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Hilmer SN, Johnell K, Mach J. Pre-clinical Models for Geriatric Pharmacotherapy. Drugs Aging 2024:10.1007/s40266-024-01129-6. [PMID: 38982010 DOI: 10.1007/s40266-024-01129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
With ageing of the population worldwide and discovery of new medications for prevention and management of age-related conditions, there is increasing use of medications by older adults. There are international efforts to increase the representativeness of participants in clinical trials to match the intended real-world users of the medications across a range of characteristics including age, multimorbidity, polypharmacy and frailty. Currently, much of the data on medication-related harm in older adults are from pharmacovigilance studies. New methods in pre-clinical models have allowed for measurement of exposures (such as chronic exposure, polypharmacy and deprescribing) and outcomes (such as health span functional measures and frailty) that are highly relevant to geriatric pharmacotherapy. Here we describe opportunities for design and implementation of pre-clinical models that can better predict drug effects in geriatric patients. This could improve the translation of new drugs from bench to bedside and improve outcomes of pharmacotherapy in older adults.
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Affiliation(s)
- Sarah N Hilmer
- Kolling Institute, The University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - John Mach
- Kolling Institute, The University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
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Dil-Nahlieli D, Ben-Yehuda A, Souroujon D, Hyam E, Shafran-Tikvah S. Validation of a novel Artificial Pharmacology Intelligence (API) system for the management of patients with polypharmacy. Res Social Adm Pharm 2024; 20:633-639. [PMID: 38637208 DOI: 10.1016/j.sapharm.2024.04.003] [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: 10/08/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Medication management of patients with polypharmacy is highly complex. We aimed to validate a novel Artificial Pharmacology Intelligence (API) algorithm to optimize the medication review process in a comprehensive, personalized, and scalable way. MATERIALS AND METHODS The study was conducted on anonymized retrospective electronic health records (EHR) of 49 patients. Each patient's file was reviewed by the API system, a clinical pharmacist, and a judging committee. Validation was assessed by comparing the overall agreement of the judging committee (as the gold standard, blinded to the identity of the analyzer) to both the API system and clinical pharmacists' conclusions. Five medication-related problem (MRP) categories were assessed: duplication of therapy, age-related issues, incorrect dose, current side effects and future side effects' risk. For each category the overall validity parameters, agreement, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were analyzed. RESULTS The agreement between the API system and the judging committee was 93.5 % (95 % CI 92.7-94.4), while the agreement between the clinical pharmacists and the judging committee was 73.9 % (95 % CI 72.5-75.3). The PPV was 92.2 % (90.9-93.5) and NPV was 94.2 % (93.1-95.2) for the API system and 76.3 % (69.8-82.8) and 73.5 % (72.3-74.8) respectively for the clinical pharmacists. DISCUSSION AI systems can equip clinicians with sophisticated tools and scale manual processes such as comprehensive medication reviews, thus reducing MRPs and drug-related hospitalizations related to multidrug treatments. The API system validated in this study provided comprehensive, multidrug, multilayered analysis intended to bridge the innate complexity of personalized polypharmacy treatment. CONCLUSIONS The API system was validated as a tool for providing actionable clinical insights non-inferior to a manual clinical review of a clinical pharmacist. The API system showed promising results in reducing MRPs.
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Affiliation(s)
- Dorit Dil-Nahlieli
- Department of Research and Development, MDI Health Technologies, Ramat Gan, Israel.
| | - Arie Ben-Yehuda
- Department of Medicine, Hadassah Medical Center Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Eytan Hyam
- Department of Research and Development, MDI Health Technologies, Ramat Gan, Israel
| | - Sigal Shafran-Tikvah
- Nursing Division, Hadassah University Medical Center & Jerusalem College of Technology, Jerusalem, Israel
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Prasad N, Lau ECY, Wojt I, Penm J, Dai Z, Tan ECK. Prevalence of and Risk Factors for Drug-Related Readmissions in Older Adults: A Systematic Review and Meta-Analysis. Drugs Aging 2024; 41:1-11. [PMID: 37864770 PMCID: PMC10770220 DOI: 10.1007/s40266-023-01076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Older adults are at an increased risk of drug-related problems, especially following discharge from hospital. Drug-related readmissions place a large burden on the patient and the healthcare system. However, previous studies report inconsistent results on the prevalence and associated risk factors for drug-related hospital readmissions in older adults. OBJECTIVES We aimed to assess the prevalence of drug-related readmissions in older adults aged 65 years and older and investigate the drug classes, preventability and risk factors most associated with these readmissions. METHODS A systematic review and meta-analysis were undertaken to answer our objectives. A search of four databases (MEDLINE, Embase, CINAHL and Scopus) was conducted. Three authors independently performed title and abstract screening, full-text screening and data extraction of all included studies. A meta-analysis was conducted to calculate the pooled prevalence of drug-related readmissions across all studies, and a subgroup analysis was performed to explore heterogeneity among studies reporting on adverse drug reaction-related readmissions. RESULTS A total of 1978 studies were identified in the initial search, of which four studies were included in the final synthesis. Three studies focused on readmissions due to adverse drug reactions and one study focused on readmissions due to drug-related problems. A pooled prevalence of 9% (95% confidence interval 2-18) was found for drug-related readmissions across all studies, and a pooled prevalence of 6% (95% confidence interval 4-10) was found for adverse drug reaction-related readmissions. Three studies explored the preventability of readmissions and 15.4-22.2% of cases were deemed preventable. The drug classes most associated with adverse drug reaction readmissions included anticoagulants, antibiotics, psychotropics and chemotherapy agents. Polypharmacy (the use of five or more medications) and several comorbidities such as cancer, liver disease, ischaemic heart disease and peptic ulcer disease were identified as risk factors for drug-related readmissions. CONCLUSIONS Almost one in ten older adults discharged from hospital experienced a drug-related hospital readmission, with one fifth of these deemed preventable. Several comorbidities and the use of polypharmacy and high-risk drugs were identified as prominent risk factors for readmission. Further research is needed to explore possible causes of drug-related readmissions in older adults for a more guided approach to the development of effective medication management interventions.
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Affiliation(s)
- Narisha Prasad
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Edward C Y Lau
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Ilsa Wojt
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Zhaoli Dai
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Edwin C K Tan
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
- Charles Perkins Centre, Pharmaceutical Policy Node, The University of Sydney, Sydney, NSW, Australia.
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Garedow AW, Mamo MD, Tesfaye GT. Medication Related-Problems and Associated Factors Among Patients with Hypertension at a Tertiary Care Hospital in Ethiopia: A Prospective Interventional Study. Integr Blood Press Control 2023; 16:123-136. [PMID: 38054013 PMCID: PMC10695137 DOI: 10.2147/ibpc.s434072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
Background Hypertension affects more than 1.4 billion people worldwide currently, with that number anticipated to climb to 1.6 billion by 2025 with high mortality and morbidity effects. Medication related problems in cardiovascular disease patients, especially among hypertension patients were found to be high and a critical problem which is associated with high mortality, complication, prolonged hospital stay, compromised quality of life and increase health care cost. Objective To determine medication related problems and its predictors among hypertension patients on chronic follow-up at Jimma Medical Center. Methods A prospective interventional study was conducted among hypertension patients from November 28, 2021 to June 30, 2022 at Jimma Medical Center. Medication related problems were classified and identified based on Pharmaceutical care network Europe drug classification tool version 9.0. Interventions were done through discussion with individual prescriber and patients. Consecutive sampling technique was used. Binary Logistic regression was used to identify independent predictors of medication related problems. Variables having P-values < 0.05 were considered statistically significant. Results Among 384 hypertension patients included in the study, 219 (57.1%) were male. The mean (SD) age was 49.06+17.79. Two thirds of study participants had at least one medication related problem. A total of 483 MRPs were identified among 231 (60.15%) patients. Treatment effectiveness related problem (55.48%) was the most common observed medication related problems. Alcoholism (AOR; 3.15, 95% CI [1.46-7.23]), stage II hypertension (AOR=2.77, 95% CI= [3.53-4.66]); comorbidity (AOR=2.88, 95% CI= [1.47-5.66]) and polypharmacy (AOR=3.07, 95% CI= [1.57-5.99]) were the independent predictors of medication related problems. Conclusion The prevalence of medication related problems was high among hypertensive patients. Alcoholism, stage II hypertension, comorbidity and poly-pharmacy were the predictors of medication related problems. Therefore, to overcome the problems, clinical pharmacists, physicians and other health care professionals have to work in collaboration.
