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Kim JH, Song JH, Kim M, Hong JH, Sunwoo J, Jung JG. Pharmacokinetic Comparison of a Fixed-Dose Combination of Candesartan Cilexetil/Amlodipine/Atorvastatin Versus Co-administration of Individual Formulations in Healthy Participants. Adv Ther 2024; 41:2808-2825. [PMID: 38771476 PMCID: PMC11213815 DOI: 10.1007/s12325-024-02869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/04/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Fixed-dose combinations (FDCs) of angiotensin II receptor blockers, calcium channel blockers, and statins are conventional therapeutic interventions prescribed for cardiovascular diseases. This study aimed at drawing a comparison between the pharmacokinetics and safety of an FDC and the corresponding individual formulations in healthy subjects. METHODS A randomized, open-label, single-dose, three-sequence, three-period, partially repeated crossover study was conducted with a cohort of healthy volunteers. A 14-day washout period was maintained between each of the three periods. In this study, candesartan cilexetil, amlodipine, and atorvastatin was administered orally as FDCs of 16/10/40 mg in study 1 and 16/5/20 mg in study 2. The maximum plasma concentration (Cmax) and area under the plasma concentration-time curve from time zero to the time of the last quantifiable concentration (AUClast) of candesartan, amlodipine, and atorvastatin were estimated as the geometric mean ratios (GMRs) and 90% confidence intervals (CIs) of the FDC to individual formulations. If the within-subject coefficient of variation (CVwr) of Cmax was greater than 0.3, the bioequivalence (BE) range calculated using the reference-scaled average bioequivalence was used to assess whether the 90% CI was within the BE range. RESULTS The GMRs (90% CIs) for the AUClast for candesartan and amlodipine were 0.9612 (0.9158-1.0089)/0.9965 (0.9550-1.0397) and 1.0033 (0.9800-1.0271)/1.0067 (0.9798-1.0344), and the GMRs (90% CIs) for Cmax were 0.9600 (0.8953-1.0294)/0.9851 (0.9368-1.0359) and 1.0198 (0.9950-1.0453)/1.0003 (0.9694-1.0321) in studies 1 and 2, respectively. The extended BE ranges calculated from the CVwr of the Cmax of atorvastatin were 0.7814-1.2797 and 0.7415-1.3485, respectively. The GMRs (90% CIs) for the AUClast of atorvastatin were 1.0532 (1.0082-1.1003)/1.0252 (0.9841-1.0680), and the GMRs (90% CIs) for Cmax were 1.0630 (0.9418-1.1997)/0.9888 (0.8792-1.1120) in studies 1 and 2, respectively. CONCLUSION The Cmax and AUClast values of candesartan cilexetil/amlodipine/atorvastatin 16/10/40 mg and 16/5/20 mg, respectively, were within the BE ranges. There were no clinically significant differences in safety between the two formulations. TRIAL REGISTRATION ClinicalTrials.gov identifier, study 1: NCT04478097; study 2: NCT04627207.
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Affiliation(s)
- Jae Hoon Kim
- Clinical Trials Center, Chungnam National University Hospital, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ji Hye Song
- Clinical Trials Center, Chungnam National University Hospital, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - MinYoung Kim
- Pharmaceutical Research and Technology Development Center, Chong Kun Dang Pharmaceutical Corporation, Yongin, Gyeonggi, Republic of Korea
| | - Jang Hee Hong
- Clinical Trials Center, Chungnam National University Hospital, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
- Department of Pharmacology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung Sunwoo
- Clinical Trials Center, Chungnam National University Hospital, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
| | - Jin-Gyu Jung
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
- Department of Family Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
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Kosirova S, Urbankova J, Klimas J, Foltanova T. Assessment of potentially inappropriate medication use among geriatric outpatients in the Slovak Republic. BMC Geriatr 2023; 23:567. [PMID: 37715169 PMCID: PMC10504736 DOI: 10.1186/s12877-023-04260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is a highly prevalent problem among older people, making it challenging to improve patient safety. The aim of this study was to assess the use of PIMs among geriatric outpatients (OUTs) in the Slovak Republic according to the EU(7) PIM list and to identify the differences in PIM prescriptions among general practitioners (GPs), internists (INTs) and geriatricians (GERs). METHODS In total, 449 patients (65 years and older) from 4 medical centres who were in the care of GPs (32.5%), INTs (22.7%) or GERs (44.8%) were included in this retrospective analysis. Data were collected from 1.12.2019-31.3.2020. PIMs were identified according to the EU(7) PIM list from patients' records. PIM prescriptions by GPs, INTs and GERs were assessed. All obtained data were statistically analysed. RESULTS Polypharmacy (68.8% of patients), and PIM use (73% of patients) were observed. The mean number of all prescribed drugs was 6.7 ± 0.2 drugs per day/patient. The mean number of prescribed PIMs was 1.7 ± 0.1 PIMs per day/patient. Drugs from Anatomical Therapeutic Chemical (ATC) classes C, N and A accounted for the greatest number of PIMs. Significantly higher numbers of prescribed drugs as well as PIMs were prescribed by GPs than INTs or GERs. There were 4.2 times higher odds of being prescribed PIMs by GPs than by GERs (p < 0.001). CONCLUSIONS Polypharmacy and overprescription of PIMs were identified among geriatric patients in our study. We found a positive relationship between the number of prescribed drugs and PIMs. The lowest odds of being prescribed PIMs were observed among those who were in the care of a geriatrician. The absence of geriatricians and lack of information about PIMs among general practitioners leads to high rates of polypharmacy and overuse of potentially inappropriate medications in geriatric patients in the Slovak Republic.
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Affiliation(s)
- Stanislava Kosirova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Jana Urbankova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Jan Klimas
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Tatiana Foltanova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic.
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Thomas P. [Psychotropic drugs in the elderly]. SOINS. GERONTOLOGIE 2023; 28:27-29. [PMID: 37716778 DOI: 10.1016/j.sger.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The use of psychotropic drugs in the elderly is frequent, and can be problematic due to the risks associated with their inappropriate use and adverse effects. It is essential to adopt a cautious, individualized approach to prescribing psychotropic drugs, regularly assessing their efficacy and considering other non-drug approaches where possible. Collaboration between healthcare professionals and patients can contribute to more appropriate use of these drugs in the elderly.
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Affiliation(s)
- Philippe Thomas
- Centre de recherches sémiotiques (CeReS), EA 3648, Université de Limoges, 39 rue Camille-Guérin, 87000 Limoges, France.
