PIPs per 10-unit increase in BMI) and poorer functional status (30% extra PIPs with 6-point increase). The feasibility of the GheOP³S tool was acceptable although digitalization of the tool would improve implementation. Despite detecting at least one PIP in 987 patients, only 39 physicians were contacted by the community pharmacists to discuss the items. Conclusion A high prevalence of PIP in community-dwelling older polypharmacy patients in Belgium was detected which urges for interventions to reduce PIP.
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Affiliation(s)
- Eline Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Inge Van Tongelen
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Mirko Petrovic
- Department of Internal medicine, Faculty of Medicine and Health Sciences, Ghent University, B-9000, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, B-9000, Belgium
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Sophie Demarche
- Department of Clinical Pharmacy, CIRM (Centre for Interdisciplinary Research on Medicines), University of Liège, B-9000, Belgium
| | - Thierry Van Hees
- Department of Clinical Pharmacy, CIRM (Centre for Interdisciplinary Research on Medicines), University of Liège, B-9000, Belgium
| | - Thierry Christiaens
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, B-9000, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
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Colombo F, Nunnari P, Ceccarelli G, Romano AV, Barbieri P, Scaglione F. Measures of Drug Prescribing at Care Transitions in an Internal Medicine Unit. J Clin Pharmacol 2018; 58:1171-1183. [PMID: 29723431 DOI: 10.1002/jcph.1123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/23/2018] [Indexed: 11/09/2022]
Abstract
Care transitions represent a common source of drug errors and confusions. The purpose of our prospective observational study was to assess the prevalence of medication discrepancies at care transitions, along with potentially inappropriate medications and potential drug-drug interactions, in an internal medicine unit of an Italian hospital. Adverse drug reactions that occurred in the 30-day period after the discharge from the hospital were included. A related-samples McNemar test was performed for evaluating the effects of hospitalization on the above-mentioned measures of drug prescribing. Medication discrepancies were frequent both on admission (93.4% [95%CI 0.8749, 0.9713]) and at discharge (78.7% [95%CI 0.7035, 0.8558]), with a significant difference between transition times (-14.7% [95%CI -21.82%, -7.69%]; P < .001)]. A high potentially inappropriate medication use prevalence was revealed without differences between care transitions. Potential drug-drug interactions were more frequent at admission to the hospital, with a significant difference of 8.2% in the distribution of patients with potential drug-drug interactions between care transitions. None of the adverse drug reactions recorded on follow-up was related to unintentional discrepancies, and the prevalence rate of patients with potentially inappropriate medication-related adverse drug reactions ranged between 4.9% and 6.9%, and the prevalence rate of patients with drug-drug interaction-related adverse drug reactions was 4.1% of patients. This study is important to raise awareness of the potential dangers medication discrepancies, potentially inappropriate medications, and potential drug-drug interactions could have on older adults. Clinicians and clinical pharmacologists must collaborate to improve patient care and minimize drug-related clinical outcomes.
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Affiliation(s)
- Fabrizio Colombo
- Internal Medicine Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pietro Nunnari
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Giovanni Ceccarelli
- Quality and Clinical Risk Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Valerio Romano
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Pietro Barbieri
- Quality and Clinical Risk Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.,Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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131
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Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality. Int Psychogeriatr 2018; 30:715-726. [PMID: 29145919 DOI: 10.1017/s1041610217002290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people. OBJECTIVE To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France. METHODS The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years). RESULTS Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11-6.16 and aOR≥10 drugs 2.69, 95% CI 1.06-6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04-6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94-5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28-4.12). CONCLUSIONS This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.
