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Hammouda N, Vargas-Torres C, Doucette J, Hwang U. Geriatric emergency department revisits after discharge with Potentially Inappropriate Medications: A retrospective cohort study. Am J Emerg Med 2021; 44:148-156. [PMID: 33621716 DOI: 10.1016/j.ajem.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To determine whether Potentially Inappropriate Medications (PIMs) prescribed in an academic emergency department (ED) are associated with increased ED revisits in older adults. METHODS A retrospective chart review of Medicare beneficiaries 65 years and older, discharged from an academic ED (January 2012 - November 2015) with any PIMs versus no PIMs. PIMs were defined using Category 1 of the 2015 Updated Beers criteria. Primary outcomes, obtained from a Medicare database linked to hospital ED subjects, were ED revisits 3 and 30 days from index ED discharge. Adjusted multiple logistic regression was used with entropy balance weighted covariates: Age in years, Gender, Race, Number of discharge medications, Charlson Comorbidity Index (CCI) score, Emergency Severity Index scores (ESI), Chief Complaint, Medicaid status, and prior 90 Day ED visits. RESULTS Over the study period, there were a total of 7,591 Medicare beneficiaries 65+ discharged from the ED with a prescription; 1,383 (18%) received one or more PIMs. ED revisits in 30 days were fewer for the PIMs cohort (12% PIMs vs 16% no PIMs, OR 0.79, 95% CI 0.65 - 0.95, P value <0.005). Hospital admissions in 30 days were fewer for the PIMs cohort (4 PIMs vs 7% no PIMs, OR 0.75, 95% CI 0.56 - 1.00, P value <0.005). In addition to PIMs, covariate risk factors associated with ED revisits in 30 days included comorbidity severity, history of prior ED revisits, chief complaint, and Medicaid status. Risk factors associated with hospitalization in 30 days included those plus age and emergency severity index, but not race nor ethnicity. CONCLUSIONS Patients discharged from the ED receiving potentially inappropriate medications as defined by Category 1 of the 2015 updated Beers criteria had lower odds of revisiting the ED within 30 days of index visit. Sociodemographic factors such as gender and race did not predict ED revisits or hospital admissions. Clinical characteristics predicted ED revisits and hospital admissions, the strongest risk being increasing Charlson Comorbidity Index score followed by triage acuity and chief complaint. Future studies are needed to delineate the implications of our findings.
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Affiliation(s)
- Nada Hammouda
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA.
| | - Carmen Vargas-Torres
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA
| | - John Doucette
- Department of Environmental Medicine and Public Health, Mount Sinai School of Medicine, New York City, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY, USA
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Kim K, Jung J, Kim H, Kim JT, Oh JM, Kim H. Potentially Inappropriate Prescriptions to Older Patients in Emergency Departments in South Korea: A Retrospective Study. Ther Clin Risk Manag 2021; 17:173-181. [PMID: 33642859 PMCID: PMC7903959 DOI: 10.2147/tcrm.s291458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the incidence of the administration of potentially inappropriate medications (PIMs) and the potential drug–drug interactions (pDDIs) in older patients in emergency departments (EDs) over a 12-month period and to identify the factors associated with the administration of PIMs. Patients and Methods This retrospective study was conducted using the electronic medical records from two university-affiliated teaching hospitals in South Korea. ED visit cases of patients aged 65 and older from January 1, 2013, to December 31, 2013, were included in the analysis. Among the medications administered in ED, PIMs or pDDIs were identified using a drug utilization review program available in Korea. Results During the study period, a total of 13,002 ED visit cases were reported from 10,686 patients. The proportion of ED visit cases with any PIM was 79.2% and the average number of PIMs was 2.7 (range, 1–17). The most commonly administered PIMs that were contraindicated or should have been used with caution were ketorolac (41.3%) and metoclopramide (10.3%), respectively. Multivariate regression analysis indicated that female patients (p = 0.012), patients with more than six drugs in the ED (p < 0.001), and visits longer than 300 minutes (p = 0.026) were significantly associated with PIM administration in the ED. Potential DDIs between the medications administered in EDs were observed in 20.5% of total visit cases, with ketorolac being the most frequently reported drug in contraindicated drug combinations. Conclusion This study demonstrated a high incidence of the administration of PIMs and medications with pDDIs in older patients in EDs and revealed the characteristics that are significantly associated with an increased risk of PIM administration. Healthcare providers in EDs should consider the risk of administering PIMs or medications with pDDIs, especially when treating older patients.
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Affiliation(s)
- Kyungim Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea.,Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Jinyoung Jung
- Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Haesook Kim
- Department of Pharmacy, Gang Neung Asan Hospital, Gangneung, Republic of Korea
| | - Jung Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea.,Drug Information Research Institute, College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
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Weir DL, Lee TC, McDonald EG, Motulsky A, Abrahamowicz M, Morgan S, Buckeridge D, Tamblyn R. Both New and Chronic Potentially Inappropriate Medications Continued at Hospital Discharge Are Associated With Increased Risk of Adverse Events. J Am Geriatr Soc 2020; 68:1184-1192. [PMID: 32232988 PMCID: PMC7687123 DOI: 10.1111/jgs.16413] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Admission to hospital provides the opportunity to review patient medications; however, the extent to which the safety of drug regimens changes after hospitalization is unclear. OBJECTIVE To estimate the number of potentially inappropriate medications (PIMs) prescribed to patients at hospital discharge and their association with the risk of adverse events 30 days after discharge. DESIGN Prospective cohort study. SETTING Tertiary care hospitals within the McGill University Health Centre Network in Montreal, Quebec, Canada. PARTICIPANTS Patients from internal medicine, cardiac, and thoracic surgery, aged 65 years and older, admitted between October 2014 and November 2016. MEASURES Abstracted chart data were linked to provincial health databases. PIMs were identified using AGS (American Geriatrics Society) Beers Criteria®, STOPP, and Choosing Wisely statements. Multivariable logistic regression and Cox models were used to assess the association between PIMs and adverse events. RESULTS Of 2,402 included patients, 1,381 (57%) were male; median age was 76 years (interquartile range [IQR] = 70‐82 years); and eight discharge medications were prescribed (IQR = 2‐8). A total of 1,576 (66%) patients were prescribed at least one PIM at discharge; 1,176 (49%) continued a PIM from prior to admission, and 755 (31%) were prescribed at least one new PIM. In the 30 days after discharge, 218 (9%) experienced an adverse drug event (ADE) and 862 (36%) visited the emergency department (ED), were rehospitalized, or died. After adjustment, each additional new PIM and continued community PIM were respectively associated with a 21% (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 1.01‐1.45) and a 10% (OR = 1.10; 95% CI = 1.01‐1.21) increased odds of ADEs. They were also respectively associated with a 13% (hazard ratio [HR] = 1.13; 95% CI = 1.03‐1.26) and a 5% (HR = 1.05; 95% CI = 1.00‐1.10) increased risk of ED visits, rehospitalization, and death. CONCLUSIONS Two in three hospitalized patients were prescribed a PIM at discharge, and increasing numbers of PIMs were associated with an increased risk of ADEs and all‐cause adverse events. Improving hospital prescribing practices may reduce the frequency of PIMs and associated adverse events. J Am Geriatr Soc 68:1184–1192, 2020. See related editorial by Donna M. Fick in this issue.