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Jabri FF, Liang Y, Alhawassi TM, Johnell K, Möller J. Potentially Inappropriate Medications in Older Adults-Prevalence, Trends and Associated Factors: A Cross-Sectional Study in Saudi Arabia. Healthcare (Basel) 2023; 11:2003. [PMID: 37510444 PMCID: PMC10379671 DOI: 10.3390/healthcare11142003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Potentially inappropriate medications (PIMs) in older adults are associated with drug-related problems, adverse health consequences, repeated hospital admissions and a higher risk of mortality. In Saudi Arabia and some Arab countries, studies of PIMs among large cohorts of older adults are limited. This study aimed to determine the prevalence of PIMs, trends and associated factors among outpatient older adults in Saudi Arabia. (2) Methods: A cross-sectional study was carried out. Over three years (2017-2019), data on 23,417 people (≥65 years) were retrieved from outpatient clinics in a tertiary hospital in Riyadh, Saudi Arabia. PIMs were assessed using the 2019 Beers Criteria. Covariates included sex, age, nationality, number of dispensed medications, and number of diagnoses. A generalized estimating equation model was used to assess trends and factors associated with PIMs. (3) Results: The prevalence of PIMs was high and varied between 57.2% and 63.6% over the study years. Compared with 2017, the prevalence of PIMs increased significantly, with adjusted odds ratios (OR) (95% confidence interval (95% CI)) of 1.23 (1.18-1.29) and 1.15 (1.10-1.21) for 2018 and 2019, respectively. Factors associated with being prescribed PIMs included ≥5 dispensed medications (OR_adjusted = 23.91, 95% CI = 21.47-26.64) and ≥5 diagnoses (OR_adjusted = 3.20, 95% CI = 2.88-3.56). Compared with females, males had a lower risk of being prescribed PIMs (OR_adjusted = 0.90, 95% CI = 0.85-0.94); (4) Conclusions: PIMs were common with an increasing trend among older adults in Saudi Arabia. A higher number of dispensed medications, increased number of diagnoses and female sex were associated with being prescribed PIMs. Recommendations on how to optimize prescriptions and implement de-prescribing strategies are urgently needed.
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Affiliation(s)
- Fouad F Jabri
- Department of Biostatistics, Epidemiology and Public Health, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GPH, 171 77 Stockholm, Sweden
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GPH, 171 77 Stockholm, Sweden
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, C8 Medicinsk Epidemiologi och Biostatistik, 171 77 Stockholm, Sweden
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GPH, 171 77 Stockholm, Sweden
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Zito S, Poluzzi E, Pierantozzi A, Onder G, Da Cas R, Ippoliti I, Lunghi C, Cangini A, Trotta F. Medication use in Italian nursing homes: preliminary results from the national monitoring system. Front Pharmacol 2023; 14:1128605. [PMID: 37266155 PMCID: PMC10229842 DOI: 10.3389/fphar.2023.1128605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/21/2023] [Indexed: 06/03/2023] Open
Abstract
Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies. Objectives: This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs). Methods: Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used. Results: In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses-DDDs/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs/100 days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs/100 days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs/100 days of NH stay. Conclusion: The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness.
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Affiliation(s)
- S. Zito
- Italian Medicine Agency (AIFA), Rome, Italy
| | - E. Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - G. Onder
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacral Heart, Rome, Italy
| | - R. Da Cas
- National Centre for Drug Research and Evaluation, Pharmacoepidemiology Unit, Italian National Institute of Health, Rome, Italy
| | - I. Ippoliti
- National Centre for Drug Research and Evaluation, Pharmacoepidemiology Unit, Italian National Institute of Health, Rome, Italy
| | - C. Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A. Cangini
- Italian Medicine Agency (AIFA), Rome, Italy
| | - F. Trotta
- Italian Medicine Agency (AIFA), Rome, Italy
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Lee Y, Jang S, Kang HJ, Jang S. Comparative analysis of potentially inappropriate medication use in long-term care facility residents and community-dwelling elders: A matched cohort study. Medicine (Baltimore) 2022; 101:e31739. [PMID: 36626501 PMCID: PMC9750672 DOI: 10.1097/md.0000000000031739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.
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Affiliation(s)
- Yumin Lee
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Hee-Jin Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * Correspondence: Sunmee Jang, College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea (e-mail: )
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Koçak FÖK, Taşkıran E, Öztürk ZK, Şahin S. Potentially Inappropriate Medication Use among Nursing Home Residents: Medication Errors Associated with Pro re nata Medications and the Importance of Pill Burden. Ann Geriatr Med Res 2022; 26:233-240. [PMID: 36200289 PMCID: PMC9535375 DOI: 10.4235/agmr.22.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background The use of potentially inappropriate medications (PIM) has become more common among nursing home residents (NHR). This study focused on drugs initially prescribed as pro re nata (PRN) medications and pill burden in association with PIM among NHR. Methods This observational cross-sectional study was conducted between March and April 2019 on 225 adult NHR aged ≥60 years. Results The prevalence of PIM was 47.6% among NHR according to the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2. The most frequent PIM was the use of any drug prescribed without evidence-based clinical indication; most medication errors were associated with PRN medications. The prevalence rates of PRN in non-PIM and PIM users were 12% and 62.4%, respectively. PRN medications that most commonly caused PIM were non-steroidal anti-inflammatory drugs and proton pump inhibitors. The cut-off value for both medications and pills to correctly identify participants with PIM was 5.5. Pill burden had a similar sensitivity to polypharmacy in identifying individuals with PIM. Conclusion Medication errors associated with PRN medications were overlooked as factors that increased the risk of PIMs. The most common error related to PRN medications was the continued daily use despite symptom resolution.
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Affiliation(s)
- Fatma Özge Kayhan Koçak
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
- Corresponding Author: Fatma Özge Kayhan Koçak, MD Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey E-mail:
| | - Emin Taşkıran
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Zehra Kosuva Öztürk
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sevnaz Şahin
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
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Riedl L, Kiesel E, Hartmann J, Fischer J, Roßmeier C, Haller B, Kehl V, Priller J, Trojan M, Diehl-Schmid J. A bitter pill to swallow - Polypharmacy and psychotropic treatment in people with advanced dementia. BMC Geriatr 2022; 22:214. [PMID: 35296254 PMCID: PMC8925050 DOI: 10.1186/s12877-022-02914-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypharmacy is common in people with dementia. The use of psychotropic drugs (PDs) and other, potentially inappropriate medications is high. The aims of this cross-sectional study were 1) to investigate the use of drugs in people with advanced dementia (PWAD), living at home or in long term care (LTC); 2) to focus on PD use; and 3) to identify determinants of PD use. METHODS The study was performed in the context of EPYLOGE (IssuEs in Palliative care for people in advanced and terminal stages of YOD and LOD in Germany). 191 PWAD were included. All drugs that were administered at the date of the examination were recorded. Multiple logistic regression analysis identified determinants of PD use. RESULTS 96% of PWAD received medication with a median number of four drugs. 49.7% received five or more drugs. According to the Beers Criteria 39% of PWAD ≥ 65 years received at least one potentially inappropriate medication. 79% of PWAD were treated with PDs. Older PWAD and PWAD living in LTC facilities received significantly more drugs than younger PWAD, and PWAD living at home, respectively. Dementia etiology was significantly associated with the use of antipsychotics, antidepressants and sedative substances. Place of living was associated with the use of pain medication. Behavioral disturbances were associated with the use of antipsychotics and sedative substances. CONCLUSIONS To mitigate the dangers of polypharmacy and medication related harm, critical examination is required, whether a drug is indicated or not. Also, the deprescribing of drugs should be considered on a regular basis. TRIAL REGISTRATION Clinicaltrial.gov, NCT03364179 . Registered 6 December 2017.