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Cai S, Huang X, Van C, Li W, Yan M, Lu Y, Li H, Deng Z, Lu P, Xu Z. General practitioners' attitudes towards and frequency of collaboration with pharmacists in China: a cross-sectional study. BMC Health Serv Res 2023; 23:1174. [PMID: 37891601 PMCID: PMC10612245 DOI: 10.1186/s12913-023-10151-0] [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: 07/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Building interprofessional working relationships between general practitioners (GPs) and pharmacists is essential to ensure high-quality patient care. However, there is limited Chinese literature on GP-pharmacist collaboration, and few studies have explored GPs' experiences with pharmacist integration into general practices. This study aimed to investigate GPs' attitudes towards and frequency of collaboration with pharmacists in China. METHODS This cross-sectional study used an online self-administered questionnaire integrating two scales, ATCI-GP and FICI-GP, which had been translated and validated to investigate 3,248 GPs from February 15 to March 15, 2023 across Zhejiang Province, China. Descriptive analyses were used, and the factors associated with GPs' frequency of collaboration with pharmacists were explored using logistic regression analysis. RESULTS A total of 2,487 GPs (76.6%) responded and consented to participate in the survey; 52.3% were male and the mean age was 35.4 years. Most GPs agreed that they shared common goals and objectives with pharmacists when caring for patients (90.0%), and pharmacists were open to working with them on patients' medication management (80.8%). However, half of the GPs did not change or seldom changed the patient's medication on the pharmacist's advice (51.4%). Logistic regression analysis showed that GPs who were older and had more years of practice were more likely to agree that pharmacists were willing to collaborate, had common goals for treatment and that they would change the patient's medication on the advice of the pharmacist. GPs who had regular communication protocols (adjusted odds ratio1 [aOR1] = 1.88, 95% CI 1.45-2.45; aOR2 = 3.33, 95% CI 2.76-4.02), participated in joint continuing education (aOR1 = 1.87, 95% CI 1.44-2.43; aOR2 = 2.27, 95% CI 1.91-2.70), provided recommendations for medication review (aOR1 = 3.01, 95% CI 2.07-4.38; aOR2 = 3.50, 95% CI 2.51-4.86), and communicated with pharmacists during resident training (aOR1 = 2.15, 95% CI 1.78-2.60; aOR2 = 1.38, 95% CI 1.18-1.62) were associated with a more positive attitude towards and higher frequency of cooperation. CONCLUSIONS GPs in China displayed a positive attitude towards cooperating with pharmacists, but they did not demonstrate a similar level of practice. As environmental determinants impact interdisciplinary collaboration, healthcare managers and policy-makers need to implement measures that foster a supportive environment conducive to interdisciplinary collaboration.
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Affiliation(s)
- Songtao Cai
- Department of General Practice, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, 518172, China
| | - Xianghui Huang
- Xinsheng Community Health Service Center, Shenzhen Longgang Central Hospital, Shenzhen, 518116, China
| | - Connie Van
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Wanchao Li
- Lincheng Healthcare Center of Changxing County, Huzhou, 310016, China
| | - Ming Yan
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yiting Lu
- Department of General Practice, Tongji University School of Medicine, Shanghai, 200092, China
| | - Haixin Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhiling Deng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Panpan Lu
- Department of General Practice, Taizhou Municipal Hospital, Taizhou, 318000, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88, Jiefang Rd, Hangzhou, Shangcheng District, 310009, China.
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Hsieh KP, Huang RY, Yang YH, Ho PS, Chen KP, Tung CL, Chu YL, Tsai JH. Using PIM-Taiwan, PRISCUS, and Beers criteria to assess potentially inappropriate medication use among older adults with 90-day rehospitalization: a population-based study in Taiwan. Front Pharmacol 2023; 14:1194537. [PMID: 37521484 PMCID: PMC10374845 DOI: 10.3389/fphar.2023.1194537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Background: Multimorbidity and polypharmacy increase the risk of hospitalization in older adults receiving potentially inappropriate medication (PIM). The current study compared the ability of PIM-Taiwan, PRISCUS, and Beers criteria to predict 90-day rehospitalization in older patients with and without PIM. Methods: The retrospective cohort study used Taiwan's Longitudinal Health Insurance Database to retrieve quarterly information about prescribed medication for adults aged ≥65 years hospitalized between 2001 and 2018. We analyzed the association of PIM with 90-day rehospitalization using logistic regression. Results: The study cohort included 206,058 older adults (mean age: 72.5 years). In the analysis, 133,201 (64.6%), 97,790 (47.5%), and 147,450 (71.6%), were identified as having PIM exposure in PIM-Taiwan, PRICUS, and Beers criteria, respectively. PIM-Taiwan criteria found exposure to PIM affecting the cardiovascular (adjusted OR [aOR] 1.37, 95% confidence interval [CI] = 1.32-1.41), gastrointestinal (aOR 1.26, 95% CI = 1.23-1.30), central nervous (aOR 1.11, 95% CI = 1.08-1.14), and respiratory (aOR 1.16, 95% CI = 1.12-1.20) systems significantly increased the risk of 90-day rehospitalization, after adjustment for covariates. In PRISCUS criteria, exposure to PIM affecting the respiratory (aOR 1.48, 95% CI = 1.41-1.56), central nervous (aOR 1.12, 95% CI = 1.09-1.15), and cardiovascular (aOR 1.20, 95% CI = 1.16-1.24) systems significantly increased the risk. In Beers criteria, exposure to PIM affecting the cardiovascular (aOR 1.37, 95% CI = 1.32-1.41), gastrointestinal (aOR 1.38, 95% CI = 1.35-1.42), central nervous (aOR 1.18, 95% CI = 1.15-1.21), endocrine (aOR 1.10, 95% CI = 1.06-1.15), and respiratory (aOR 1.09, 95% CI = 1.04-1.13) systems significantly increased the risk. Patients with 90-day rehospitalization had higher rates of the potentially harmful drug-drug interaction (DDI) pairs of serotonin syndrome (n = 19; 48.8%), QT prolongation (n = 4; 30.8%), extrapyramidal symptoms (EPS) (n = 102; 24.5%), and hypokalemia (n = 275; 20.1%). Conclusion: Beers criteria was more efficient in predicting 90-day rehospitalization among older adults experiencing PIM in Taiwan than either PIM-Taiwan or PRISCUS. The risk of 90-day rehospitalization was associated with the potentially harmful DDI classes of serotonin syndrome, QT prolongation, EPS, and hypokalemia.