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Affiliation(s)
- Daniala L Weir
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Aude Motulsky
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Steven Morgan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.,Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Ramadanov N, Klein R, Schumann U, Aguilar ADV, Behringer W. Factors, influencing medication errors in prehospital care: A retrospective observational study. Medicine (Baltimore) 2019; 98:e18200. [PMID: 31804342 PMCID: PMC6919435 DOI: 10.1097/md.0000000000018200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the frequency of medication errors in prehospital care and to investigate the influencing factors - diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment.We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ, the Mann-Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05.MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%-60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA.The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3-6 AM) were identified as high risk for medication errors by the emergency physicians.
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Affiliation(s)
- Nikolai Ramadanov
- Center for Emergency Medicine, University Hospital Jena, Friedrich Schiller
| | | | - Urs Schumann
- Center for Internal Medicine, Clinic for Endocrinology and Diabetology Niemegker Str. Bad Belzig, Germany
| | | | - Wilhelm Behringer
- Center for Emergency Medicine, University Hospital Jena, Friedrich Schiller
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Chang CB, Lai HY, Hwang SJ, Yang SY, Wu RS, Liu HC, Chan DC. Prescription of potentially inappropriate medication to older patients presenting to the emergency department: a nationally representative population study. Sci Rep 2018; 8:11727. [PMID: 30082816 PMCID: PMC6078949 DOI: 10.1038/s41598-018-30184-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/23/2018] [Indexed: 12/22/2022] Open
Abstract
Potentially inappropriate medication (PIM) was associated with adverse clinical outcomes and higher healthcare resource utilization among older patients. In order to investigate the prevalence of PIM use based on three different sets of criteria and their associated factors among older patients in the emergency department (ED) in Taiwan. The National Health Insurance Research Database was used for this cross-sectional study. Older patients who visited the ED at least once in 2009 were enrolled. PIMs were identified based on the Beers Criteria, PIM-Taiwan criteria, and PRISCUS criteria. Average patient age was 76.7 ± 7.4 years and patients visited the ED 1.8 ± 2.1 times in 2009. The prevalence and frequency of being prescribed at least one PIM at each visit were high according to all three sets of criteria. Performance of the PIM-Taiwan criteria was only inferior to that of the Beers Criteria. The most important factor associated with PIM was the number of medications prescribed in the ED, and PIM use was associated with higher annual health resource utilization in the ED. PIM use was a significant issue and was associated with higher annual emergency care resource utilization in the ED.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Internal Medicine, National Taiwan University Chu-Tung Branch, Hsin-Chu County, Taiwan.,Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, 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 Veteran General Hospital, Taipei, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Shu-Yu Yang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Taipei City Psychiatry Center, Taipei City Hospital, Taipei, 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.,Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Superintedent Office, National Taiwan University Hospital Chu-Tung Branch, Hsin-Chu County, Taiwan.
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6
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Jeon HL, Park J, Han E, Kim DS. Potentially inappropriate medication and hospitalization/emergency department visits among the elderly in Korea. Int J Qual Health Care 2018; 30:50-56. [PMID: 29438504 DOI: 10.1093/intqhc/mzx171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/11/2018] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the association between potentially inappropriate medicine (PIM) use, defined using the American Geriatric Society (AGS) 2012 Beers criteria, and the risk of hospitalization or emergency department (ED) visits in elderly patients, and to examine the most frequently used PIMs among patients with adverse outcomes. Design/Setting This was a retrospective study using National Health Insurance claims data from 2010 to 2012. Intervention(s) Elderly patients who took PIMs are compared to those who were not taking PIMs. Study participants Elderly patients (n = 79 552) who visited medical institutions in Jeju Island during 2011. Main outcome measure Hospitalization and ED visits were evaluated according to whether the patients took PIMs during the study period. The most frequent medications used by the PIM group were also investigated. Results The likelihood of hospitalization was higher in older patients who took at least one PIM than in those who were not taking PIMs during the study period (odds ratio 2.25, 95% confidence interval 2.09-2.44). Patients taking PIMs were more likely to visit EDs (odds ratio 1.59, 95% confidence interval 1.50-1.67). Among patients who were hospitalized or visited EDs, 45.5% had taken at least one PIM on that day. The most commonly used PIMs included chlorpheniramine maleate, diazepam, metoclopramide HCl and diclofenac sodium. Conclusion Our findings indicate that PIM use can lead to negative health consequences, providing further evidence of the inappropriateness of these medications. Thus, pharmaceutical policies regarding PIM use may need to be implemented for elderly adults in Korea.