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Affiliation(s)
- Lina Riedl
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Esther Kiesel
- School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany
| | - Julia Hartmann
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julia Fischer
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carola Roßmeier
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- School of Medicine, Münchner Studienzentrum, Munich Germany, Technical University of Munich, Munich, Germany
| | - Josef Priller
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Neuropsychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany.,University of Edinburgh and UK DRI, Edinburgh, UK
| | - Monika Trojan
- School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Bednarczyk E, Cook S, Brauer R, Garfield S. Stakeholders' views on the use of psychotropic medication in older people: a systematic review. Age Ageing 2022; 51:6550831. [PMID: 35305087 PMCID: PMC8934150 DOI: 10.1093/ageing/afac060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals’, patients’ and family caregivers’ attitudes towards the use of psychotropic medication in older people. Methods a systematic literature search was carried out from inception to September 2020 using PUBMED, EMBASE, PsycINFO and CINAHL and hand-searching of reference lists. Included studies investigated stakeholder views on psychotropic in adults over the age of 65. Findings were thematically synthesised. Results overall, there was an acceptance of long-term psychotropic medication for older people both living in the community and in residential care. While healthcare professionals were aware of guidelines for the use of benzodiazepines and psychotropic medicines, they identified barriers to following them on individual, team and organisational levels. Alternative non-pharmacological approaches were not always available or accepted by patients. Conclusion psychotropic medicine use in older adults remains a complex issue, which needs to be addressed on a broad level. Attitudes of older people and healthcare professionals encourage long-term use. Meanwhile, various internal and external factors act as barriers to the use of non-drug alternatives in this population. In order to reduce overprescribing of psychotropics, there is a need to increase the acceptability and accessibility of alternative interventions in both care homes and the community.
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Affiliation(s)
- Eliza Bednarczyk
- Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, UK
| | - Sarah Cook
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, UK
| | - Sara Garfield
- Research Department of Practice and Policy, School of Pharmacy, University College London (UCL), London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, London, UK
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Sanchez S, Chrusciel J, Ndiongue BM, Blochet C, Forget JF, Letty A, Hay PE, Novella JL. Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010423. [PMID: 35010682 PMCID: PMC8744764 DOI: 10.3390/ijerph19010423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
AIM The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. METHODS Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. RESULTS In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. CONCLUSION This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.
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Affiliation(s)
- Stéphane Sanchez
- Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France;
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
- EA 3797, Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, Université Reims Champagne Ardennes, 51100 Reims, France;
- Correspondence: ; Tel.: +33-25-49-75-61
| | - Jan Chrusciel
- Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France;
| | - Biné Mariam Ndiongue
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | | | | | - Aude Letty
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | - Paul Emile Hay
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | - Jean Luc Novella
- EA 3797, Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, Université Reims Champagne Ardennes, 51100 Reims, France;
- Pole Autonomie Santé, Centre Hospitalier Universitaire de Reims, 92130 Issy les Moulineaux, France
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11
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Ribeiro PRDS, Schlindwein AD. Benzodiazepine deprescription strategies in chronic users: a systematic review. Fam Pract 2021; 38:684-693. [PMID: 33907803 DOI: 10.1093/fampra/cmab017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As long-term use of benzodiazepines increases, adverse effects also become more frequent, especially in elderly adults. Due the potential of causing dependence, poor patient adherence and a lack of awareness of side effects, deprescription is challenging. OBJECTIVE This study aimed to identify what are the effective approaches to motivate and promote deprescription of benzodiazepines. METHODS We used MeSH terms to search in five databases that were MEDLINE, Cochrane CENTRAL, LILACS, SCIELO and Science Direct. Then, we selected articles accordingly to inclusion and exclusion criteria. Risk of bias assessment for randomized controlled trials and prospective interventional studies was made using RoB 2.0 and ROBINS-I tools, respectively. For cohort studies, we used the clarity group by McMaster University tool. RESULTS Database search retrieved 412 results, and 11 studies were selected for analysis. Interventions focusing on patient education to improve community awareness about deprescription presented better discontinuation rates and more potential on motivating discussions about deprescribing with physicians. Interventions based on counselling by different health professionals were not well evaluated as they presented four of six studies as high, serious or critical risk of bias. CONCLUSIONS Although the comparison of different strategies was impaired by the high risk of bias in some studies, patient education focused interventions presented good results. Future studies should consider doing a follow-up of 6 months or longer with evaluation of withdrawal symptoms and sleep patterns, inclusion of young adults on the sample and some form of cognitive evaluation that might influence the results of the intervention.
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Affiliation(s)
| | - Aline Daiane Schlindwein
- Science and Technology Division, Directorate of Permanent Health Education, State Secretariat of Health of Santa Catarina, Brazil
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12
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Kristensson JH, Zahirovic I, Londos E, Modig S. Medications causing potential cognitive impairment are common in nursing home dementia units – A cross-sectional study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100054. [PMID: 35480606 PMCID: PMC9031036 DOI: 10.1016/j.rcsop.2021.100054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/14/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background With advancing age the brain becomes more sensitive to centrally acting drugs thus increasing the risk of cognitive side-effects. The Swedish National Board of Health and Welfare developed indicators to measure and follow quality in older people's drug therapy, one being “Potentially Inappropriate Medications risking Cognitive impairment (PIMcogn)”. Associations between anticholinergics and cognitive impairment are described, especially in persons with Alzheimer's disease or Lewy Body Dementia/Parkinson's disease dementia, due to degenerated cholinergic pathways. Objectives To examine the prevalence of PIMcogn and if it differed between nursing home residents with and without a dementia diagnosis and between residents with different dementia aetiologias. Methods Descriptive cross-sectional study, based on residents ≥65 years in nursing home dementia units in Malmö, Sweden, in 2012–2013 (N = 574). Results The study population consisted of 76% women, the mean age was 86 years and a dementia diagnosis was registered in 92%. A total of 74% were prescribed at least one PIMcogn. Benzodiazepines were prevalent in 59%, opioids in 27%, antipsychotics in 20% and anticholinergics in 13%. Opioids used regularly and antiepileptics were more common in residents without a dementia diagnosis. The lowest proportion of anticholinergics was seen in the oldest age group, 11.0%. There was no difference seen in anticholinergics between dementia types with considerable cholinergic deficit and other dementia diagnoses. Conclusions Treatment with at least one PIMcogn was common. Usage of benzodiazepines and antipsychotics was, despite the knowledge of alarming side-effects, high. An awareness of the inappropriateness in prescribing anticholinergics to the oldest old seems to be apparent, but not to persons with cholinergic deficit. Benzodiazepine use was alarmingly high, despite the knowledge of increased risk of sedation, cognitive impairment, delirium and fall in older people. Antipsychotics were common in residents with dementia. This is worrying since alarming side-effects are seen in these persons and treatment effects of antipsychotics are modest in BPSD. An awareness of the inappropriateness in prescribing anticholinergics to the oldest old seem to be apparent, but not to persons with cholinergic deficit due to Alzheimer's disease or LBD/PDD.