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Affiliation(s)
- Kun-Pin Hsieh
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ru-Yu Huang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Pei-Shan Ho
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-Peng Chen
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chun-Liong Tung
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ya-Lan Chu
- Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Sönnerstam E, Harlin F, Gustafsson M. Potentially inappropriate medications among elderly people with neurocognitive disorders - A nationwide register-based study using 3 different explicit criteria. Res Social Adm Pharm 2023; 19:758-763. [PMID: 36717339 DOI: 10.1016/j.sapharm.2023.01.010] [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: 11/10/2022] [Revised: 12/22/2022] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is a problem since it might contribute significantly to adverse drug reactions and hospital admissions among elderly with major neurocognitive disorder (NCD). To assess the appropriateness of drug treatment, different explicit criteria have been developed. OBJECTIVES To investigate and compare the prevalence of PIM users among elderly with major NCD on a nationwide basis using 3 different explicit criteria. Furthermore, the study aimed to investigate factors associated with the use of PIMs. METHODS This nationwide register-based study included 35,212 people, 65 years or older, diagnosed with major NCD and registered in the Swedish registry for cognitive/dementia disorders up to June 30, 2017 and alive December 31, 2017. PIMs were identified using 3 different explicit criteria; the Swedish quality indicators, the EU(7)-PIM list and the AGS Beers Criteria. PIM use was defined as having collected a minimum of one PIM at least once between July 01 - December 31, 2017. RESULTS The numbers of people using one or more PIMs were 7629 (21.7%) according to the Swedish quality indicators, 11,838 (33.6%) according to the EU(7)-PIM list, and 12,002 (34.1%) according to AGS Beers Criteria. Antipsychotics, antithrombotic agents and anxiolytics were the most frequently used PIM class according to the different assessment tools, respectively. The use of PIMs was positively associated with vascular dementia and Lewy body dementia/Parkinson's disease dementia, regardless of the assessment tool used. However, the association between using at least one PIM and age, sex, MMT-value and frontotemporal dementia, differed depending on the criteria used. CONCLUSIONS The different results and included PIMs indicate the different perspectives on PIMs between criteria, which make it difficult to compare the results. However, psychotropic drug use requires further highlighting, as well as the association between PIM use and different types of major NCD.
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Affiliation(s)
- Eva Sönnerstam
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Frida Harlin
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
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Discrepancies in patients' medication lists from pharmacies in Sweden: an interview study before the implementation of the Swedish National Medication List. Int J Clin Pharm 2023; 45:88-96. [PMID: 36307661 PMCID: PMC9938824 DOI: 10.1007/s11096-022-01480-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Discrepancies in medication lists are common and can contribute to drug-related problems. This study was performed before the implementation of the National Medication List in Sweden, an intervention expected to improve the accuracy of medication lists. AIM The aim of the study was to examine the number and type of discrepancies in the medication list from pharmacies in Sweden. The secondary aim was to describe the information sources Swedish patients used as their medication lists and how confident they were with the information. METHOD Structured interviews were conducted with patients at 13 community pharmacies in Sweden during the period October 5, 2020, to April 16, 2021. The printed medication list was reviewed together with the patient to identify any discrepancies and missing information. RESULTS A total of 327 patients were included in the study (response rate 51%). The printed medication list from pharmacies was the most common information source for patients to know which medications to use. Two thirds (n = 215) of the patients had at least one discrepancy among their prescriptions and 32% (n = 106) were missing at least one prescription medication. Among all prescriptions (n = 2567) 10% (n = 264) were non-current prescriptions, 9% (n = 238) were duplicates and 3% (n = 88) had the wrong dose. The proportion of prescriptions with discrepancies differed between drug-groups. CONCLUSION The discrepancies described in this study can have serious consequences, and results provide a baseline for studies after the implementation of the National Medication List.
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Viana SDSC, Souza NPDS, Aliberti MJR, Jacob-Filho W. Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions. EINSTEIN-SAO PAULO 2022; 20:eAO8024. [PMID: 35792759 PMCID: PMC9239534 DOI: 10.31744/einstein_journal/2022ao8024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.
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Pharmacist-led interventions during transitions of care of older adults admitted to short term geriatric units: Current practices and perceived barriers. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100090. [PMID: 35478512 PMCID: PMC9032444 DOI: 10.1016/j.rcsop.2021.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
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Schiavo G, Forgerini M, Lucchetta RC, Mastroianni PDC. A comprehensive look at explicit screening tools for potentially inappropriate medication: A systematic scoping review. Australas J Ageing 2022; 41:357-382. [PMID: 35226786 DOI: 10.1111/ajag.13046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To map explicit screening tools to identify potentially inappropriate medication (PIMs), and the characteristics and limitations of these tools. Including PIMs-interactions, therapeutic alternatives and the clinical management of PIMs. METHODS A systematic scoping review was conducted in PubMed and Scopus (until May 2021). The number of PIMs listed as essential drugs was identified in Model List of Essential Medicines by the World Health Organization (WHO) and National List of Essential Medicines (Brazil). In addition to reporting the therapeutic alternatives and clinical management proposed by explicit screening tools to identify PIMs, we suggested our own alternatives for the PIMs most frequently reported. RESULTS Fifty-eight tools reported 614 PIMs and 747 PIMs-interactions. Limited overlap between the tools was observed: 123 (69.1%) of 178 therapeutic alternatives proposed by the tools were considered inappropriate by other tools, and 222 (36.1%) of the 614 PIMs identified were named as being inappropriate only once. Only 21 tools were developed by a Delphi panel technique associated with systematic review. The PIMs listed as essential medication in Brazil and by the WHO were 30.6% and 23.3% of the total reported, respectively. For the most-cited PIMs, such as non-steroidal anti-inflammatory drugs, tricyclic antidepressants and benzodiazepines, we suggested the use of non-opioid and opioid analgesics; agomelatine, bupropion or moclobemide; and melatonin, respectively. CONCLUSIONS The next stages in the development of explicit screening tools to identify PIMs include achieving more consensus between them and improving their applicability across countries. Further, it is recommended that tools include PIMs risks and advice on therapeutic alternatives.
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Affiliation(s)
- Geovana Schiavo
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Marcela Forgerini
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Rosa Camila Lucchetta
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
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Li H, Deng J, Yu P, Ren X. Drug-Related Deaths in China: An Analysis of a Spontaneous Reporting System. Front Pharmacol 2022; 13:771953. [PMID: 35281929 PMCID: PMC8914085 DOI: 10.3389/fphar.2022.771953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Adverse drug reactions with an outcome of death represent the most serious consequences and are inherently important for pharmacovigilance. The nature and characteristics of drug-related deaths are to a large extent unknown in the Chinese population. This study aims to characterize drug-related deaths by analysis of individual case safety reports (ICSRs) with an outcome of death in China. Methods: The characteristics of death ICSRs were analyzed by descriptive statistics of a large multi-provincial pharmacovigilance database in China. Results: There were 1,731 ICSRs with an outcome of death, representing 0.95% of all serious cases and 0.05% of all reported ICSRs. Most death ICSRs (78.57%) were reported by medical institutions. Only 16.00% of death ICSRs were reported by manufacturers or distributors. The reporting rate of death ICSRs in the age group of 0–4 years was significantly higher than patients aged 5–64 years. Patients aged over 64 years had the highest reporting rate of death ICSRs. Male patients generally had a higher reporting rate of death ICSRs than female patients. However, the reporting rate of female patients exceeded that of male patients in the age group of 20–34 years. Among 3,861 drugs implicated, ceftriaxone sodium with 146 (3.78%) records of death ranked first. Dexamethasone with 131 (3.39%) records of death ranked second. Qingkailing, an injectable traditional Chinese medicine with 75 (1.94%) records of death, ranked the fifth most frequently implicated medicine. Conclusion: Young children and elderly patients have a higher risk of drug-related deaths than patients aged 5–64 years. Female patients generally have a lower risk of drug-related deaths than male patients. However, female patients of reproductive age (aged 20–34 years) have a higher risk of drug-related deaths than male patients, hinting that physiological changes and drug uses for child bearing, giving birth, or birth control may significantly increase the risk of death for female patients aged 20–34 years. This paper suggests more research on the safe use of drugs for young children, elderly patients, and female patients of reproductive ages. Pharmacovigilance databases can be valuable resources for comprehensive understanding of drug-related problems.