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Affiliation(s)
- Ha-Lim Jeon
- Department of Research, Health Insurance Review & Assessment Service, Hyeoksin-ro 60, Wonju-si, Ganwon-do, Seoul 26465, South Korea
| | - Juhee Park
- Department of Research, Health Insurance Review & Assessment Service, Hyeoksin-ro 60, Wonju-si, Ganwon-do, Seoul 26465, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Science, Yonsei University, 162-1 Songdo-Dong, Yeonsu-Gu Incheon, South Korea
| | - Dong-Sook Kim
- Department of Research, Health Insurance Review & Assessment Service, Hyeoksin-ro 60, Wonju-si, Ganwon-do, Seoul 26465, South Korea
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Rodríguez Del Río E, Perdigones J, Fuentes Ferrer M, González Del Castillo J, González Armengol J, Borrego Hernando MI, Arias Fernández ML, Martín-Sánchez FJ. [Impact of medium-term outcomes of inappropriate prescribing in older patients discharged from a short stay unit]. Aten Primaria 2017; 50:467-476. [PMID: 29079010 PMCID: PMC6837115 DOI: 10.1016/j.aprim.2017.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/21/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022] Open
Abstract
Objetivo Estudiar la asociación entre prescripciones potencialmente inapropiadas (PPI) y eventos adversos a los 30 y 180 días tras el alta de una unidad de corta estancia (UCE). Material y método Estudio analítico observacional de cohortes retrospectivo que incluyó pacientes ≥ 75 años al alta de una UCE. Se utilizó la versión 2 de los criterios STOPP-START. La variable resultado fue la presencia de algún evento adverso a 30 y 180 días. Resultados Se incluyeron 179 pacientes con una media de 84 (DE: 5) años. La presencia de ≥ 1PPI al alta no se asoció con la aparición de algún evento adverso a los 30 ni a los 180 días de manera global. La presencia de ≥ 1PPI al alta de fármacos del proceso cardiovascular tuvo mayor riesgo de presentar algún evento adverso a los 30 días del alta (OR ajustada 2,1; IC 95%: 1,0-3,2; p = 0,045), los fármacos del proceso «neuropsiquiátrico y riesgo de caídas» se relacionaron con deterioro funcional a los 30 días del alta (OR ajustada 6,3; IC 95%: 1,7-22,5; p = 0,005), y la omisión de fármacos del sistema cardiovascular se asoció con el reingreso a los 180 días (OR ajustada 3,6; IC 95%: 1,5-8,3, p = 0,003). Conclusiones La presencia de eventos adversos de pacientes ancianos dados de alta de una UCE podría relacionarse con PPI detectadas por algunos criterios STOPP-START, y concretamente con los fármacos de los procesos cardiovasculares, neuropsiquiátrico y relacionado con las caídas.
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Affiliation(s)
- Elena Rodríguez Del Río
- Servicio de Farmacia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - Javier Perdigones
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Manuel Fuentes Ferrer
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - M Isabel Borrego Hernando
- Servicio de Farmacia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - M Lourdes Arias Fernández
- Servicio de Farmacia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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8
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Prevalence and predictors of potentially inappropriate prescribing of central nervous system and psychotropic drugs among elderly patients: A national population study in Korea. Arch Gerontol Geriatr 2017; 74:1-8. [PMID: 28917110 DOI: 10.1016/j.archger.2017.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To investigate the prevalence of potentially inappropriate prescribing (PIP) of central nervous system and psychotropic (CNS-PS) drugs to the Korean elderly population, and to identify PIP-associated factors. METHODS Ambulatory care visits were identified from the 2013 National Aged Patient Sample (HIRA-APS-2013) data, composed of 20% random samples of all enrollees in the universal health security program aged ≥65 years. The CNS-PS section of Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria version 2 was used to identify PIP at these visits. RESULTS A total of 24,427,069 prescription claims records and 1,122,080 patients were included in the study; 10.73% of the claims and 53.64% of the patients satisfied at least one STOPP criterion in the prescription of CNS-PS drugs. The highest prevalence of PIP was observed for the criteria of "first-generation antihistamines" (FGAH), followed by tricyclic antidepressants (TCA) in patients with prostatism and TCA in patients with dementia. The generalized estimating equation logistic regression analysis showed that the PIP of FGAH was significantly associated with polypharmacy (5-9 drugs: odds ratio (OR) 4.965, 95% confidence interval (CI) 4.936-4.994; ≥10 drugs: OR 5.704, 95% CI 5.604-5.807), less severe health conditions (Charlson Comorbidity Index (CCI)=2: OR 0.852, 95% CI 0.842-0.862; CCI=1: OR 0.975, 95% CI 0.964-0.986), prescriptions from clinics (OR>1.0), and outpatient care by general practitioners (OR>1.0). CONCLUSIONS Appropriate interventions to reduce PIP should be made, especially for the criteria that indicate a high PIP prevalence. Targeted strategies are necessary to modify the risk factors of PIP identified from this study.
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Abstract
Abdominal pain in the elderly can be a challenging and difficult condition to diagnose and treat. The geriatric population has significant comorbidities and often takes polypharmacy that can mask symptoms. The presentation of common conditions can be different than that in the younger population, often lacking the traditional indicators of disease, making it of pivotal importance for the clinician to consider a wide differential during their workup. It is also important to consider extra-abdominal abnormality that may manifest as abdominal pain.
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Affiliation(s)
- Amy Leuthauser
- Department of Emergency Medicine, Bay of Plenty District Health Board, Tauranga Hospital, Cameron Road, Private bag 12024, Tauranga 3142, New Zealand.
| | - Benjamin McVane
- Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai Hospital, 1 gustav levy place, New York, NY 10028, USA
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10
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Pohl-Dernick K, Meier F, Maas R, Schöffski O, Emmert M. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list. BMC Health Serv Res 2016; 16:109. [PMID: 27039188 PMCID: PMC4818863 DOI: 10.1186/s12913-016-1366-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. METHODS Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. RESULTS In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. CONCLUSIONS The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.