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132
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Potentially Inappropriate Medication Prescribing and Risk of Unplanned Hospitalization among the Elderly: A Self-Matched, Case-Crossover Study. Drug Saf 2018; 41:959-968. [DOI: 10.1007/s40264-018-0676-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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133
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Ivanova I, Elseviers M, Wauters M, Christiaens T, Vander Stichele R. European repository of explicit criteria of potentially inappropriate medications in old age. Geriatr Gerontol Int 2018; 18:1293-1297. [DOI: 10.1111/ggi.13331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ivana Ivanova
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit; Ghent University; Ghent Belgium
| | - Monique Elseviers
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit; Ghent University; Ghent Belgium
- Center for Research and Innovation in Care, Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - Maarten Wauters
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit; Ghent University; Ghent Belgium
| | - Thierry Christiaens
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit; Ghent University; Ghent Belgium
| | - Robert Vander Stichele
- Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit; Ghent University; Ghent Belgium
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134
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de Germay S, Lapeyre-Mestre M, Montastruc JL, Montastruc F. [Atropinic burden and anticholinergic drugs: Interest and application in clinical practice in the elderly]. Therapie 2018; 76:665-673. [PMID: 29625707 DOI: 10.1016/j.therap.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022]
Abstract
Anticholinergic drugs (also called antimuscarinics or atropinics) increase the risk of falls, cognitive impairment and/or mortality in older patients. These drugs belong to the lists of potentially inappropriate medications in the elderly. The aim of this review was to present and discuss the different tools available to measure the atropinic risk in drug exposure of older patients. Several scales, developed from biological and/or clinical criteria, allow to classify anticholinergic drugs according to their atropinic potency and to assign to them an atropinic burden. Total atropinic burden of patient drug exposure can be calculated as the sum of atropinic score of each drug. Other tools include drug daily doses to better estimate the atropinic risk. These different methods are a precious help to decrease atropinic exposure in the elderly. Nevertheless, they have to be considered as upgradable and it is necessary to adapt them regularly according to the introduction of new drugs in clinical practice.
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Affiliation(s)
- Sibylle de Germay
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées d'évaluation et d'information sur la pharmacodépendance et d'addictovigilance (CEIP-A), centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament et pharmacopôle Midi-Pyrénées, 31000 Toulouse, France
| | - François Montastruc
- Service de pharmacologie médicale et clinique, centre hospitalier universitaire et faculté de médecine de Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, université de Toulouse, 31000 Toulouse, France; Centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament et pharmacopôle Midi-Pyrénées, 31000 Toulouse, France
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135
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Motter FR, Fritzen JS, Hilmer SN, Paniz ÉV, Paniz VMV. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol 2018; 74:679-700. [PMID: 29589066 DOI: 10.1007/s00228-018-2446-0] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Potentially inappropriate medication (PIM) use causes preventable adverse drug reactions in older patients. Several assessment tools have been published to identify and avoid PIM use. In this systematic literature review, we aim to provide summaries and comparisons of validated PIMs lists published between 1991 and 2017 internationally. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), we performed a systematic review of articles describing the development and validation of criteria for identification of PIMs among older people published between January 1991 and April 2017. The searches were conducted on PUBMED, AgeLine, Academic Search, Academic Search Premier, and CINAHL. We identified the most common medications/classes described as PIM. We also identified the drug-disease interactions and drug-drug interactions reported among criteria. RESULTS From 2933 articles screened, 36 met our inclusion criteria. The majority used the Delphi method to validate their criteria. We identified 907 different medications/classes, 536 different drug disease interactions involving 84 diseases/conditions, and 159 drug-drug interactions. Benzodiazepines and nonsteroidal anti-inflammatory drugs were the medications most commonly reported as potentially inappropriate for older people. CONCLUSION Although approaches aimed at detecting inappropriate prescribing have intensified in recent years, we observed limited overlap between different PIM lists. Additionally, some PIM lists did not provide special considerations of use and alternative therapies to avoid PIMs. These facts may compromise the use of PIM lists in clinical practice. Future PIM lists should integrate information about alternative therapies and special considerations of use in order to help clinicians in the drug prescription.