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Affiliation(s)
- Haona Li
- Huaihe Hospital of Henan University, Kaifeng, China
- *Correspondence: Haona Li,
| | - Jianxiong Deng
- Adverse Drug Reaction Monitoring Center of Guangdong Province, Guangzhou, China
| | - Peiming Yu
- School of Pharmacy, Henan University, Kaifeng, China
| | - Xuequn Ren
- Huaihe Hospital of Henan University, Kaifeng, China
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13
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Athuraliya N, Etherton-Beer C. Health in Men Study: is frailty a predictor of medication-related hospitalization? QJM 2022; 115:84-90. [PMID: 33313927 DOI: 10.1093/qjmed/hcaa324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults are at high risk of medication-related hospitalizations. Frailty is a phenotype commonly observed in older people due to declining physiological functions. AIM To examine the association of frailty with medication-related hospitalization among community dwelling older men. METHODS A prospective observational cohort study was conducted among community dwelling older men (mean age 75.6 years SD 5.9) from Western Australia (4324) who participated in the Health in Men Study. Participants were followed-up at 12 and 24 months to determine adverse drug event-related hospitalization, hospitalizations for other causes and mortality. RESULTS AND DISCUSSION The prevalence of frailty was 13.2%. At baseline, frailty was associated with exposure to polypharmacy, potentially inappropriate medication use and potential adverse drug-drug interactions with unadjusted odds ratios; [4.13 (3.48-4.89) P < 0.001], [2.46 (1.91-3.17) P < 0.001], [3.85 (3.03-4.90) P < 0.001], respectively. In unadjusted models, frail men were more likely to have non-accidental falls [OR 3.16 (2.51-3.99) P < 0.001], acute kidney injury [OR 3.37 (2.35-4.82) P < 0.001], ADE-related hospitalizations at 12 months [OR 6.83 (4.91-9.51)] and non-ADE-related hospitalizations [OR 2.63 (2.01-3.45)], or to be dead at 12 months [OR 2.97 (1.79-4.92)] and at 24 months [OR 3.14 (2.28-4.33)] when compared with non-frail men. After adjusting for age, living alone, cognitive decline, smoking status and comorbidity, frailty remained associated with ADE-related hospitalization [OR 3.60 (2.41-5.37)], non-ADE-related hospitalizations [OR 1.74 (1.29-2.36)] and death [OR 1.67 (1.15-2.41)]. CONCLUSION The study suggests that frailty is a predictor of medication-related harm with poorer clinical outcomes including mortality.
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Affiliation(s)
- N Athuraliya
- Department of Medicine, The Maitland Clinical School, Hunter New England Health, New South Wales, Australia
- The University of Newcastle, New South Wales, Australia
| | - C Etherton-Beer
- Western Australia Centre for Health and Ageing, The University of Western Australia 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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14
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Geriatric characteristics and the risk of drug-related hospital admissions in older Emergency Department patients. Eur Geriatr Med 2021; 13:329-337. [PMID: 34755308 DOI: 10.1007/s41999-021-00580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Drug-Related Admissions (DRAs) are a well-known problem among older patients in the Emergency Department (ED). The aim of this study was (a) to investigate the prevalence and clinical manifestations of DRAs and the responsible drugs, (b) to study the association between geriatric characteristics and DRAs, and (c) to study the predictive performance of geriatric screeners for identifying DRAs in older ED patients. METHODS Patients aged ≥ 70 hospitalized from the ED were included. Demographics, geriatric characteristics and medications were collected. The the Acutely Presenting Older Patient (APOP)-screener, the Identification of Seniors At Risk (ISAR) and the ISAR-Hospitalized Patients (ISAR-HP) were used as geriatric screeners. Potential DRAs were identified retrospectively, the association between geriatric screeners and DRAs was investigated with logistic regression and the predictive performance was assessed by calculating the Area under the Curve (AUC) of the Receiver Operator Characteristics (ROC). RESULTS The mean age of patients was 78 (IQR 73-83), using an average of 6 medications. Out of 240 admissions, 77 (30%) were classified as a DRA. Independent risk factors for DRAs were polypharmacy (OR 2.42; 95% CI 1.23-4.74) and the ADL dependency (OR 1.23; 95%CI 1.05-1.44). ISAR (OR 3.27; 95%CI 1.60-6.69) and ISAR-HP (OR 1.83; 95% CI 1.02-3.27) associated with increased risk of DRAs, whereas the APOP screener did not (OR 1.56; 95% CI 0.82-2.97). The predictive performance of all geriatric screeners for predicting DRAs was poor (AUC for all screeners < 0.60). CONCLUSION DRAs are highly prevalent in older ED patients. Polypharmacy, ADL dependency and a high ISAR or ISAR-HP are associated with higher risk for DRAs, but the predictive value of geriatric screeners is insufficient.