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Affiliation(s)
- Katharina Pohl-Dernick
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany.
| | - Florian Meier
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, 91054, Erlangen, Germany
| | - Oliver Schöffski
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
| | - Martin Emmert
- Junior Professor for Health Services Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
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11
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Bergamo D, Pastorino A, Greppi F, Versino E, Bo M, D'Amelio P, Pezzilli MS, Furno E, Isaia G. Inappropriate Proton Pump Inhibitor Prescription in Elderly Adults: As Usual As Dangerous. J Am Geriatr Soc 2016; 63:2198-9. [PMID: 26480988 DOI: 10.1111/jgs.13691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Daniele Bergamo
- Geriatric Division, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Alessandra Pastorino
- Geriatric Division, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Francesca Greppi
- Geriatric Division, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Elisabetta Versino
- Division of Epidemiology, Department of Clinical and Biological Sciences, Azienda Ospedaliero-Universitaria San Luigi, University of Turin, Orbassano, Turin, Italy
| | - Mario Bo
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Turin, Italy
| | - Patrizia D'Amelio
- Geriatric Section, Department of Medical and Surgical Disciplines, San Giovanni Battista Hospital, Turin, Italy
| | - Maria Stella Pezzilli
- Geriatric Division, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Elisabetta Furno
- Geriatric Division, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Gianluca Isaia
- Geriatric Division, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Chen CC, Cheng SH. Potentially Inappropriate Medication and Health Care Outcomes: An Instrumental Variable Approach. Health Serv Res 2015; 51:1670-91. [PMID: 26601656 DOI: 10.1111/1475-6773.12417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the effects of potentially inappropriate medication (PIM) use on health care outcomes in elderly individuals using an instrumental variable (IV) approach. DATA SOURCES/STUDY SETTING Representative claim data from the universal health insurance program in Taiwan from 2007 to 2010. STUDY DESIGN We employed a panel study design to examine the relationship between PIM and hospitalization. We applied both the naive generalized estimating equation (GEE) model, which controlled for the observed patient and hospital characteristics, and the two-stage residual inclusion (2SRI) GEE model, which further accounted for the unobserved confounding factors. The PIM prescription rate of the physician most frequently visited by each patient was used as the IV. PRINCIPAL FINDINGS The naive GEE models indicated that patient PIM use was associated with a higher likelihood of hospitalization (odds ratio [OR], 1.399; 95 percent confidence interval [CI], 1.363-1.435). Using the physician PIM prescribing rate as an IV, we identified a stronger significant association between PIM and hospitalization (OR, 1.990; 95 percent CI, 1.647-2.403). CONCLUSIONS PIM use is associated with increased hospitalization in elderly individuals. Adjusting for unobserved confounders is needed to obtain unbiased estimates of the relationship between PIM and health care outcomes.
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Affiliation(s)
- Chi-Chen Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shou-Hsia Cheng
- Department of Public Health, College of Medicine, Fu Jen Catholic University, Taiwan
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Kang HA, Lee SM, Park C, Kim DS. Prevalence and predictors of non-steroidal anti-inflammatory drug/analgesic therapeutic duplication in the South Korean ambulatory care setting. Eur J Clin Pharmacol 2015; 72:109-16. [DOI: 10.1007/s00228-015-1958-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
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Evaluation of the heterogeneity of studies estimating the association between risk factors and the use of potentially inappropriate drug therapy for the elderly: a systematic review with meta-analysis. Eur J Clin Pharmacol 2015; 71:1037-50. [PMID: 26111636 DOI: 10.1007/s00228-015-1891-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/15/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE This study was conducted to evaluate the heterogeneity of studies estimating the association between risk factors (age, gender, and polypharmacy) and the use of potentially inappropriate drug therapy for the elderly (PIDT). METHODOLOGY This study is a systematic review with meta-analysis of observational studies. LILACS, PubMed, Scopus, and the Web of Science databases were reviewed. The following data were extracted from the included studies: country, type of study, characteristics of the sample, practice scenarios, instruments to evaluate potentially inappropriate drug therapy for the older adults, and patient-related variables. RESULTS Twenty-nine articles (17 cross-sectional and 12 cohort) were included. The majority of the studies were conducted in Europe. Regarding the study durations, 3 to 18 months was necessary to perform the research. As for the sample characteristics, all the studies analyzed involved the older adults and included anywhere from 96 patients to 33,830,599 outpatient consultations. Of the variables analyzed, only polypharmacy presented a positive association with the use of PIDT. All meta-analysis studies showed high heterogeneity, indicating the lack of a methodological standardization of the studies included, among other factors.
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Santos APAL, Silva DT, Alves-Conceição V, Antoniolli AR, Lyra DP. Conceptualizing and measuring potentially inappropriate drug therapy. J Clin Pharm Ther 2015; 40:167-76. [PMID: 25682702 DOI: 10.1111/jcpt.12246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Elderly people are the principal consumers of prescription drugs. The more the medication used by the patient, the greater the likelihood there is of the patient being subjected to potentially inappropriate drug therapy (PIDT). PIDT has been measured in the literature with both implicit and explicit tools. The purpose of this review was to assess the use of tools to detect PIDT in various studies and to determine which terms are used to refer to PIDT in practice. METHODS A systematic review was conducted according to the following steps: the first was identification. In this step, studies were selected from different combinations of the descriptors 'aged', 'elderly', 'inappropriate prescribing' and 'drug utilization' in three different languages, using the Embase, Medline, Scielo, Scopus and Web of Science databases. Second, the papers that satisfied the inclusion criteria for data extraction were carefully examined by three evaluators to determine the tools used and terms that referred to PIDT. RESULTS AND DISCUSSION From the combinations of keywords, 8610 articles were found. At the end of the selection process, 119 of the articles complied with the specified criteria. The degree of agreement among evaluators was moderate for the study titles (κ1 = 0·479) and substantial for abstracts (κ2 = 0·647). With respect to the PIDT evaluation criteria used by the studies, 27·7% used two criteria. Of the 27 evaluation criteria identified, the Beers criteria were used by 82·3% of the studies. More than 50 different terms to identify PIDT were found in the literature. WHAT IS NEW AND CONCLUSION This review is the first study to conceptualize and discuss terms that refer to PIDT. At present, there is no consensus regarding terms used to refer to PIDT, with over 50 different terms currently in use. This review shows an increase in the number of articles aimed at evaluating PIDT using implicit and explicit tools.