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Affiliation(s)
- Fabiane Raquel Motter
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), Av. Unisinos, 920, Sao Leopoldo, RS, 93022-000, Brazil. .,Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital and University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia.
| | - Janaína Soder Fritzen
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), Av. Unisinos, 920, Sao Leopoldo, RS, 93022-000, Brazil
| | - Sarah Nicole Hilmer
- Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital and University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Érika Vieira Paniz
- Faculty of Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400,4º andar Faculdade de Medicin, Porto Alegre, RS, 90035-003, Brazil
| | - Vera Maria Vieira Paniz
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), Av. Unisinos, 920, Sao Leopoldo, RS, 93022-000, Brazil
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136
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Saqib A, Atif M, Scahill S. Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anum Saqib
- Department of Pharmacy; The Islamia University of Bahawalpur; Bahawalpur Pakistan
| | - Muhammad Atif
- Department of Pharmacy; The Islamia University of Bahawalpur; Bahawalpur Pakistan
| | - Shane Scahill
- School of Management; Massey University; Wellington New Zealand
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137
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Graf J, Lucke T, Herrera R, Watz H, Holle R, Vogelmeier C, Ficker JH, Jörres RA. Compatibility of medication with PRISCUS criteria and identification of drug interactions in a large cohort of patients with COPD. Pulm Pharmacol Ther 2018; 49:123-129. [PMID: 29421666 DOI: 10.1016/j.pupt.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
Patients with COPD are often of advanced age and have a high number of medications due to their lung disease and comorbidities. Thus they are at risk for unwanted effects from drugs, either due to age or due to interactions between drugs. These issues are not clarified. We therefore assessed the number of medications and potential adverse effects in a large cohort of patients with COPD. The analysis was performed in 2741 patients of the German COPD cohort COSYCONET, using baseline data (visit 1) and follow-up data after about 1.5 years (visit 3). Spirometric GOLD grades 1-4 were found in 8/35/32/9% of patients and GOLD groups ABCD in 7/25/4/48% of patients, while the remaining patients (n = 450, 16.4%) could not be classified according to GOLD criteria. The compatibility of medication with age was evaluated via the PRISCUS list, drug interactions via the AiD clinic system, whereby only drug combinations occurring in at least 10 patients were considered (nine unwanted interactions, one wanted interaction). The median numbers of medications were 5 or more in all patient categories, among them 3 or more non-respiratory medications. In the total population there were 153 patients (10.2%) aged ≥65 years who had any medication of the PRISCUS list with intermediate or low risk. Serious adverse combinations of drugs according to AiD occurred in 114 patients (4.2%), while the number of unwanted but only potentially clinically relevant combinations was 175 (6.4%). The number of wanted combinations was 219 (8.0%). These numbers did not markedly change when restricting the analysis to patients of GOLD grades 1-4. Moreover, the results were similar for visit 1 and visit 3. We conclude that in a large cohort of COPD patients about 10% of patients aged at least 65 years had medications that could interfere with their age and that the proportions of patients with either unwanted or wanted drug interactions were both in the range of 8-10%. These results suggest that problems arising from the high number of medications were not very frequent in the COPD cohort analysed.
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Affiliation(s)
- Jana Graf
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Ronald Herrera
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Center for International Health, Ludwig-Maximilians-University (LMU) Munich, München, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Rolf Holle
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Claus Vogelmeier
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Center Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany; Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany.