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15
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Delanaye P, Björk J, Courbebaisse M, Couzi L, Ebert N, Eriksen BO, Dalton RN, Dubourg L, Gaillard F, Garrouste C, Grubb A, Jacquemont L, Hansson M, Kamar N, Lamb EJ, Legendre C, Littmann K, Mariat C, Melsom T, Rostaing L, Rule AD, Schaeffner E, Sundin PO, Berg U, Åsling-Monemi K, Selistre L, Åkesson A, Larsson A, Bökenkamp A, Pottel H, Nyman U. Performance of creatinine-based equations to estimate glomerular filtration rate with a methodology adapted to the context of drug dosage adjustment. Br J Clin Pharmacol 2021; 88:2118-2127. [PMID: 34709683 DOI: 10.1111/bcp.15132] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022] Open
Abstract
AIM The Cockcroft-Gault (CG) creatinine-based equation is still used to estimate glomerular filtration rate (eGFR) for drug dosage adjustment. Incorrect eGFR may lead to hazardous over- or underdosing METHODS: In a cross-sectional analysis, CG was validated against measured GFR (mGFR) in 14,804 participants and compared with the Modification-of-Diet-in-Renal-Diseases (MDRD), Chronic-Kidney-Disease-Epidemiology (CKD-EPI), Lund-Malmö-Revised (LMR), and European-Kidney-Function-Consortium (EKFC) equations. Validation focused on bias, imprecision, and accuracy (percentage of estimates within ±30% of mGFR, P30), overall and stratified for mGFR, age, and body mass index at mGFR <60 mL/min, as well as classification in mGFR stages. RESULTS The CG equation performed worse than the other equations, overall and in mGFR, age and BMI subgroups in terms of bias (systematic overestimation), imprecision and accuracy except for patients ≥65 years where bias and P30 were similar to MDRD and CKD-EPI, but worse than LMR and EKFC. In subjects with mGFR<60 mL/min and at BMI [18.5-25[kg/m2 , all equations performed similarly and for BMI<18.5kg/m2 CG and LMR had the best results though all equations had poor P30-accuracy. At BMI≥25kg/m2 the bias of the CG increased with increasing BMI (+17.2mL/min at BMI≥40kg/m2 ). The four more recent equations also classified mGFR stages better than CG. CONCLUSIONS The CG equation showed poor ability to estimate GFR overall and in analyses stratified for GFR, age, and BMI. CG was inferior to correctly classify the patients in the mGFR staging compared to more recent creatinine-based equations.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Marie Courbebaisse
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, INSERM U1151-CNRS UMR8253, Paris, France
| | - Lionel Couzi
- CHU de Bordeaux, Nephrologie - Transplantation - Dialyse, Université de Bordeaux, CNRS-UMR 5164 Immuno ConcEpT, France
| | - Natalie Ebert
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Björn O Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
| | - R Neil Dalton
- The Wellchild Laboratory, Evelina London Children's Hospital, London, United Kingdom
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Francois Gaillard
- Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Anders Grubb
- Department of Clinical Chemistry, Skåne University Hospital, Lund, Lund University, Sweden
| | - Lola Jacquemont
- Renal Transplantation Department, CHU Nantes, Nantes University, Nantes, France
| | - Magnus Hansson
- Function area Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital Huddinge and Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR -BMT, University Paul Sabatier, Toulouse, France
| | - Edmund J Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | | | - Karin Littmann
- Department of Medicine Huddinge (MedH), Karolinska Institute, Huddinge, Sweden
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, France
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsö, Norway
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Hôpital Michallon, CHU Grenoble-Alpes, France
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Elke Schaeffner
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Per-Ola Sundin
- Department of Geriatrics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ulla Berg
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kajsa Åsling-Monemi
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Luciano Selistre
- Mestrado em Ciências da Saúde -Universidade Caxias do Sul Foundation CAPES, Brazil
| | - Anna Åkesson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Arend Bökenkamp
- Department of Paediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
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16
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Han N, Oh JM, Kim IW. Adverse Events Related to Off-Label Drugs Using Spontaneous Adverse Event Reporting Systems. Ther Clin Risk Manag 2021; 17:877-887. [PMID: 34456568 PMCID: PMC8387311 DOI: 10.2147/tcrm.s321789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this study was to investigate the adverse events (AEs) related to the use of off-label drugs. Materials and Methods A cross-sectional study was carried out using available data pertaining to off-label drug were sourced from U.S. FDA spontaneous adverse drug reaction reporting database (FAERS) and Korea Adverse Event Reporting System database (KIDS-KD) for the years 2014 to 2018. The number and frequencies of AE cases were calculated. Disproportionality was analyzed using the proportional reporting ratio (PRR), the reporting odds ratio (ROR), the information component (IC), and the empirical Bayes geometric mean (EBGM) methods. Results The reported AEs associated with off-label drug use were more common among older patients compared with younger patients. Gastric nonspecific symptoms and therapeutic procedure (4.16–4.57%) and haemorrage term (4.16–5.29%) were the most common AE symptoms and antithrombotic agents and immunosuppressants were the drugs most commonly reported to cause AEs in FAERS. Secondary term events (43.45–48.62%) including inappropriate schedule of drug administration and medication error were the most common AEs, and immunosuppressants and antipsychotics were the most common AE-related drugs from KIDS-KD. The numbers of reported AEs in new drug categories such as other antineoplastic agents trended to increase from 2014 to 2018 in both datasets. Conclusion The numbers of reported AEs with off-label drug increased annually. AEs associated with off-label drugs may have a significant impact on older patients. Healthcare experts should be concerned about prescriptions of off-label drugs, especially anticoagulants and newly developed drugs such as immunosuppressants and antineoplastic agents.
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Affiliation(s)
- Nayoung Han
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.,College of Pharmacy, Jeju National University, Jejusi, Jeju Special Self-Governing Province, Republic of Korea
| | - Jung Mi Oh
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.,College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - In-Wha Kim
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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17
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Vatcharavongvan P, Puttawanchai V. Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications. J Prim Care Community Health 2021; 12:21501327211035088. [PMID: 34315288 PMCID: PMC8323440 DOI: 10.1177/21501327211035088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Most older adults with comorbidities in primary care clinics use multiple
medications and are at risk of potentially inappropriate medications (PIMs)
prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai
criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected
from electronic medical records in a primary care clinic in 2018. Samples
were patients aged ≥65 years old with at least 1 prescription. Variables
included age, gender, comorbidities, and medications. The list of risk drugs
for Thai elderly version 2 was the criteria for PIMs. The prevalence of
polypharmacy and PIMs were calculated, and multiple logistic regression was
conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively.
Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were
anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory
drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM
prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI
2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing
unnecessary medications is crucial to prevent negative health outcomes from
PIMs. Computer-based clinical decision support, pharmacy-led interventions,
and patient-specific drug recommendations are promising interventions to
reduce PIMs in a primary care setting.
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18
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Ng TM, Hing WC, Koh TY, Chang WT, Chang GSW, Heng JW, Abuaman IB, Sia BY, Saw YC, Chan D, Tan CH, Fan WS, Franky F, Tan PC, Tan CWY, Sng JHL, Yap CW, Gnanamani SUD, Tan DSY. Merits of a harmonised system to classify drug-related problems in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:572-577. [PMID: 34342338 DOI: 10.47102/annals-acadmedsg.202176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Tat Ming Ng
- Division of Pharmacy, Tan Tock Seng Hospital, Singapore
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19
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Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021; 14:ph14060514. [PMID: 34071813 PMCID: PMC8230242 DOI: 10.3390/ph14060514] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
Both inflammation and smoking can influence a drug’s pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients’ drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior—both clinically relevant in psychiatry—that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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20
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Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs—Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021. [DOI: 10.3390/ph14060514
expr 938544256 + 801362328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Both inflammation and smoking can influence a drug’s pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients’ drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior—both clinically relevant in psychiatry—that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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21
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Moschny N, Hefner G, Grohmann R, Eckermann G, Maier HB, Seifert J, Heck J, Francis F, Bleich S, Toto S, Meissner C. Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs-Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals (Basel) 2021; 14:514. [PMID: 34071813 PMCID: PMC8230242 DOI: 10.3390/ph14060514&set/a 947965394+957477086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Both inflammation and smoking can influence a drug's pharmacokinetic properties, i.e., its liberation, absorption, distribution, metabolism, and elimination. Depending on, e.g., pharmacogenetics, these changes may alter treatment response or cause serious adverse drug reactions and are thus of clinical relevance. Antipsychotic drugs, used in the treatment of psychosis and schizophrenia, should be closely monitored due to multiple factors (e.g., the narrow therapeutic window of certain psychotropic drugs, the chronicity of most mental illnesses, and the common occurrence of polypharmacotherapy in psychiatry). Therapeutic drug monitoring (TDM) aids with drug titration by enabling the quantification of patients' drug levels. Recommendations on the use of TDM during treatment with psychotropic drugs are presented in the Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology; however, data on antipsychotic drug levels during inflammation or after changes in smoking behavior-both clinically relevant in psychiatry-that can aid clinical decision making are sparse. The following narrative review provides an overview of relevant literature regarding TDM in psychiatry, particularly in the context of second- and third-generation antipsychotic drugs, inflammation, and smoking behavior. It aims to spread awareness regarding TDM (most pronouncedly of clozapine and olanzapine) as a tool to optimize drug safety and provide patient-tailored treatment.