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Affiliation(s)
- A P A L Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Pharmacy College, Federal University of Sergipe, São Cristóvão, Brazil
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Chen MC, Lai JN, Chen PC, Wang JD. Concurrent Use of Conventional Drugs with Chinese Herbal Products in Taiwan: A Population-based Study. J Tradit Complement Med 2014; 3:256-62. [PMID: 24716186 PMCID: PMC3925000 DOI: 10.4103/2225-4110.119734] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The increased use of Chinese herbal products (CHPs) worldwide has raised the concern of herb-drug interactions. The aim of this study was to determine the prevalence and utilization patterns of concurrent use of conventional drugs and CHPs in Taiwan. The usage and frequency of services in the co-prescription of a CHP and a conventional drug were evaluated. Subjects were recruited from a simple random sample of 1,000,000 subjects from over 22 million beneficiaries of the National Health Insurance in 2007. The logistic regression method was employed to estimate the odds ratios (ORs) for the co-prescription of a CHP and a conventional drug (CH + D) and a conventional drug alone (D-alone). The prevalence of the CH + D was 14.1%. Females, regular salary earners, and elderly (65 years and above) were more likely to consume a CHP and a conventional drug concurrently. Painkillers, especially acetaminophen, and anti-cough medicines were the top two conventional drugs that were most frequently co-prescribed with a CHP. Anti-cough medication is the most common conventional drug co-prescribed with CHP, after painkillers. We recommend that safety issues be investigated in future research and integrating both healthcare technologies may be beneficial for the overall health and quality of life of patients.
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Affiliation(s)
- Ming-Chen Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Family Medicine, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan
| | - Jung-Nien Lai
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Chinese Medicine, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan. ; Department of Public Health, National Taiwan University, College of Public Health, Taipei, Taiwan
| | - Jung-Der Wang
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan City, Taiwan
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Shade MY, Berger AM, Chaperon C. Potentially inappropriate medications in community-dwelling older adults. Res Gerontol Nurs 2014; 7:178-92. [PMID: 24530281 DOI: 10.3928/19404921-20140210-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022]
Abstract
Potentially inappropriate medication (PIM) use is a significant worldwide public health problem. Community-dwelling older adults are susceptible to the negative outcomes associated with the use of PIMs. A database search (January 1991-June 2013) produced 19 prospective correlational and 10 intervention studies. The current state of the science reveals that conceptual clarity is lacking regarding the use of PIMs. The prevalence of PIM use is well documented in an abundance of descriptive studies. However, researchers have not examined an intervention's effects on health outcomes in community-dwelling older adults. Although independent older adults can acquire PIMs outside of a provider, current interventions aim to change the behavior of the prescribing physician and pharmacist. Nurses need to collaborate with other disciplines in PIM use research. Priority needs are to design interventions that reduce the use of PIMs and negative health outcomes.
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Price SD, Holman CDJ, Sanfilippo FM, Emery JD. Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother 2014; 48:6-16. [PMID: 24396090 DOI: 10.1177/1060028013504904] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Predisposition to adverse drug events with advancing age has led to the development of lists of potentially inappropriate medications (PIMs) to be avoided in the elderly, such as the Beers Criteria. The prevalence of Beers medications has been studied widely, but it is still unclear whether PIM use is predictive of adverse events in older people. OBJECTIVES To examine potential associations between exposure to PIMs from the general Beers list and unplanned hospitalizations in elderly Western Australians. METHODS Using an enhanced case-time-control design and conditional logistic regression applied to the pharmaceutical claims and other linked health data of 251 305 Western Australians aged ≥65 years (1993-2005), odds ratios for unplanned hospitalization were obtained, from which attributable fractions, number and proportion of hospitalizations associated with drug exposure were derived. RESULTS Based on the health profiles of 383 150 hospitalized index subjects, overall PIM exposure was associated with an elevated risk of unplanned hospitalization (adjusted odds ratio = 1.18; 95% confidence interval = 1.15-1.21), this estimated risk increasing with the number of different PIMs and PIM quantity taken. Fifteen percent of unplanned hospitalizations in exposed index subjects (1980 per year) were attributed to PIM exposure. Patients taking meperidine (pethidine), nitrofurantoin, promethazine, indomethacin, and thioridazine appeared to be at particularly high risk of unplanned hospitalization, whereas temazepam, oxazepam, diazepam, digoxin, amiodarone, ferrous sulfate, and naproxen were attributed the greatest numbers of unplanned hospitalizations. CONCLUSIONS Due caution prescribing Beers medications in the elderly seems justified, paying particular attention to PIMs listed above and to the concurrent use of multiple PIMs. Our results also support the retention of specific medications on PIM lists in future developments.