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13
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Rinnan E, André B, Espnes GA, Drageset J, Garåsen H, Haugan G. Despite Symptom Severity, do Nursing Home Residents Experience Joy-of-Life? The Associations Between Joy-of-Life and Symptom Severity in Norwegian Nursing Home Residents. J Holist Nurs 2021; 40:84-96. [PMID: 34213960 PMCID: PMC9121523 DOI: 10.1177/08980101211021219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Finding new approaches to increase health and well-being among nursing home (NH) residents is highly warranted. From a holistic perspective, several Norwegian municipalities have implemented the certification scheme framed "Joy-of-Life Nursing Home" Aims: In a holistic perspective on NH care, this study investigated if NH residents despite potential symptom severity experience joy-of-life (JoL). Therefore, we examined the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents. Methods: A cross-sectional design was employed. Using the QLQ-C15-PAL quality-of-life questionnaire, hospital anxiety and depression scale, and JoL scale, a total of 188 cognitively intact NH residents participated. Results: Symptom severity was high; 54% reported fatigue, 52% reported constipation, 45% reported pain, 43% reported dyspnea, 32% reported insomnia, 22% reported appetite loss, and 20% reported nausea, while 20% reported anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related to the quality of life and negatively associated with anxiety and depression.
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Affiliation(s)
- Eva Rinnan
- 8018NTNU Norwegian University of Science and Technology.,25574Trondheim Municipality
| | - Beate André
- NTNU Norwegian University of Science and Technology
| | | | - Jorun Drageset
- 1657Western Norway University of Applied Sciences.,1658University of Bergen
| | | | - Gørill Haugan
- 8018NTNU Norwegian University of Science and Technology.,1786Nord University
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14
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Jakobsen HN, Vermehren C, Andersen JT, Dalhoff K. Drug poisoning in nursing homes: a retrospective study of data from the Danish Poison Information Centre. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00841-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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15
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Sandvik MK, Watne LO, Brugård A, Wang-Hansen MS, Kersten H. Association between psychotropic drug use and handgrip strength in older hospitalized patients. Eur Geriatr Med 2021; 12:1213-1220. [PMID: 34033072 PMCID: PMC8626357 DOI: 10.1007/s41999-021-00511-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Handgrip strength is an indicator of frailty and longevity in older adults. The association between psychotropic drug use and handgrip strength in older hospitalized patients was investigated in this study. METHODS A total of 488 patients were included in this retrospective cross-sectional study, 333 women and 155 men, from two different cohorts of older (mean age 84 years) hospitalized in-patients. We used multiple linear regression models to explore the association between psychotropic drug use and handgrip strength. We adjusted for factors known to affect handgrip strength: Age, gender, body mass index (BMI) and comorbidity (Charlson comorbidity index). RESULTS Both unadjusted and adjusted analyses showed that psychotropic drug use was associated with handgrip strength (β = - 0.183, p < 0.0001). The relationship was of a linear character, with no clear threshold value, but with the greatest reduction in handgrip strength between zero and two psychotropic drugs. CONCLUSION An increasing number of psychotropic drugs were significantly associated with reduced handgrip strength in a linearly pattern. Hence, it is timely to question the guided threshold value of avoidance of three or more psychotropic drugs in older people. Psychotropic drug use should be kept as low as possible in treatment of older patients.
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Affiliation(s)
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anniken Brugård
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Marte Sofie Wang-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
| | - Hege Kersten
- Department of Research, Telemark Hospital Trust, Skien, Norway.,Department of Pharmaceutical Bioscience, School of Pharmacy, University of Oslo, Oslo, Norway
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16
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Elli C, Novella A, Nobili A, Ianes A, Pasina L. Laxative Agents in Nursing Homes: An Example of Prescribing Cascade. J Am Med Dir Assoc 2021; 22:2559-2564. [PMID: 34023302 DOI: 10.1016/j.jamda.2021.04.021] [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: 01/25/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Laxatives are among the most prescribed medications to nursing home (NH) patients, and we evaluated the hypothesis that laxative agents could be prescribed as a result of a prescribing cascade. The aims of the study are (1) to investigate the use of laxative drugs in a large sample of Italian NHs and (2) to assess the relationship between medications that can induce constipation and laxative use. DESIGN Retrospective cross-sectional multicenter study. SETTING AND PARTICIPANTS Individuals living in long-term care NHs. METHODS Study conducted in a sample of Italian long-term care NHs distributed throughout the country. Information on drug prescriptions, diseases and sociodemographic characteristics collected 4 times during 2018 and 2019. RESULTS Among the 2602 patients recruited from 27 NHs (mean age ± standard deviation: 88.4 ± 8.5; women: 1994, 76.6%), 1248 were receiving laxatives (48%). Parkinson disease, cerebrovascular disease, and hemiplegia were associated with laxative prescription, and diabetes was associated with a decrease. Benzodiazepines, anti-Parkinson dopaminergic agents, and antidepressants (tricyclic antidepressants and mirtazapine) were associated with laxative treatment in univariate and adjusted models. Tricyclic antidepressants users were 3 times more likely to be taking laxatives than nonusers (odds ratio 2.98, 95% confidence interval 1.31-6.77, P = .0093). A larger number of drugs that can induce constipation was associated with laxative use (P = .0003). In all, 2002 individuals had at least 2 different prescription times: from the first to the last visit laxative use rose from 46.1% to 49.9%. Time of stay was also associated with laxative use (P = .016). CONCLUSIONS AND IMPLICATIONS Laxatives are among the most prescribed medications in Italian NHs. Medications that can induce constipation, such as antidepressants, anti-Parkinson dopaminergic agents, and benzodiazepines, are often used together with laxatives, and combinations of these drugs further increase the use of laxatives. Optimizing the prescription of psychotropic drugs could help reduce the "prescribing cascade" with laxatives. The length of stay in NHs is often proportional to laxative use and chronic treatment is very common.