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Affiliation(s)
- Nicole Moschny
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
- Correspondence: ; Tel.: +49-511-532-3656
| | - Gudrun Hefner
- Department of Psychiatry and Psychotherapy, Vitos Clinic for Forensic Psychiatry, Kloster-Eberbach-Str. 4, 65346 Eltville, Germany;
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nussbaum-Str. 7, 80336 Munich, Germany;
| | - Gabriel Eckermann
- Department of Forensic Psychiatry and Psychotherapy, Hospital Kaufbeuren, Kemnater-Str. 16, 87600 Kaufbeuren, Germany;
| | - Hannah B Maier
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
| | - Flverly Francis
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
| | - Catharina Meissner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (H.B.M.); (J.S.); (F.F.); (S.B.); (S.T.); (C.M.)
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22
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Bhagavathula AS, Gebreyohannes EA, Fialova D. Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country: A Systematic Review and Meta-Analysis. Gerontology 2021; 68:136-145. [PMID: 33975303 DOI: 10.1159/000516075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. METHODS We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). RESULTS We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16-2.51) was significantly associated with PIM use. CONCLUSION This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia
| | | | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia.,Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
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23
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Hammar T, Hamqvist S, Zetterholm M, Jokela P, Ferati M. Current Knowledge about Providing Drug-Drug Interaction Services for Patients-A Scoping Review. PHARMACY 2021; 9:69. [PMID: 33805205 PMCID: PMC8103271 DOI: 10.3390/pharmacy9020069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
Drug-drug interactions (DDIs) pose a major problem to patient safety. eHealth solutions have the potential to address this problem and generally improve medication management by providing digital services for health care professionals and patients. Clinical decision support systems (CDSS) to alert physicians or pharmacists about DDIs are common, and there is an extensive body of research about CDSS for professionals. Information about DDIs is commonly requested by patients, but little is known about providing similar support to patients. The aim of this scoping review was to explore and describe current knowledge about providing digital DDI services for patients. Using a broad search strategy and an established framework for scoping reviews, 19 papers were included. The results show that although some patients want to check for DDIs themselves, there are differences between patients, in terms of demands and ability. There are numerous DDI services available, but the existence of large variations regarding service quality implies potential safety issues. The review includes suggestions about design features but also indicates a substantial knowledge gap highlighting the need for further research about how to best design and provide digital DDI to patients without risking patient safety or having other unintended consequences.
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Affiliation(s)
- Tora Hammar
- Department of Medicine and Optometry, The eHealth Institute, Linnaeus University, 391 82 Kalmar, Sweden;
| | - Sara Hamqvist
- Department of Media and Journalism, Linnaeus University, 391 82 Kalmar, Sweden;
| | - My Zetterholm
- Department of Medicine and Optometry, The eHealth Institute, Linnaeus University, 391 82 Kalmar, Sweden;
- Department of Informatics, Linnaeus University, 391 82 Kalmar, Sweden; (P.J.); (M.F.)
| | - Päivi Jokela
- Department of Informatics, Linnaeus University, 391 82 Kalmar, Sweden; (P.J.); (M.F.)
| | - Mexhid Ferati
- Department of Informatics, Linnaeus University, 391 82 Kalmar, Sweden; (P.J.); (M.F.)
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24
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Gervais F, Novais T, Goutelle S, Chappuy M, Parat S, Cabelguenne D, Mouchoux C. Drug-related problems among older patients: Analysis of 8 years of pharmacist's interventions. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:511-521. [PMID: 33587921 DOI: 10.1016/j.pharma.2021.02.002] [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: 08/27/2020] [Revised: 12/18/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To analyse the most frequent DRP over time and pharmacists' interventions made among older patients aged over 75 years old. DRP between older patients and younger patients aged 18 to 74 years and between older patients treated in geriatric wards or not were also compared. METHODS A cross-sectional observational study conducted on DRP detected by pharmacists at the university hospital centre of Lyon and prospectively recorded in the Act-IP© database from January 2008 to December 2015. RESULTS A total of 56,223 DRP were investigated - 19,056 in older patients and 37,167 in younger patients. A supratherapeutic dosage was mainly reported (22.4% in older patients vs. 19.0% in younger patient) and pharmacists made interventions mostly to adjust dosage (27.3% vs. 24.2%). Physicians' acceptance was significantly lower in older patients (57.1% vs. 64.3%). DRP associated to a drug included a supratherapeutic use of acetaminophen (5.2% vs. 3.8%) and hypnotics (4.0% vs. 1.4%), medication in cardiology used without indication (1.4% vs. 0.2%) and underuse of vitamin D (1.2% vs. 0.1%). Supratherapeutic dosages were more significantly detected with a lower overall physicians' acceptance in older patients treated in general wards. CONCLUSIONS This study highlights the specificity of DRP among older patients and encourages health care professionals to remain especially alert regarding older patients treated in general wards. These findings can contribute to define or adjust training needs and quality indicators to improve the daily practices of health care professionals.
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Affiliation(s)
- F Gervais
- Pharmacie, Groupement hospitalier centre, Hospices civils de Lyon, Lyon, France.
| | - T Novais
- Pharmacie, Groupement hospitalier centre, Hospices civils de Lyon, Lyon, France; ISPB - Facultés de pharmacie de Lyon, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Université de Lyon, EA-7425 HESPER, Health Services and Performance Research, 69003 Lyon, France
| | - S Goutelle
- Pharmacie, Groupement hospitalier Nord, Hospices civils de Lyon, Lyon, France; ISPB - Facultés de pharmacie de Lyon, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Université de Lyon, Université Claude-Bernard Lyon 1, UMR CNRS 5558, Laboratoire de biométrie et biologie évolutive, Villeurbanne, France
| | - M Chappuy
- Pharmacie, Groupement hospitalier centre, Hospices civils de Lyon, Lyon, France; Pharmacie, Groupement hospitalier Nord, Hospices civils de Lyon, Lyon, France
| | - S Parat
- Pharmacie, Groupement hospitalier Sud, Hospices civils de Lyon, Lyon, France
| | - D Cabelguenne
- Pharmacie, Groupement hospitalier Sud, Hospices civils de Lyon, Lyon, France
| | - C Mouchoux
- Pharmacie, Groupement hospitalier centre, Hospices civils de Lyon, Lyon, France; ISPB - Facultés de pharmacie de Lyon, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; INSERM U1028; CNRS UMR5292; Lyon Neuroscience Research Centre, Brain Dynamics and Cognition Team, 69000 Lyon, France
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25
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Wang X, Wang S, Yu X, Ma Z, Wang H, Yang J, Liu L. Impact of pharmacist-led medication therapy management in ambulatory elderly patients with chronic diseases. Br J Clin Pharmacol 2021; 87:2937-2944. [PMID: 33474758 DOI: 10.1111/bcp.14709] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS This study aimed to assess the impact of pharmacist-led medication therapy management (MTM) performed on ambulatory elderly patients with chronic diseases. METHODS Patients who came to a pharmacist-led outpatient clinic between January 2016 and June 2018 were enrolled in this study. Eligible subjects received MTM services from the pharmacists at least twice a year and the clinical data of these patients were complete. Drug-related problems (DRPs) and recommendations were evaluated using The Pharmaceutical Care Network Europe Classification for Drug related problems V8.03. RESULTS A total of 525 DRPs were identified during the study period. Treatment effectiveness (53.71%) was the most common DRP. The most frequently recommended intervention was changing the drug (48.76%). There were 92.38% patients accepting the interventions and 90.48% patients completely implemented. The number of drugs taken was the significant associated factor for DRPs. Postintervention data collection showed lower levels in systolic blood pressure (BP) and diastolic BP compared to the preintervention data collection. There were statistically significant changes in total cholesterol, low-density lipoprotein cholesterol and triglycerides between the pre- and postintervention data collections. The average cost of medications per patient for every month decreased from 387.72 to 355.17 renminbi (P = .009). CONCLUSION We confirmed that pharmacists had a valuable role to perform MTM services for ambulatory elderly patients, not only in identifying and solving the DRPs, but also in improving clinical outcomes (BP and lipid level) and cost-saving effect.