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Frequency of inappropriate medication prescription in hospitalized elderly patients in Italy. PLoS One 2013; 8:e82359. [PMID: 24349262 PMCID: PMC3861441 DOI: 10.1371/journal.pone.0082359] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/23/2013] [Indexed: 12/14/2022] Open
Abstract
Background Older people often need comprehensive treatment, including many medications, and polypharmacy is common. The aims of this cross-sectional investigation were to examine the potentially inappropriate medication during the hospitalization and to identify the factors that may influence such inappropriateness among elderly in Italy. Methods A sample of 605 individuals aged 65 years and older admitted in non-academic public acute care hospitals was randomly selected. Prescription of inappropriate medications were evaluated during the period from the day of admission to a randomly preselected day (index day). Beers Criteria were used to evaluate appropriateness. Results At least one potentially inappropriate medication prescription from the day of hospital admission to the index day has been observed in 188 patients (31.1%), and respectively 84.1% and 15.9% of them had received one or two inappropriate medications. A total of 15 medications was prescribed inappropriately to these 188 patients, for 215 times with a total of 1143 doses. The multivariate logistic regression analysis revealed that the significant predictors for having at least one potentially inappropriate medication prescription during the hospitalization were: patients having an elementary education level, a lower pre-admission performance-based measure of basic activities of daily living, having received an inappropriate drug before the hospitalization, a hospital stay in the general and in the specialties surgical wards, a longer length of hospital stay from the admission to the index day, and having received a higher number of drugs from the day of the hospital admission to the index day. The most prevalent inappropriate medications administered were ketorolac (27.4%), amiodarone (19.1%), and clonidine (11.2%). Conclusions This study supports the need for clinical guidelines implementation to assist physicians in choosing the most appropriate drugs for the elderly and for effective education of all physicians.
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Using pharmacists to optimize patient outcomes and costs in the ED. Am J Emerg Med 2013; 32:673-7. [PMID: 24703064 DOI: 10.1016/j.ajem.2013.11.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/16/2013] [Accepted: 11/17/2013] [Indexed: 11/20/2022] Open
Abstract
Participation of hospital clinical pharmacists in the care of inpatients is widespread, often encouraged by the dicta promulgated by regulatory bodies. For years, clinical pharmacists have ventured out of the pharmacy to participate in rounds and, otherwise, in the care of patients on hospital floors and in intensive care units. In fact, it has been well documented in many research studies published in the last 20 years that having pharmacists prospectively involved with orders generates significant cost savings for the hospital and benefit to patients. Until recently, the emergency department (ED) seemed to be a hectic environment that would be inhospitable to the careful, meticulous, and usually deliberate process of many clinical pharmacists. The potential benefits were recognized, but the pace and costs seemed prohibitive. The addition of pharmacists in the ED has reduced medication errors and provided numerous other benefits that will be discussed in this article. We will show that recent data indicate that using an ED clinical pharmacist promotes patient safety and is cost-effective.
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O’Sullivan DP, O’Mahony D, Parsons C, Hughes C, Murphy K, Patterson S, Byrne S. A Prevalence Study of Potentially Inappropriate Prescribing in Irish Long-Term Care Residents. Drugs Aging 2012; 30:39-49. [DOI: 10.1007/s40266-012-0039-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Chang CB, Yang SY, Lai HY, Wu RS, Liu HC, Hsu HY, Hwang SJ, Chan DC. Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan. Pharmacoepidemiol Drug Saf 2012; 21:1269-79. [PMID: 22517563 DOI: 10.1002/pds.3274] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/13/2012] [Accepted: 03/11/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Explicit criteria for potentially inappropriate medications (PIMs) developed from other regions were often difficult to apply to a specific territory without significant modifications. PURPOSE To describe a process of developing a country-specific explicit PIM criteria from quality review of several published PIM criteria, followed by consensus among regional experts in Taiwan. METHODS After a review of the literature, we selected seven sets of published PIM criteria. Medications/medication classes listed in at least three of the seven sets of criteria were selected as preliminary core PIMs. We asked a group of 21 experts from various specialties to rate how appropriate they found inclusion of each medication/medication class in final PIM criteria after two rounds of modified Delphi methods. RESULTS Table 1 of the instrument included 24 medication/medication classes to be generally avoided in older adults irrespective of co-morbidities, and Table 2 included 12 chronic conditions with six medication/medication classes that patients with these conditions should avoid. The Taiwan criteria contained only half the number of statements that were included in the Beers criteria (36 vs 68 statements) but detected nearly 70-75% as many PIMs in older patients with polypharmacy in a secondary data analysis. Features included straightforward statement arrangements, suggestions of alternatives, and clear definitions of long-acting benzodiazepine and anticholinergic drugs for Table 1 PIMs. CONCLUSION A user-friendly instrument was developed to detect PIMs for Taiwanese older adults. Further prospective studies are needed to validate its use in clinical and research settings.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan
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Griffey RT, Lo HG, Burdick E, Keohane C, Bates DW. Guided medication dosing for elderly emergency patients using real-time, computerized decision support. J Am Med Inform Assoc 2011; 19:86-93. [PMID: 22052899 DOI: 10.1136/amiajnl-2011-000124] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a real-time computerized decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behavior and on adverse drug events (ADEs). DESIGN A prospective controlled trial was conducted over 26 weeks. The status of the decision support tool alternated OFF (7/17/06-8/29/06), ON (8/29/06-10/10/06), OFF (10/10/06-11/28/06), and ON (11/28/06-1/16/07) in consecutive blocks during the study period. In patients ≥65 who were ordered certain benzodiazepines, opiates, non-steroidals, or sedative-hypnotics, the computer application either adjusted the dosing or suggested a different medication. Physicians could accept or reject recommendations. MEASUREMENTS The primary outcome compared medication ordering consistent with recommendations during ON versus OFF periods. Secondary outcomes included the admission rate, emergency department length of stay for discharged patients, 10-fold dosing orders, use of a second drug to reverse the original medication, and rate of ADEs using previously validated explicit chart review. RESULTS 2398 orders were placed for 1407 patients over 1548 visits. The majority (49/53; 92.5%) of recommendations for alternate medications were declined. More orders were consistent with dosing recommendations during ON (403/1283; 31.4%) than OFF (256/1115; 23%) periods (p≤0.0001). 673 (43%) visits were reviewed for ADEs. The rate of ADEs was lower during ON (8/237; 3.4%) compared with OFF (31/436; 7.1%) periods (p=0.02). The remaining secondary outcomes showed no difference. LIMITATIONS Single institution study, retrospective chart review for ADEs. CONCLUSION Though overall agreement with recommendations was low, real-time computerized decision support resulted in greater acceptance of medication recommendations. Fewer ADEs were observed when computerized decision support was active.