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138
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Impact of collaborative pharmaceutical care on in-patients' medication safety: study protocol for a stepped wedge cluster randomized trial (MEDREV study). Trials 2018; 19:19. [PMID: 29310711 PMCID: PMC5759250 DOI: 10.1186/s13063-017-2412-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022] Open
Abstract
Background Clinical pharmaceutical care has long played an important role in the improvement of healthcare safety. Pharmaceutical care is a collaborative care approach, implicating all the actors of the medication circuit in order to prevent and correct drug-related problems that can lead to adverse drug events. The collaborative pharmaceutical care performed during patients’ hospitalization requires two mutually reinforcing activities: medication reconciliation and medication review. Until now, the impact of the association of these two activities has not been clearly studied. Methods This is a multicentric stepped wedge randomized study involving six care units from six French University Hospitals (each unit corresponding to a cluster) over seven consecutive 14-day periods. Each hospital unit will start with a control period and switch to an experimental period after a randomized number of 14-day periods. Patients aged at least 65 years hospitalized in one of the participating care units and having given their consent to be called for a 30-day and 90-day follow-up can be enrolled. For each 14-day period, 15 patients will be recruited in each care unit to obtain a total of 630 patients enrolled in all centers. Patients with a hospital stay of more than 21 days will be excluded. During the control period, there will be no clinical pharmacist in the care unit, whereas during the experimental period a clinical pharmacist will perform medication reconciliation and review with the healthcare team. The primary outcome will assess the impact of collaborative pharmaceutical care on preventable medication error rate. The secondary outcomes will evaluate the clinical impact of the strategy, the acceptance rate of pharmaceutical interventions, the induced and avoided costs of the strategy (cost-consequence analysis), and the healthcare team’s satisfaction. Discussion This study will assess the impact of collaborative pharmaceutical care associating medication reconciliation and review at patient admission to hospital in terms of preventable medication error rate and costs. This activity will prevent and correct medication errors arising earlier in the hospitalization. Trial registration ClinicalTrials.gov, NCT02598115. Registered on 4 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2412-7) contains supplementary material, which is available to authorized users.
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139
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Rouch L, Farbos F, Cool C, McCambridge C, Hein C, Elmalem S, Rolland Y, Vellas B, Cestac P. Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care. J Nutr Health Aging 2018; 22:328-334. [PMID: 29484345 DOI: 10.1007/s12603-017-0940-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. DESIGN Observational prospective cohort study. SETTING Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. PARTICIPANTS 206 subjects with a mean age of 85 years. MEASUREMENTS Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists' and GPs' opinions about quality of communication and information transfer at hospital-general practice interface were investigated. RESULTS 5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients' discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients' hospitalization. CONCLUSION Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.
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Affiliation(s)
- L Rouch
- Laure Rouch,Toulouse University Hospital, Department of Pharmacy, France,
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140
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Sourdet S, Rochette C, de Souto Barreto P, Nourhashemi F, Piau A, Vellas B, Rolland Y. Drug Prescriptions in Nursing Home Residents during their Last 6 Months of Life: Data from the IQUARE Study. J Nutr Health Aging 2018; 22:904-910. [PMID: 30272091 DOI: 10.1007/s12603-018-1071-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the drug prescriptions of nursing home (NH) residents during the 6 months prior to their death, and the impact of the recognition of « life expectancy lower than 6 months » by the NH staff on the prescriptions. DESIGN Prospective study. SETTING 175 nursing homes in France. PARTICIPANTS 6275 residents were included from May to June 2011. MEASUREMENTS The initial drug prescriptions of the residents who deceased within 6 months were compared with those who did not decease. Among the residents deceased within 6 months, the drug prescriptions were compared between the residents who were «considered at the end of their life» and those who were not. Potentially inappropriate prescriptions (PIP) were analyzed using Laroche criteria and a list of therapies considered as inappropriate at the end of life. RESULTS 498 residents (7.9%) died within 6 months after their inclusion: they had significantly more therapies (8.3 ± 3.8 vs. 7.9 ± 3.5, p=0.048) than non-deceased people. Sixty-one of the residents deceased within 6 months were considered by the NH staff as «end of life residents » (12.2%). They received significantly less drugs (6.4 ± 4.2 vs 8.5 ± 3.6, p<0.001) than NH's residents not identified at the end of their life. They had a more frequent prescription of opioids (p<0.001), and less antipsychotics (p<0.001), lipid-lowering drugs (p=0.006), or antihypertensive therapies (p<0.01). They also received significantly less PIP (59.0% received at least one inappropriate prescription, vs. 87.2%, p<0.001). CONCLUSION An important proportion of nursing home residents received PIP. The quality of prescriptions in patients identified at the end of their life seems to improve, but more than half still receive inappropriate drugs. Special attention in prescribing should be given to these patients presenting a high risk of adverse events.