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Affiliation(s)
- Chiara Elli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Alessio Novella
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Anfinogenova ND, Trubacheva IA, Popov SV, Efimova EV, Ussov WY. Trends and concerns of potentially inappropriate medication use in patients with cardiovascular diseases. Expert Opin Drug Saf 2021; 20:1191-1206. [PMID: 33970732 DOI: 10.1080/14740338.2021.1928632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The use of potentially inappropriate medications (PIM) is an alarming social risk factor in cardiovascular patients. PIM administration may result in iatrogenic disorders and adverse consequences may be attenuated by limiting PIM intake.Areas covered: The goal of this review article is to discuss the trends, risks, and concerns regarding PIM administration with focus on cardiovascular patients. To find data, we searched literature using electronic databases (Pubmed/Medline 1966-2021 and Web of Science 1975-2021). The data search terms were cardiovascular diseases, potentially inappropriate medication, potentially harmful drug-drug combination, potentially harmful drug-disease combination, drug interaction, deprescribing, and electronic health record.Expert opinion: Drugs for heart diseases are the most commonly prescribed medications in older individuals. Despite the availability of explicit and implicit PIM criteria, the incidence of PIM use in cardiovascular patients remains high ranging from 7 to 85% in different patient categories. Physician-induced disorders often occur when PIM is administered and adverse effects may be reduced by limiting PIM intake. Main strategies promising for addressing PIM use include deprescribing, implementation of systematic electronic records, pharmacist medication review, and collaboration among cardiologists, internists, geriatricians, clinical pharmacologists, pharmacists, and other healthcare professionals as basis of multidisciplinary assessment teams.
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Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Irina A Trubacheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Elena V Efimova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
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Challenges Faced by Health Professionals in Obtaining Correct Medication Information in the Absence of a Shared Digital Medication List. PHARMACY 2021; 9:pharmacy9010046. [PMID: 33671820 PMCID: PMC8006028 DOI: 10.3390/pharmacy9010046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022] Open
Abstract
Information about patient medication use is usually registered and stored in different digital systems, making it difficult to share information across health care organisations. The lack of digital systems able to share medication information poses a threat to patient safety and quality of care. We explored the experiences of health professionals with obtaining and exchanging information on patient medication lists in Norwegian primary health care within the context of current digital and non-digital solutions. We used a qualitative research design with semi-structured interviews, including general practitioners (n = 6), pharmacists (n = 3), nurses (n = 17) and medical doctors (n = 6) from six municipalities in Norway. Our findings revealed the following five challenges characterised by being cut off from information on patient medication lists in the current digital and non-digital solutions: ‘fragmentation of information systems’, ‘perceived risk of errors’, ‘excessive time use’, ‘dependency on others’ and ‘uncertainty’. The challenges were particularly related to patient transitions between levels of care. Our study shows an urgent need for digital solutions to ensure seamless, up-to-date information about patient medication lists in order to prevent medication-related problems. Future digital solutions for a shared medication list should address these challenges directly to ensure patient safety and quality of care.
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19
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Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study. BJGP Open 2021; 5:BJGPO.2021.0167. [PMID: 34620596 PMCID: PMC9447292 DOI: 10.3399/bjgpo.2021.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Care home residents often have multiple cognitive and physical impairments, and are at high risk of adverse drug events (ADEs). AIM To describe excessive polypharmacy and potentially inappropriate prescribing predisposing care home residents to ADEs. DESIGN & SETTING A cross-sectional analysis of all dispensed prescriptions for 147 care home residents in Tayside and Fife, Scotland. METHOD Prevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted. RESULTS In total, 32.3% (n = 1444/4468) of residents had excessive polypharmacy, which was more common in residents aged 70-74 years (adjusted odds ratio [aOR] 1.86, 95% confidence interval [CI] = 1.04 to 3.34) and 80-84 years (aOR 1.75, 95% CI = 1.01 to 3.02), living in a residential care home (aOR 1.50, 95% CI = 1.19 to 1.88), and located in Fife (aOR 1.37, 95% CI = 1.09 to 1.71). Excessive polypharmacy was less common in residents with dementia (aOR 0.73, 95% CI = 0.64 to 0.84), and 8.9% (95% CI = 5.9% to 11.6%) of the variation was attributable to care home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories, with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%). CONCLUSION Excessive polypharmacy is common in care home residents and is associated with both individual and care home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADE categories is common. Research is needed to support and evaluate safe care home prescribing practices.
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20
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Pasina L, Novella A, Elli C, Nobili A, Ianes A. Inappropriate use of antiplatelet agents for primary prevention in nursing homes: An Italian multicenter observational study. Geriatr Gerontol Int 2020; 20:828-832. [PMID: 32716596 DOI: 10.1111/ggi.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
AIM The benefits of antiplatelets to prevent cardio- and cerebrovascular disease are recognized and appropriate only for "secondary prevention." This multicenter retrospective study was designed to (i) examine the prevalence of residents receiving antiplatelets for primary and secondary cardio- and cerebrovascular prevention, and (ii) evaluate the predictors of inappropriate antiplatelet prescription. METHODS This study was conducted in a sample of Italian long-term care nursing homes (NHs). Appropriate use of antiplatelets was defined in accordance with the strongest evidence-based indications. RESULTS Among the 2579 patients recruited from 27 long-term care NHs (age mean ± SD: 86.8 ± 7.3; women: 1995; 77.4%), 1092 were treated with antiplatelets (42.3%) and 619 (56.7%) were receiving antiplatelet agents for inappropriate primary prevention of cardio- or cerebrovascular atherothrombotic events. Age, dementia or cerebral atherosclerosis, congestive heart failure, peripheral vascular disease, diabetes without chronic complication and hypertension were predictors of inappropriate prescription of antiplatelets. Patients inappropriately treated with antiplatelets also had a higher risk of receiving proton pump inhibitors than those appropriately not treated in univariate (OR 95% CI = 2.79 (2.25-3.46, p < 0.0001) and multivariate models (OR 95% CI 2.71 (2.16-3.40, p < 0.0001). CONCLUSIONS Most patients receiving antiplatelet agents in NHs are being inappropriately treated for primary prevention of cardio- or cerebrovascular disease. NH residents with diagnosis of dementia or cerebral atherosclerosis, congestive heart failure, peripheral vascular disease, diabetes without chronic complication and hypertension seemed more likely to receive antiplatelets inappropriately. Patients without an evidence-based indication for antiplatelets also received proton-pump inhibitors in an unnecessary "prescribing cascade," which should be assessed for de-prescribing. Geriatr Gerontol Int 2020; 20: 828-832.