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Affiliation(s)
- Richard T Griffey
- Division of Emergency Medicine, Washington University Institute for Public Health, St. Louis, Missouri, USA.
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Shin JY, Choi NK, Jung SY, Kim YJ, Seong JM, Park BJ. Overlapping medication associated with healthcare switching among Korean elderly diabetic patients. J Korean Med Sci 2011; 26:1461-8. [PMID: 22065902 PMCID: PMC3207049 DOI: 10.3346/jkms.2011.26.11.1461] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 09/21/2011] [Indexed: 01/21/2023] Open
Abstract
This study was performed to describe the patterns of healthcare switching with overlapping use of anti-diabetic medication in the elderly using the Korea Health Insurance Review and Assessment Service's claims data. The study subjects were ambulatory elderly diabetic patients (ICD-10, E10-14) receiving at least one oral anti-diabetic drug or insulin, and visiting healthcare facilities more than two times between January and December 2005. A total of 457,975 elderly diabetic ambulatory care patients were identified. The mean of visiting frequencies was 9.0 ( ± 3.6) and switching frequencies was 1.5 ( ± 0.8) during 2005. Switching group consisted of 33% of total study subject. Healthcare switching was common in female patients who were older, and had treated polytherapy more in rural areas. The movement among primary care medical services was very common among the patients in the switching group (52.6%). A statistically significant correlation was observed between the healthcare switching and concomitant drug use (rho = 0.96), and overlapping days (rho = 0.57). The use of overlapping anti-diabetic medication increased with the extent of healthcare switching. Further, frequent switching of healthcare between primary clinics was observed. Efforts should be made to establish continuity for the elderly diabetic patients with the identification of frequent switching with overlapping medication.
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Affiliation(s)
- Ju-Young Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Sun-Young Jung
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ye-Jee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Mi Seong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
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Lin YJ, Peng LN, Chen LK, Lin MH, Hwang SJ. Risk factors of potentially inappropriate medications among older patients visiting the community health center in rural Taiwan. Arch Gerontol Geriatr 2011; 53:225-8. [DOI: 10.1016/j.archger.2010.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/13/2010] [Accepted: 11/15/2010] [Indexed: 12/20/2022]
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Schnitker L, Martin-Khan M, Beattie E, Gray L. Negative health outcomes and adverse events in older people attending emergency departments: A systematic review. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.aenj.2011.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wen YW, Tsai YW, Huang WF, Hsiao FY, Chen PF. The potentially inappropriate prescription of new drug: thiazolidinediones for patients with type II diabetes in Taiwan. Pharmacoepidemiol Drug Saf 2010; 20:20-9. [PMID: 21182151 DOI: 10.1002/pds.2010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 05/31/2010] [Accepted: 06/01/2010] [Indexed: 11/06/2022]
Abstract
PURPOSE To examine the potentially inappropriate prescription of thiazolidinediones (TZD). METHODS Data on TZD prescriptions were collected from Taiwan's National Health Insurance dataset from 2001 to 2006. TZDs were considered inappropriately prescribed when they were prescribed to patients who were (1) under 18 years old, (2) pregnant, who had (3) type 1 diabetes, (4) severe heart failure, (5) hepatic insufficiency, or (6) renal insufficiency and taking TZD + metformin in combination. We aggregated potentially inappropriate prescriptions of TZD for each health-care institution in each month starting from March 2001, when TZD was introduced to Taiwan's market. RESULTS The potentially inappropriate prescription of TZD increased from 9.41% in 2001 to 12.50% in 2006. Prior inappropriate prescription led to a 0.06% (95%CI: 0.04-0.08) further increase in its later inappropriate prescription. Accumulated months of experience prescribing TZD was found associated with higher proportion of inappropriate prescription of TZD (0.03%, 95%CI: 0.01-0.05). However, it was negatively associated with new incidence of inappropriate prescription of TZD (-0.20, 95%CI: -0.22 to -0.18). The greater the volume of prior TZD prescription (-0.87%, 95%CI: -0.93 to -0.81) and the greater the number of accumulated months since adoption (-0.14%, 95%CI: -0.16 to -0.12), the greater the decrease in rates of new inappropriate prescriptions. CONCLUSIONS Along with the quick penetration of the new DM drug came an increased possibility that it would be prescribed inappropriately, a trend that persisted over time.
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Affiliation(s)
- Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan
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Histamine, histamine receptors and antihistamines: new concepts. An Bras Dermatol 2010; 85:195-210. [PMID: 20520935 DOI: 10.1590/s0365-05962010000200010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022] Open
Abstract
Drugs with antihistamine action are the most commonly prescribed medication in daily dermatologic practice, both to adults and children. This article addresses new concepts of the role of histamine receptors (H1 receptors) and discusses the anti-inflammatory effects of these drugs. Second generation antihistamines differs from first generation because of their high specificity and affinity for peripheral H1-receptors. Second generation antihistamines are also less likely to produce sedation because they have less effect on the central nervous system. Although the efficacy of the various H1-antihistamines in the treatment of allergic patients is similar, even when comparing first- and second-generation drugs, these drugs are still very different in terms of their chemical structure, pharmacology and toxic properties. Consequently, knowledge of their pharmacokinetic and pharmacodynamic characteristics is essential for a better medical care, especially that offered to pregnant women, children, the elderly, and patients with comorbidities.