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Affiliation(s)
- S Sourdet
- S Sourdet, Centre Hospitalier Universitaire de Toulouse, France,
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141
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Renom-Guiteras A, Thürmann PA, Miralles R, Klaaßen-Mielke R, Thiem U, Stephan A, Bleijlevens MHC, Jolley D, Leino-Kilpi H, Rahm Hallberg I, Saks K, Soto-Martin M, Zabalegui A, Meyer G. Potentially inappropriate medication among people with dementia in eight European countries. Age Ageing 2018; 47:68-74. [PMID: 28985257 DOI: 10.1093/ageing/afx147] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/02/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and 'drugs for acid-related disorders' (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.
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Affiliation(s)
- Anna Renom-Guiteras
- School of Nursing Science, University of Witten/Herdecke, Witten, Germany
- Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Petra A Thürmann
- Chair of Clinical Pharmacology, University of Witten/Herdecke, Witten, Germany
- Philipp Klee-Institute of Clinical Pharmacology, HELIOS University Clinic Wuppertal, Wuppertal, Germany
| | - Ramón Miralles
- Geriatrics Department, University Hospital Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
| | - Ulrich Thiem
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
- Department of Geriatrics, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Astrid Stephan
- School of Nursing Science, University of Witten/Herdecke, Witten, Germany
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther UniversityHalle-Wittenberg, Halle (Saale), Germany
| | - Michel H C Bleijlevens
- Care and Public Health Research Institute (Caphri), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - David Jolley
- Honorary Reader in Old Age Psychiatry, Personal Social Services Unit, University of Manchester, Manchester, UK
| | - Helena Leino-Kilpi
- Department of Nursing Science and Nurse Director, University of Turku, Turku University Hospital, Turku, Finland
| | | | - Kai Saks
- Department of Internal Medicine, University of Tartu, Tartu, Estonia
| | - Maria Soto-Martin
- Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, France
| | - Adelaida Zabalegui
- Hospital Clinic de Barcelona, Barcelona, Spain
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Gabriele Meyer
- School of Nursing Science, University of Witten/Herdecke, Witten, Germany
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther UniversityHalle-Wittenberg, Halle (Saale), Germany
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142
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Leger DY, Moreau S, Signol N, Fargeas JB, Picat MA, Penot A, Abraham J, Laroche ML, Bordessoule D. Polypharmacy, potentially inappropriate medications and drug-drug interactions in geriatric patients with hematologic malignancy: Observational single-center study of 122 patients. J Geriatr Oncol 2018; 9:60-67. [DOI: 10.1016/j.jgo.2017.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/23/2017] [Accepted: 07/27/2017] [Indexed: 01/02/2023]
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143
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Schmiedl S, Rottenkolber M, Szymanski J, Drewelow B, Siegmund W, Hippius M, Farker K, Guenther IR, Hasford J, Thuermann PA. Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. Expert Opin Drug Saf 2017; 17:125-137. [PMID: 29258401 DOI: 10.1080/14740338.2018.1415322] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies evaluating the impact of age and potentially inappropriate medication (PIM) on avoidable adverse drug reactions (ADRs) are scarce. METHODS In this prospective, multi-center, long-term (8.5 years) observational study, we analysed ADRs leading to hospitalization in departments of internal medicine. ADRs causality and preventability were assessed using standardised algorithms. PIM was defined based on the PRISCUS-list. Multivariate analyses and estimation of ADR incidence rates were conducted. RESULTS Of all 6,427 ADR patients, a preventable ADR was present in 1,253 (19.5%) patients (elderly patients ≥70 years: 828). Risk factors for preventable ADRs in elderly patients were multimorbidity, two to four ADR-causative drugs, and intake of particular compounds (e.g. spironolactone) but not sex, PIM usage, or the total number of drugs. Regarding particular compounds associated with preventable ADRs, highest incidence rates for preventable ADRs were found for patients aged ≥70 years for spironolactone (3.3 per 1,000 exposed persons (95% CI: 1.4-6.6)) and intermediate-acting insulin (3.3 per 1,000 exposed persons (95% CI: 1.6-6.1)). CONCLUSION Avoiding PIM usage seems to be of limited value in increasing safety in elderly patients whereas our results underline the importance of an individualized medication review of the most commonly implicated drugs in preventable ADRs (supported by BfArM FoNr: V-11337/68605/2008-2010).