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Affiliation(s)
- Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessio Novella
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Elli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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21
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Wang KN, Bell JS, Tan EC, Gilmartin-Thomas JF, Dooley MJ, Ilomäki J. Statin use and fall-related hospitalizations among residents of long-term care facilities: A case-control study. J Clin Lipidol 2020; 14:507-514. [PMID: 32571729 DOI: 10.1016/j.jacl.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Statins are associated with muscle-related adverse events, but few studies have investigated the association with fall-related hospitalizations among residents of long-term care facilities (LTCFs). OBJECTIVE The objective of the study is to investigate whether statin use is associated with fall-related hospitalizations from LTCFs. METHODS A case-control study was conducted among residents aged ≥65 years admitted to hospital from 2013 to 2015. Cases (n = 332) were residents admitted for falls and fall-related injuries. Controls (n = 332) were selected from patients admitted for reasons other than cardiovascular and diabetes. Cases and controls were matched 1:1 by age (±2 years), index date of admission (±6 months), and sex. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression, after considering for history of falls, hypertension, dementia, functional comorbidity index, polypharmacy (≥9 regular preadmission medications), and fall-risk medications. Subanalyses were performed for individual statins, dementia, and statin intensity. RESULTS Overall, 43.1% of cases and 27.1% of controls used statins. Statins were associated with fall-related hospitalizations (aOR = 2.24, 95% CI 1.56-3.23), in particular simvastatin (aOR = 2.26, 95% CI 1.22-4.20) and atorvastatin (aOR = 2.08, 95% CI 1.33-3.24). Statins were associated with fall-related hospitalizations in residents with (aOR = 2.34, 95% CI 1.33-4.11) and without dementia (aOR = 2.30, 95% CI 1.46-3.63). There was no association between statin intensity and fall-related hospitalizations (aOR = 0.78, 95% CI 0.43-1.40). CONCLUSION This study suggests a possible association between statin use and fall-related hospitalizations among residents living in LTCFs. However, there was minimal evidence for a relationship between statin intensity and fall-related hospitalizations. Further research is required to substantiate these hypothesis-generating findings.
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Affiliation(s)
- Kate N Wang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Edwin Ck Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Julia Fm Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Temporal Trends in the Use of Anticholinergic Drugs Among Older People Living in Long-Term Care Facilities in Helsinki. Drugs Aging 2020; 37:27-34. [PMID: 31705445 PMCID: PMC6965041 DOI: 10.1007/s40266-019-00720-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The use of drugs with anticholinergic properties (DAPs) is common among older adults despite their known adverse effects, such as cognitive decline. Professionals should pay attention to DAPs, since evidence on their adverse effects has been accumulating during the last decade. However, to our knowledge previous studies exploring temporal trends in the use of DAPs are scarce. Objective The aim of this study was to assess temporal trends in the use of DAPs from 2003 to 2017 in long-term care facilities in Helsinki. Methods Four cross-sectional studies were conducted in 2003, 2007, 2011, and 2017. Participants included older people (≥ 65 years) living in nursing homes (NHs) in 2003 (n = 1979), 2011 (n = 1568), and 2017 (n = 750), and in assisted living facilities (ALFs) in 2007 (n = 1336), 2011 (n = 1556), and 2017 (n = 1673) in Helsinki, Finland. Data on demographics, medication use, and diagnoses were collected by structured questionnaires. The assessments were conducted as a point prevalence over 1 day. The use of DAPs and the total anticholinergic burden were defined by the Anticholinergic Risk Scale (ARS). Results In ALFs, there has been an increasing trend in the use of DAPs over a 10-year period (41.2% in 2007 and 53.7% in 2017). In NHs, by contrast, the use of DAPs remained quite stable (52.3% in 2003 and 52.4% in 2017). The burden of DAPs measured by ARS score decreased in NHs and remained stable in ALFs. Marked changes occurred in the DAPs used; antidepressants, especially mirtazapine, increased in both settings, whereas the use of hydroxyzine and urinary antispasmodics nearly disappeared. The proportion of users of DAP antipsychotics increased in ALFs. Participants with dementia had a lower anticholinergic burden than those without dementia, in both settings. Conclusions Despite increased knowledge of the harms of DAPs, they remain widely used. Physicians seem to be aware of the harms of DAPs among people with dementia, and some other favorable trends in prescribing were also observed. Clinicians should especially consider the indications behind the use of DAP antidepressants and antipsychotics, and carefully weigh their potential benefits and harms.
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Pasina L, Novella A, Cortesi L, Nobili A, Tettamanti M, Ianes A. Drug prescriptions in nursing home residents: an Italian multicenter observational study. Eur J Clin Pharmacol 2020; 76:1011-1019. [DOI: 10.1007/s00228-020-02871-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
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Schjøtt J, Schjøtt P, Assmus J. Analysis of consensus among drug interaction databases with regard to combinations of psychotropics. Basic Clin Pharmacol Toxicol 2019; 126:126-132. [PMID: 31468698 DOI: 10.1111/bcpt.13312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
Drug interaction databases are important tools in today's clinical decision support. However, there is great variation with regard to classification and presentation of interactions among databases. The present study aimed to investigate consensus among databases with regard to combinations of psychotropics. A database integrated in Norwegian computerised clinical decision support systems and three international recommended subscription databases were compared. Combinations of psychotropics (two or more) prescribed to patients 65 years or older on a single day from three nursing homes in Bergen, Norway 16 years apart (2000 and 2016) were studied. The databases were compared in a common analysis with the following questions: interaction (no, not contraindicated or contraindicated), type (pharmacodynamic or pharmacokinetic), the total number of interactions, and the first ranked interaction among several in each patient. Consensus among the four drug interaction databases was associated with pharmacokinetic interactions involving mainly older psychotropics in the common analysis. The qualities that best characterised interactions with consensus was primarily the evidence including a description of manageability. There was a surprising lack of consensus with regard to contraindicated interactions, even when older psychotropics were involved. Lack of consensus decreased with the number of psychotropics in the combinations. This was mainly because the highest ranked interactions in the respective databases involved different drugs. We propose evidence and manageability as core factors when ranking and presenting interactions in clinical decision support.