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Potentially inappropriate medication use in elderly Japanese patients. ACTA ACUST UNITED AC 2010; 8:146-60. [PMID: 20439064 DOI: 10.1016/j.amjopharm.2010.03.005] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Modified Beers criteria for elderly Japanese patients were developed in 2008 by consensus among 9 experts to reflect regional clinical practice and available medications in Japan. Since then, many physicians and pharmacists have expressed interest in obtaining more information about the criteria and alternative drug choices. OBJECTIVE This study examined the incidence, health care utilization, and costs associated with potentially inappropriate medications (PIMs) in elderly patients based on the modified Beers criteria. METHODS A retrospective, observational cohort study was conducted using health insurance claims data in Japan. The study population included elderly patients aged >or=65 years who had at least 2 pharmacy claims in separate months over a 1-year period (April 2006 through March 2007). Use of the PIMs was identified using the modified criteria, and 1-year incidence rates were calculated for the total study population and for subgroups stratified by age and sex. A logistic regression model was used to examine demographic and clinical characteristics associated with PIMs. Health care utilization rates and costs were also analyzed and compared between patients with and without PIMs using generalized linear models. All models included dummy variables indicating age category, female sex, hospitalization, polypharmacy, index month, and number of Elixhauser comorbidities to adjust for potential confounders. RESULTS Among 6628 elderly patients, 71.2% (4721/6628) were female and 62.9% (4167/6628) were aged 65 to 74 years; 43.6% (2889/6628) were prescribed at least one PIM. The most commonly used PIMs were histamine-2 blockers (20.5% [1356/6628]), benzodiazepines (11.4% [756/6628]), and anticholinergics and antihistamines (7.9% [526/6628]). No significant differences in incidence rates were observed based on age or sex. Inpatient service use, polypharmacy, and comorbidities of peptic ulcer, depression, and cardiac arrhythmias were significant predictors of PIM use while controlling for other factors. PIM users had significantly higher hospitalization risk (1.68-fold), more outpatient visit days (1.18-fold), and higher medical costs (33% increase) than did nonusers. CONCLUSIONS In a group of elderly Japanese patients, 43.6% used at least one PIM over a 1-year period in this study. PIM use was associated with greater health care utilization rates and costs.
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Abstract
The definition of "polypharmacy" ranges from the use of a large number of medications; the use of potentially inappropriate medications, which can increase the risk for adverse drug events; medication underuse despite instructions to the contrary; and medication duplication. Older adults are particularly at risk because they often present with several medical conditions requiring pharmacotherapy. Cancer-related therapy adds to this risk in older adults, but few studies have been conducted in this patient population. In this review, we outline the adverse outcomes associated with polypharmacy and present polypharmacy definitions offered by the geriatrics literature. We also examine the strengths and weaknesses of these definitions and explore the relationships among these definitions and what is known about the prevalence and impact of polypharmacy.
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Affiliation(s)
- Ronald J Maggiore
- Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA
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Lai HY, Hwang SJ, Chen YC, Chen TJ, Lin MH, Chen LK. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clin Ther 2009; 31:1859-70. [PMID: 19808145 DOI: 10.1016/j.clinthera.2009.08.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of potentially inappropriate medications can have profound medical consequences for elderly patients and place a substantial burden on the health care system. OBJECTIVES This study was conducted to determine the prevalence of potentially inappropriate medication prescribing at ambulatory care visits by patients aged > or =65 years covered by the Taiwanese National Health Insurance program, to examine the characteristics of and risk factors for such prescribing, and to investigate its influence on health care resource utilization. METHODS Ambulatory care visits by patients aged > or =65 years in 2001-2004 were identified from the National Health Insurance claims database. The 2003 Beers criteria for drugs to be avoided in the elderly were used to identify potentially inappropriate medications prescribed at these visits. Only drugs with the potential to lead to higher-severity adverse events were included. Multivariate logistic regression was used to determine predictors of the prescribing of potentially inappropriate medications at ambulatory care visits. Independent variables in the regression model included patient characteristics (eg, sex, age), physician characteristics (sex, age, and specialty), and visit characteristics (site and prescribed drug number). The dependent variable was visits that included a prescription for a potentially inappropriate medication. RESULTS Overall, 176,661,994 ambulatory care visits by patients aged > or =65 years were identified in 2001-2004. Of these, 19.1% involved a prescription for a potentially inappropriate medication. Although the frequency of potentially inappropriate medication prescribing declined over the study period, 62.5% of elderly patients were exposed to such medications in 2004. The only patient characteristic associated with an increased likelihood of the prescribing of potentially inappropriate medications was female sex (male sex: odds ratio [OR] = 0.982 [95% CI, 0.980-0.983], P < 0.001). Physician characteristics associated with a greater likelihood of the prescribing of potentially inappropriate medications was male sex (OR = 1.206 [95% CI, 1.202-1.210], P < 0.001); older age (43-50 years: OR = 1.021 [95% CI, 1.018-1.025], P < 0.001; >/=51 years: OR = 1.238 [95% CI, 1.235-1.242], P < 0.001); and family medicine/general practice (OR = 1.267 [95% CI, 1.265-1.269], P < 0.001). For visit characteristics, significant associations were found with visits to a primary care clinic (OR = 1.887 [95% CI, 1.881-1.892], P < 0.001) and the number of drugs prescribed (4-6 drugs: OR = 2.701 [95% CI, 2.696-2.706], P < 0.001; > or =7 drugs: OR = 4.528 [95% CI, 4.517-4.538], P < 0.001). The most commonly prescribed types of potentially inappropriate medications were antihistamines (4.8% of all prescriptions in 48.3% of elderly patients), muscle relaxants/antispasmodics (4.0% and 40.3%, respectively), and long-acting benzodiazepines (2.4% and 21.4%). In 2004, the mean number of ambulatory care visits per patient was significantly higher among those who received potentially inappropriate medications compared with those who did not (30.78 vs 16.57, respectively; P < 0.001). Patients who received potentially inappropriate medications also had significantly more emergency department visits (0.27 vs 0.15; P < 0.001) and hospital admissions (0.46 vs 0.27; P < 0.001). CONCLUSION There was a high prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients in Taiwan in 2001-2004.
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Affiliation(s)
- Hsiu-Yun Lai
- Center for Geriatrics and Gerontology, Department of Family Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei 111217, Taiwan
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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