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Affiliation(s)
- S Schmiedl
- a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.,b Department of Clinical Pharmacology, School of Medicine, Faculty of Health , Witten/Herdecke University , Witten , Germany
| | - M Rottenkolber
- c Institute for Medical Information Sciences, Biometry, and Epidemiology , Ludwig-Maximilians-Universitaet Muenchen , Munich , Germany
| | - J Szymanski
- a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.,b Department of Clinical Pharmacology, School of Medicine, Faculty of Health , Witten/Herdecke University , Witten , Germany
| | - B Drewelow
- d Institute of Clinical Pharmacology, Center for Pharmacology and Toxicology , University of Rostock , Rostock , Germany
| | - W Siegmund
- e Institute of Clinical Pharmacology , University of Greifswald , Greifswald , Germany
| | - M Hippius
- f Department of Clinical Pharmacology , Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena , Jena , Germany
| | - K Farker
- f Department of Clinical Pharmacology , Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena , Jena , Germany.,g Sophien- und Hufeland-Klinikum Weimar , Weimar , Germany
| | - I R Guenther
- f Department of Clinical Pharmacology , Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena , Jena , Germany.,g Sophien- und Hufeland-Klinikum Weimar , Weimar , Germany
| | - J Hasford
- c Institute for Medical Information Sciences, Biometry, and Epidemiology , Ludwig-Maximilians-Universitaet Muenchen , Munich , Germany
| | - P A Thuermann
- a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.,b Department of Clinical Pharmacology, School of Medicine, Faculty of Health , Witten/Herdecke University , Witten , Germany
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144
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Iatrogénie médicamenteuse chez la personne âgée, comprendre et agir. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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145
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146
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Pillon F. La lutte contre les effets indésirables médicamenteux, toujours une priorité. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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147
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Ferret L, Ficheur G, Delaviez E, Luyckx M, Quenton S, Beuscart R, Chazard E, Beuscart JB. Inappropriate anticholinergic drugs prescriptions in older patients: analysing a hospital database. Int J Clin Pharm 2017; 40:94-100. [PMID: 29147963 DOI: 10.1007/s11096-017-0554-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/26/2017] [Indexed: 01/25/2023]
Abstract
Background Although many anticholinergics are inappropriate in older patients, the prescription of these drugs in a hospital setting has not been extensively studied. Objective To describe prescriptions of anticholinergic drugs in terms of frequency, at risk situations and constipation in hospitalized, older adults. Setting Using a database from a French general hospital (period 2009-2013), we extracted information on 14,090 hospital stays by patients aged 75 and over. Methods Anticholinergic drug prescriptions were automatically detected, with a focus on prescriptions in three well-known at-risk situations: falls, dementia, and benign prostatic hyperplasia. Cases of constipation that might have been causally related to the administration of anticholinergic drugs were screened for and reviewed. Main outcome measure Prescriptions with a high associated risk of anticholinergic related adverse reactions. Results Administration of an anticholinergic drug was detected in 1412 (10.0%) of the hospital stays by older patients. At-risk situations were identified in 413 (36.5%) of these stays: 137 (9.7%) for falls, 243 (17.2%) for dementia, and 114 (8.1%) for benign prostatic hyperplasia; 78 (18.9%) of these 413 stays featured a combination of two or three at-risk situations. Cases of constipation induced by anticholinergic drug administration were identified in 188 (13.3%) patient stays by using validated adjudication rules for adverse drug reactions: 85 and 103 cases were respectively evaluated as "possible" or "probable" adverse drug reactions. Conclusions Anticholinergic drugs prescription was found in 10.0% of hospitalized, older patients. More than one third of these prescriptions occurred in at-risk situations and more than one in ten prescriptions induced constipation.