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Affiliation(s)
- Xin Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shihui Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaojia Yu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhuo Ma
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huaguang Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing Yang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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26
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Bendayan M, Mardigyan V, Williamson D, Chen-Tournoux A, Eintracht S, Rudski L, MacNamara E, Blostein M, Afilalo M, Afilalo J. Muscle Mass and Direct Oral Anticoagulant Activity in Older Adults With Atrial Fibrillation. J Am Geriatr Soc 2021; 69:1012-1018. [PMID: 33432589 DOI: 10.1111/jgs.16992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) are hydrophilic drugs with plasma levels inversely proportional to lean body mass. Sarcopenic patients with low muscle mass may be at risk for supra-therapeutic DOAC levels and bleeding complications. We therefore sought to examine the influence of lean body mass on DOAC levels in older adults with atrial fibrillation (AF). METHODS A prospective cohort study was conducted with patients 65 years of age or more receiving rivaroxaban or apixaban for AF. Appendicular lean mass (ALM) was measured using a bioimpedance device and a dual X-ray absorptiometry scanner. DOAC levels were measured using a standardized anti-Xa assay 4 hours after (peak) and 1 hour before (trough) ingestion. RESULTS The cohort consisted of 62 patients (47% female, 77.0 ± 6.1 years). The prescribed DOACs were apixaban 2.5 mg (21%), apixaban 5 mg (53%), and rivaroxaban 20 mg (26%). Overall, 16% had supra-therapeutic DOAC levels at trough and 25% at peak. In the multivariable logistic regression model, lower ALM was independently associated with supra-therapeutic DOAC levels at trough (odds ratio per ↓ 1-kg 1.23, 95% confidence interval 1.02 to 1.49) and peak (odds ratio per ↓ 1-kg 1.18, 95% confidence interval 1.02 to 1.37). Addition of ALM to a model consisting of age, total body weight, and renal function resulted in improved discrimination for supra-therapeutic DOAC levels. CONCLUSION Our proof-of-concept study has identified an association between ALM and DOAC levels in older adults with AF. Further research is needed to determine the impact of ALM on bleeding complications and the potential role of ALM-guided dosing for sarcopenic patients.
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Affiliation(s)
- Melissa Bendayan
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Vartan Mardigyan
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David Williamson
- Department of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Annabel Chen-Tournoux
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shaun Eintracht
- Division of Medical Biochemistry, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lawrence Rudski
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Elizabeth MacNamara
- Division of Medical Biochemistry, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mark Blostein
- Division of Hematology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marc Afilalo
- Department of Emergency Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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27
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de Lemos J, Loewen P, Nagle C, McKenzie R, You YD, Dabu A, Zed P, Ling P, Chan R. Preventable adverse drug events causing hospitalisation: identifying root causes and developing a surveillance and learning system at an urban community hospital, a cross-sectional observational study. BMJ Open Qual 2021; 10:bmjoq-2020-001161. [PMID: 33495196 PMCID: PMC7839880 DOI: 10.1136/bmjoq-2020-001161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/01/2020] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify root causes of preventable adverse drug events (pADEs) contributing to hospital admission; to develop key messages which identify actions patients/families and healthcare providers can take to prevent common pADEs found; to develop a surveillance learning system for the community. METHODS Cross-sectional observational study; 120 patients and families, 61 associated healthcare providers were interviewed then root cause analysis was performed to develop key learning messages and an electronic reporting tool was designed. Most common pADE-related medical conditions and their root causes and most common pADE root causes of entire cohort are reported. RESULTS Most common pADE-related medical conditions: chronic obstructive pulmonary disease/asthma (13.3%), bleeding (12.5%), hypotension (12%), heart failure (10%), acute kidney injury (5%) and pneumonia (5%). Most common root causes were: providers not confirming that the patient/family understands information given (29.2%), can identify how a medication helps them/have their concerns addressed (16.7%), can identify if a medication is working (14.1%) or causing a side effect (23.3%); can enact medication changes (7.5%); absence of a sick day management plan (12.5%), and other action plans to help patients respond to changes in their clinical status (10.8%); providers not assessing medication use and monitoring competency (19.2%). Ten key learning messages were developed and a pADE surveillance learning system was implemented. CONCLUSIONS To prevent pADEs, providers need to confirm that patients/families understand information given, how a medication helps them, how to recognise and respond to side effects, how to enact medication changes and follow action plans; providers should assess patient's/families' medication use and monitoring competency.
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Affiliation(s)
- Jane de Lemos
- Pharmacy, Richmond Hospital, Richmond, British Columbia, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Nagle
- Family Physician, Richmond, British Columbia, Canada
| | | | - Yong Dong You
- Internal Medicine, Richmond Hospital, Richmond, British Columbia, Canada
| | - Anna Dabu
- Internal Medicine, Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada
| | - Peter Zed
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Ling
- Internal Medicine, Richmond Hospital, Richmond, British Columbia, Canada
| | - Richard Chan
- Emergency Department, Richmond Hospital, Richmond, British Columbia, Canada
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28
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Dechanont S, Jedsadayanmata A, Butthum B, Kongkaew C. Hospital Admissions Associated With Medication-Related Problems in Thai Older Patients: A Multicenter Prospective Observational Study. J Patient Saf 2021; 17:15-22. [PMID: 31738194 DOI: 10.1097/pts.0000000000000627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the prevalence rate and risk factors of medication-related problems (MRPs) leading to hospital admissions in Thai older patients. METHODS A prospective observational study was carried out in nine hospitals in Lower Northern Thailand. Participants admitted to internal medicine units were screened for suspected MRPs by clinical pharmacists using medical record review and patient interview. Three experts evaluated suspected MRPs independently using the following four criteria: contribution of MRPs to hospital admissions, causality, severity, and preventability. RESULTS Of 1776 patients admitted during the study period, 56 patients (3.2%) were deemed to have causal MRPs; 24 (42.9%) were judged as preventable. The medication groups most commonly associated with MRPs were those targeting the endocrine system, especially antidiabetic medications, such as metformin and glipizide. Preventable MRPs were usually manifest as hypoglycemia (n = 15, 62.5%). The variables that contributed to hospital admissions associated with MRPs were age (odds ratio = 1.92; 95% confidence interval [CI] = 1.06-3.47), starting a new drug within 1 week (odds ratio = 2.31; 95% CI = 1.08-4.95), or within 1 month (odds ratio = 2.17; 95% CI = 1.05-4.48). CONCLUSIONS Hospital admissions associated with MRPs in Thai older patients continue to burden the Thai healthcare system of which nearly half were preventable. Further studies should consider analysis of costs and include hepatic and renal function status of participants.
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Affiliation(s)
- Supinya Dechanont
- From the Center for Safety and Quality in Health, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok
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29
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Hellström L, Eriksson T, Bondesson Å. Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems. Eur J Hosp Pharm 2020; 28:e128-e133. [PMID: 33199398 DOI: 10.1136/ejhpharm-2020-002492] [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: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process. OBJECTIVE To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs. METHOD Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken. RESULTS A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations. CONCLUSION DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.