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Affiliation(s)
- Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
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Kalisch Ellett LM, Kassie GM, Pratt NL, Kerr M, Roughead EE. Prevalence and Duration of Use of Medicines Recommended for Short-Term Use in Aged Care Facility Residents. PHARMACY 2019; 7:E55. [PMID: 31174405 PMCID: PMC6631023 DOI: 10.3390/pharmacy7020055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications recommended for short-term use in residents of aged care facilities in Australia. METHODS Australian Government Department of Veterans' Affairs (DVA) administrative claims data were used for this study. Veterans eligible for all health services subsidised by DVA were followed for one year from 1 July 2015 to 30 June 2016. The number of days covered for each medicine was calculated by multiplying the number of prescriptions dispensed during the year by the pack duration for the medicine. The pack duration was calculated by dividing the quantity supplied at each dispensing by the usual number of doses per day in older people according to Australian prescribing guidelines. The proportion of patients using each medicine and the number of days covered during the study period were determined. RESULTS 14, 237 residents met the inclusion criteria. One in five participants were dispensed antipsychotics, and the median duration of use was 180 days in the one-year period. More than one-third were dispensed a benzodiazepine, and the median duration of use was 240 days in the year. Half were dispensed an opioid analgesic with a median duration of use of 225 days in the year. Fifty-two percent were dispensed proton pump inhibitors with a median duration of use of 360 days in the year. A quarter received an antibiotic recommended for the management of urinary tract infection, with a median duration of use of 14 days in the year. CONCLUSION Long-term use of antipsychotics, benzodiazepines, opioid analgesics and proton pump inhibitors is common in aged care residents. Ensuring appropriate duration of use for these medicines is necessary to reduce risk of harm.
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Affiliation(s)
- Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Gizat M Kassie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Mhairi Kerr
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators. BMC Med Inform Decis Mak 2019; 19:102. [PMID: 31142298 PMCID: PMC6542081 DOI: 10.1186/s12911-019-0821-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
Background Inappropriate prescribing of psychotropics is a persistent and prevalent problem in nursing homes. The present study compared inappropriate prescribing of psychotropics in nursing homes 16 years apart with prescribing quality indicators. The purpose was to identify any change in inappropriate prescribing of relevance for medical informatics. Methods Three Norwegian nursing homes were audited in 2000 and 2016 with regard to prescribing quality. Psychotropics among 386 patients in 2000, and 416 patients in 2016, included combinations of antidepressants, antipsychotics, anxiolytics-hypnotics, and antiepileptics. Prescribing quality indicators included psychotropic polypharmacy (defined as concurrent use of three or more psychotropics) and potential inappropriate psychotropic substances or combinations. Furthermore, potential clinically relevant psychotropic interactions were classified as pharmacodynamic or pharmacokinetic using an interaction database. The first ranked (most important) interaction in each patient was selected with the following importance of categories in the database; recommended action > documentation > severity. Three levels (from low to high) within each category were used for ranking. Results From 2000 to 2016, psychotropic polypharmacy increased from 6.2 to 29.6%, potential inappropriate psychotropic substances was reduced from 17.9 to 11.3% and potential inappropriate psychotropic combinations increased from 7.8 to 27.9%. Changes in polypharmacy and combinations were predominantly associated with prescribing of anxiolytics-hypnotics. Sixty-three patients (16.3%) had psychotropic interactions in 2000 increasing to 146 patients (35.1%) in 2016. The increase in interactions was associated with prescribing of antidepressants. First ranked interactions, more than 60% of all interactions in both years, were increasingly pharmacodynamic, from 69.9 to 91.0%. Interactions in 2016 were associated with a lower level of recommended action and documentation, but not severity compared to 2000. The inappropriate prescribing of antipsychotics and antiepileptics was reduced in 2016 compared to 2000. Conclusions Using prescribing quality indicators we observed the importance of antidepressants and anxiolytics-hypnotics for inappropriate prescribing in 2016 while the role of antipsychotics and antiepileptics were reduced compared to 2000. A change to mainly pharmacodynamic interactions that lack good documentation was also observed. The present findings can be used for medical informatics-based approaches to address specific problems with prescribing, and prescribing quality indicators, in Norwegian nursing homes.
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Gold C, Eickholt J, Assmus J, Stige B, Wake JD, Baker FA, Tamplin J, Clark I, Lee YEC, Jacobsen SL, Ridder HMO, Kreutz G, Muthesius D, Wosch T, Ceccato E, Raglio A, Ruggeri M, Vink A, Zuidema S, Odell-Miller H, Orrell M, Schneider J, Kubiak C, Romeo R, Geretsegger M. Music Interventions for Dementia and Depression in ELderly care (MIDDEL): protocol and statistical analysis plan for a multinational cluster-randomised trial. BMJ Open 2019; 9:e023436. [PMID: 30928926 PMCID: PMC6475205 DOI: 10.1136/bmjopen-2018-023436] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION In older adults, dementia and depression are associated with individual distress and high societal costs. Music interventions such as group music therapy (GMT) and recreational choir singing (RCS) have shown promising effects, but their comparative effectiveness across clinical subgroups is unknown. This trial aims to determine effectiveness of GMT, RCS and their combination for care home residents and to examine heterogeneity of treatment effects across subgroups. METHODS AND ANALYSIS This large, pragmatic, multinational cluster-randomised controlled trial with a 2×2 factorial design will compare the effects of GMT, RCS, both or neither, for care home residents aged 65 years or older with dementia and depressive symptoms. We will randomise 100 care home units with ≥1000 residents in total across eight countries. Each intervention will be offered for 6 months (3 months 2 times/week followed by 3 months 1 time/week), with extension allowed if locally available. The primary outcome will be the change in the Montgomery-Åsberg Depression Rating Scale score at 6 months. Secondary outcomes will include depressive symptoms, cognitive functioning, neuropsychiatric symptoms, psychotropic drug use, caregiver burden, quality of life, mortality and costs over at least 12 months. The study has 90% power to detect main effects and is also powered to determine interaction effects with gender, severity and socioeconomic status. ETHICS AND DISSEMINATION Ethical approval has been obtained for one country and will be obtained for all countries. Results will be presented at national and international conferences and published in scientific journals. TRIAL REGISTRATION NUMBERS NCT03496675; Pre-results, ACTRN12618000156280.