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Affiliation(s)
- Laurie Ferret
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France
| | - Gregoire Ficheur
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France
- Department of Medical Information and Archives, CHU Lille, 59000, Lille, France
| | - Emeline Delaviez
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France
| | - Michel Luyckx
- Department of Pharmacy, Denain General Hospital, Denain, France
- EA GRITA -Laboratoire de pharmacologie, pharmacocinétique et pharmacie clinique, Univ. Lille, 59000, Lille, France
| | - Sophie Quenton
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France
| | - Regis Beuscart
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France
- Department of Medical Information and Archives, CHU Lille, 59000, Lille, France
| | - Emmanuel Chazard
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France
- Department of Medical Information and Archives, CHU Lille, 59000, Lille, France
| | - Jean-Baptiste Beuscart
- EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, 59000, Lile, France.
- Department of Geriatrics, CHU Lille, 59000, Lille, France.
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148
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Can clinical practice indicator relating to long-acting benzodiazepine use in the elderly be easily generated in a hospital setting? Eur J Clin Pharmacol 2017; 74:233-241. [PMID: 29147805 DOI: 10.1007/s00228-017-2371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To improve the appropriate use of long-acting benzodiazepine (la.bzd) prescriptions in the elderly, the Haute Autorité de Santé (HAS) has developed clinical practice indicators (CPI). The alert indicator (AI) evaluates the prevalence of la.bzd prescription among older people. The mastering indicator (MI) corresponds to the prevalence of elderly with a justified, i.e., appropriate, la.bzd prescription among all the elderly with la.bzd prescriptions. OBJECTIVE The objective of this study was to test the feasibility of routine generation of CPI regarding la.bzd prescriptions among the elderly in the hospital setting. DESIGN This was a retrospective study. SETTING The study was conducted in two university hospitals located in Paris. SUBJECT Eligible cases were patients aged 65 years and older who were hospitalized in acute care units from January to June 2014. METHOD The AI calculation was based on information extracted from medical databases from these hospitals. The appropriateness of la.bzd prescription was assessed by a physician and a pharmacist and was based on review of computerized patient records and prescriptions, using an ad hoc algorithm. The MI was then calculated. Variation in the level of indicators was explored according to the characteristics of patients and of their hospitalization using chi2 test. Factors associated with a potentially inappropriate prescription (PIP) of la.bzd were studied using univariate and multivariate logistic regression. RESULT Among the 4167 patients included in the study, 362 had la.bzd prescriptions, i.e., the AI was 9%. Prescriptions were found to be appropriate for 83 patients, i.e., the MI was 23% and PIP was 77%. The MI varied between 13 and 31% according to characteristics of patients and of hospitalization. In multivariate analysis, factors associated with PIP were age, number of comorbidities, type of care unit, and concurrent prescription of a neuroleptic or hypnotic. CONCLUSION Generation of the AI was routinely possible but only for acute care units with computerized prescriptions, corresponding to 78% of patients. Production of the MI has required medical record review for all patients with a la.bzd prescription and cannot be automated. However, difficulties in generating the MI have identified areas for significant improvement. Moreover, strategies to improve the care of older people with a la.bzd prescription could be targeted using characteristics of patients and of hospitalization associated with PIP. The future deployment of a single electronic medical record in all care departments would make it easier to mine the data and make possible automated production of CPI.
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Pandraud-Riguet I, Bonnet-Zamponi D, Bourcier E, Buyse M, Laribe-Caget S, Frémont P, Pautas E, Verny C, Hindlet P, Fernandez C. Monitoring of Potentially Inappropriate Prescriptions in Older Inpatients: A French Multicenter Study. J Am Geriatr Soc 2017; 65:2713-2719. [DOI: 10.1111/jgs.15081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Irène Pandraud-Riguet
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Dominique Bonnet-Zamponi
- Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique Ile de France; Paris France
- Centre de Pharmaco-Epidémiologie; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Elsa Bourcier
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
- Sorbonne Universités; UPMC Université Paris 06; INSERM; Institut Pierre Louis d'Epidémiologie et de Santé Publique; France
- Faculté de Pharmacie; Université Paris-Sud; Chatenay-Malabry France
| | - Marion Buyse
- Service de Pharmacie; Fondation Ildys; Roscoff France
| | - Sandra Laribe-Caget
- Service de Pharmacie; Hôpital Rothschild; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Patrick Frémont
- Service de Psychiatrie; CH Lagny-Marne La Vallée; Lagny sur Marne France
| | - Eric Pautas
- Court Séjour Gériatrique; Hôpital Charles-Foix; Assistance Publique - Hôpitaux de Paris; Ivry-sur-Seine France
- Unité de Formation et de Recherche de Médecine Pierre-et-Marie-Curie; Université Paris 06; Paris France
| | - Christiane Verny
- Service de Gériatrie; Assistance Publique - Hôpitaux de Paris; Hôpital Bicêtre; Le Kremlin-Bicêtre France
| | - Patrick Hindlet
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
- Sorbonne Universités; UPMC Université Paris 06; INSERM; Institut Pierre Louis d'Epidémiologie et de Santé Publique; France
- Faculté de Pharmacie; Université Paris-Sud; Chatenay-Malabry France
| | - Christine Fernandez
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
- Sorbonne Universités; UPMC Université Paris 06; INSERM; Institut Pierre Louis d'Epidémiologie et de Santé Publique; France
- Faculté de Pharmacie; Université Paris-Sud; Chatenay-Malabry France
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150
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Blanc AL, Spasojevic S, Leszek A, Théodoloz M, Bonnabry P, Fumeaux T, Schaad N. A comparison of two tools to screen potentially inappropriate medication in internal medicine patients. J Clin Pharm Ther 2017; 43:232-239. [PMID: 28990244 DOI: 10.1111/jcpt.12638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN Potentially inappropriate medication (PIM) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. OBJECTIVE To compare two PIM-screening tools-STOPP/START and PIM-Check-applied to internal medicine patients. A second objective was to compare the use of PIMs in readmitted and non-readmitted patients. METHOD A retrospective observational study, in the general internal medicine ward of a Swiss non-university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex- and age-matched patients who were not readmitted. PIMs were screened using the STOPP/START tool, developed for geriatric patients, and the PIM-Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIMs involving readmitted and non-readmitted patients were compared. RESULTS Across the whole population, PIM-Check and STOPP/START detected 1348 and 537 PIMs, respectively, representing 13.5 and 5.4 PIMs/patient. Screening time was substantially shorter with PIM-Check than with STOPP/START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIMs detected using PIM-Check and STOPP/START, respectively, were clinically relevant to individual patients' cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non-readmitted patients. WHAT IS NEW AND CONCLUSION Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly half of the PIMs detected were judged to be non-clinically relevant, however, potentially overalerting the prescriber. These tools can, nevertheless, be considered useful in daily practice. Furthermore, the relevance of any PIM detected by these tools should always be carefully evaluated within the clinical context surrounding the individual patient.
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Affiliation(s)
- A-L Blanc
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,Pharmacie Interhospitalière de la Côte, Morges, Switzerland.,School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - S Spasojevic
- School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - A Leszek
- Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland
| | - M Théodoloz
- Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - P Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - T Fumeaux
- Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - N Schaad
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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