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Affiliation(s)
- Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jasmin Eickholt
- Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Jörg Assmus
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Brynjulf Stige
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Felicity Anne Baker
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | - Imogen Clark
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | - Young-Eun Claire Lee
- Faculty of Fine Arts and Music, University of Melbourne, Southbank, Victoria, Australia
| | | | | | - Gunter Kreutz
- Department of Music, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Thomas Wosch
- Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Enrico Ceccato
- Department of Mental Health, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Alfredo Raglio
- Music Therapy Research Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Mirella Ruggeri
- Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Annemiek Vink
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Music therapy Department, Academy of Music, ArtEZ University of the Arts, Enschede, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helen Odell-Miller
- The Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Christine Kubiak
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Renee Romeo
- King’s Health Economics, King’s College London, London, UK
| | - Monika Geretsegger
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
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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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Rieckert A, Trampisch US, Klaaßen-Mielke R, Drewelow E, Esmail A, Johansson T, Keller S, Kunnamo I, Löffler C, Mäkinen J, Piccoliori G, Vögele A, Sönnichsen A. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. BMC FAMILY PRACTICE 2018; 19:113. [PMID: 30021528 PMCID: PMC6052592 DOI: 10.1186/s12875-018-0795-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Polypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients. METHODS This cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled multicentre study of polypharmacy in primary care. Patients' baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily). RESULTS Three thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22-1.71), > 8 diagnoses (OR 2.64; 95% CI 2.24-3.11), BMI ≥30 (OR 1.18; 95% CI 1.02-1.38), a lower SF-12 physical health composite score (OR 1.47; 95% CI 1.26-1.72), and a lower SF-12 mental health composite score (OR 1.33; 95% CI 1.17-1.59) than the median of the study population (≤36.6 and ≤ 48.7, respectively). Age ≥ 85 years (OR 0.83; 95% CI 0.70-0.99) led to a significantly lower risk for excessive polypharmacy. No association with excessive polypharmacy could be found for female sex, low educational level, and smoking. Regarding the study centres, being recruited in the UK led to a significantly higher risk for excessive polypharmacy compared to being recruited in Germany 1/Rostock (OR 1.71; 95% CI 1.27-2.30). Being recruited in Germany 2/Witten led to a slightly significant lower risk for excessive polypharmacy compared to Germany 1/Rostock (OR 0.74; 95% CI 0.56-0.97). CONCLUSIONS Frailty, multimorbidity, obesity, and decreased physical as well as mental health status are risk factors for excessive polypharmacy. Sex, educational level, and smoking apparently do not seem to be related to excessive polypharmacy. Physicians should especially pay attention to their frail, obese patients who have multiple diagnoses and a decreased health-related quality of life, to check carefully whether all the drugs prescribed are evidence-based, safe, and do not interact in an unfavourable way. TRIAL REGISTRATION This trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).
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Affiliation(s)
- Anja Rieckert
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Ulrike S. Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Universitätsstr. 105, 44789 Bochum, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Universitätsstr. 105, 44789 Bochum, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Aneez Esmail
- NIHR School of Primary Care Research, University of Manchester, Oxford Road 176, M13 9PL, Manchester, UK
| | - Tim Johansson
- Centre for Primary Care, NIHR School of Primary Care Research, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Sophie Keller
- Centre for Primary Care, NIHR School of Primary Care Research, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd., Kaivokatu 10 A, 00100 Helsinki, Finland
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Joonas Mäkinen
- Duodecim Medical Publications Ltd., Kaivokatu 10 A, 00100 Helsinki, Finland
| | - Giuliano Piccoliori
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100 Bolzano, Italy
| | - Anna Vögele
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100 Bolzano, Italy
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
- NIHR School of Primary Care Research, University of Manchester, Oxford Road 176, M13 9PL, Manchester, UK
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Erzkamp S, Rose O. Development and evaluation of an algorithm-based tool for Medication Management in nursing homes: the AMBER study protocol. BMJ Open 2018; 8:e019398. [PMID: 29678967 PMCID: PMC5914904 DOI: 10.1136/bmjopen-2017-019398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Residents of nursing homes are susceptible to risks from medication. Medication Reviews (MR) can increase clinical outcomes and the quality of medication therapy. Limited resources and barriers between healthcare practitioners are potential obstructions to performing MR in nursing homes. Focusing on frequent and relevant problems can support pharmacists in the provision of pharmaceutical care services. This study aims to develop and evaluate an algorithm-based tool that facilitates the provision of Medication Management in clinical practice. METHODS AND ANALYSIS This study is subdivided into three phases. In phase I, semistructured interviews with healthcare practitioners and patients will be performed, and a mixed methods approach will be chosen. Qualitative content analysis and the rating of the aspects concerning the frequency and relevance of problems in the medication process in nursing homes will be performed. In phase II, a systematic review of the current literature on problems and interventions will be conducted. The findings will be narratively presented. The results of both phases will be combined to develop an algorithm for MRs. For further refinement of the aspects detected, a Delphi survey will be conducted. In conclusion, a tool for clinical practice will be created. In phase III, the tool will be tested on MRs in nursing homes. In addition, effectiveness, acceptance, feasibility and reproducibility will be assessed. The primary outcome of phase III will be the reduction of drug-related problems (DRPs), which will be detected using the tool. The secondary outcomes will be the proportion of DRPs, the acceptance of pharmaceutical recommendations and the expenditure of time using the tool and inter-rater reliability. ETHICS AND DISSEMINATION This study intervention is approved by the local Ethics Committee. The findings of the study will be presented at national and international scientific conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00010995.
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Affiliation(s)
| | - Olaf Rose
- Elefanten-Apotheke, gegr. 1575, Steinfurt, Germany
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
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Korhonen MJ, Ilomäki J, Sluggett JK, Brookhart MA, Visvanathan R, Cooper T, Robson L, Bell JS. Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services. J Clin Lipidol 2018; 12:652-661. [PMID: 29574073 DOI: 10.1016/j.jacl.2018.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. OBJECTIVE We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. METHODS A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments. RESULTS The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93) and hospitalizations (HR 0.67, 95% CI 0.46-0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80-2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47-0.96). CONCLUSIONS The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting.
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Affiliation(s)
- Maarit J Korhonen
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - M Alan Brookhart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Renuka Visvanathan
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - Leonie Robson
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - J Simon Bell
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
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Nyborg G, Brekke M, Straand J, Gjelstad S, Romøren M. Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria. BMC Geriatr 2017; 17:220. [PMID: 28927372 PMCID: PMC5606129 DOI: 10.1186/s12877-017-0608-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. METHODS Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009-11 included residents' demographic and clinical status and all medications, regular and on demand. RESULTS 881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009). CONCLUSIONS Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population. TRIAL REGISTRATION Retrospectively registered. Data obtained from clinical trial NCT01023763 registered with ClinicalTrials.gov 12/01/2009.
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Affiliation(s)
- Gunhild Nyborg
- Department of General Practice/Family Medicine, HELSAM, Institute of Health and Society, University of Oslo, P.o. Box 1130 Blindern, 0318 Oslo, Norway
| | - Mette Brekke
- Department of General Practice/Family Medicine, HELSAM, Institute of Health and Society, University of Oslo, P.o. Box 1130 Blindern, 0318 Oslo, Norway
| | - Jørund Straand
- Department of General Practice/Family Medicine, HELSAM, Institute of Health and Society, University of Oslo, P.o. Box 1130 Blindern, 0318 Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice/Family Medicine, HELSAM, Institute of Health and Society, University of Oslo, P.o. Box 1130 Blindern, 0318 Oslo, Norway
| | - Maria Romøren
- Department of General Practice/Family Medicine, HELSAM, Institute of Health and Society, University of Oslo, P.o. Box 1130 Blindern, 0318 Oslo, Norway
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