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Affiliation(s)
- Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden .,Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Åsa Bondesson
- Department of Medicines Management and Informatics, Skåne County Council, Kristianstad, Sweden
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30
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Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv P. Risk factors for hospital readmission in older adults within 30 days of discharge - a comparative retrospective study. BMC Geriatr 2020; 20:467. [PMID: 33176721 PMCID: PMC7659222 DOI: 10.1186/s12877-020-01867-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. METHODS This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student's t-test, χ2-test or Fishers' exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. RESULTS The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). CONCLUSION Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.
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Affiliation(s)
- Maria Glans
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden. .,Department of Medications, Region Skåne Office for Hospitals in Northeastern Skåne, SE-291 85, Kristianstad, Sweden.
| | - Annika Kragh Ekstam
- Department of Orthopaedics, Region Skåne Office for Hospitals in Northeastern Skåne, SE-291 85, Kristianstad, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, SE-291 85, Kristianstad, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden
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Hammar T, Hellström L, Ericson L. The Use of a Decision Support System in Swedish Pharmacies to Identify Potential Drug-Related Problems-Effects of a National Intervention Focused on Reviewing Elderly Patients' Prescriptions. PHARMACY 2020; 8:pharmacy8030118. [PMID: 32668586 PMCID: PMC7558108 DOI: 10.3390/pharmacy8030118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 02/01/2023] Open
Abstract
In pharmacies in Sweden, a clinical decision support system called Electronic Expert Support (EES) is available to analyse patients' prescriptions for potential drug-related problems. A nationwide intervention was performed in 2018 among all Swedish pharmacy chains to increase the use of EES among patients 75 years or older. The aim of this research was to study the use of EES in connection with the national intervention in order to describe any effects of the intervention, to understand how pharmacists use EES and to identify any barriers and facilitators for the use of EES by pharmacists for elderly patients. Data on the number and categories of EES analyses, alerts, resolved alerts and active pharmacies was provided by the Swedish eHealth Agency. The effects of the intervention were analysed using interrupted time series regression. A web-based questionnaire comprising 20 questions was sent to 1500 pharmacists randomly selected from all pharmacies in Sweden. The study shows that pharmacists use and appreciate EES and that the national intervention had a clear effect during the week of the intervention and seems to have contributed to a faster increase in pharmacists' use of EES during the year to follow. The study also identified several issues or barriers for using EES.
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Affiliation(s)
- Tora Hammar
- The eHealth Institute, Department of Medicine and Optometry, Linnaeus University, 391 82 Kalmar, Sweden;
- Correspondence: ; Tel.: +46-480-497176
| | - Lina Hellström
- The eHealth Institute, Department of Medicine and Optometry, Linnaeus University, 391 82 Kalmar, Sweden;
- Pharmaceutical Department, Region Kalmar County, 391 85 Kalmar, Sweden
| | - Lisa Ericson
- The Swedish eHealth Agency, 391 29 Kalmar, Sweden;
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Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf 2020; 11:2042098620933741. [PMID: 32587680 PMCID: PMC7294476 DOI: 10.1177/2042098620933741] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/16/2020] [Indexed: 01/10/2023] Open
Abstract
A high rate of polypharmacy is, in part, a consequence of the increasing proportion of multimorbidity in the ageing population worldwide. Our understanding of the potential harm of taking multiple medications in an older, multi-morbid population, who are likely to be on a polypharmacy regime, is limited. This is a narrative literature review that aims to appraise and summarise recent studies published about polypharmacy. We searched MEDLINE using the search terms polypharmacy (and its variations, e.g. multiple prescriptions, inappropriate drug use, etc.) in titles. Systematic reviews and original studies in English published between 2003 and 2018 were included. In this review, we provide current definitions of polypharmacy. We identify the determinants and prevalence of polypharmacy reported in different studies. Finally, we summarise some of the findings regarding the association between polypharmacy and health outcomes in older adults, with a focus on frailty, hospitalisation and mortality. Polypharmacy was most often defined in terms of the number of medications that are being taken by an individual at any given time. Our review showed that the prevalence of polypharmacy varied between 10% to as high as around 90% in different populations. Chronic conditions, demographics, socioeconomics and self-assessed health factors were independent predictors of polypharmacy. Polypharmacy was reported to be associated with various adverse outcomes after adjusting for health conditions. Optimising care for polypharmacy with valid, reliable measures, relevant to all patients, will improve the health outcomes of older adult population.
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Affiliation(s)
- Mina Khezrian
- Institute of Medical Sciences, Lilian Sutton Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Chris J McNeil
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Alison D Murray
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
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Wang X, Yang J, Yu X, Wang Z, Wang H, Liu L. Characterization of drug-related problems and associated factors in ambulatory patients in China. J Clin Pharm Ther 2020; 45:1058-1065. [PMID: 32516504 DOI: 10.1111/jcpt.13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE This study aimed to investigate the prevalence and the type of drug-related problems (DRPs) in ambulatory patients and identify factors that may be associated with risk of DRPs. METHODS Consecutive patients were enrolled from pharmacist outpatient clinics between January 2018 and June 2019. The pharmacists performed a comprehensive assessment of the patient's drug therapy. The DRPs and recommendations were evaluated using the DOCUMENT classification system. RESULTS AND DISCUSSION The study population consisted of 248 patients with a mean age of 72.55 ± 6.29. The patients had a mean of 7.55 ± 4.72 ongoing medications during patients' routine clinic visits. A total of 1188 DRPs were identified during the study period. An average of 4.79 DRPs per patient was detected. Sixty-two different traditional Chinese patent medicines (TCPMs) contributed to 102 DRPs. Drug selection (24.9%) was the most common DRP followed by under treated (24.2%) and monitoring needed (24.2%). The number of medications taken was the significant factor for DRPs. Pharmacists made 1092 recommendations to address the DRPs (an average 0.92 recommendations per DRP). A change in therapy was the most common recommendation (43.6%), followed by the category 'monitoring' (28.6%). The overall acceptance rate of clinical pharmacist recommendations was 88.7%. More than a half (51.6%) of all interventions were assigned a moderate level of clinical significance. WHAT IS NEW AND CONCLUSION Drug-related problems were commonly observed among ambulatory Chinese patients. Clinical pharmacists had a valuable role to play in identifying and solving the DRPs.
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Affiliation(s)
- Xin Wang
- Department of Pharmacy, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Jing Yang
- Department of Pharmacy, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Xiaojia Yu
- Department of Pharmacy, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Zihui Wang
- Department of Pharmacy, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Huaguang Wang
- Department of Pharmacy, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
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Patel T, Ivo J, Faisal S, McDougall A, Carducci J, Pritchard S, Chang F. A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers. J Med Internet Res 2020; 22:e18073. [PMID: 32348292 PMCID: PMC7298635 DOI: 10.2196/18073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.
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Affiliation(s)
- Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.,Centre for Family Medicine Family Health Team, Kitchener, ON, Canada.,Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel-University of Waterloo Research Institute of Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Aidan McDougall
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Jillian Carducci
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Sarah Pritchard
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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Psychoactive drug use and falls among community-dwelling Turkish older people. North Clin Istanb 2020; 7:260-266. [PMID: 32478298 PMCID: PMC7251276 DOI: 10.14744/nci.2019.30316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Data on the relationship between fall and psychoactive drug use among Turkish older people are limited. This study aims to investigate the prevalence of falls and the associations between psychoactive drug use and falls in community-dwelling Turkish older people. METHODS: This single center study was performed using the medical records of subjects aged over 65 years admitted to the geriatric care unit. Demographic and lifestyle factors, clinical characteristics, medications, and data on mood, cognitive status, and functional performance were obtained from the comprehensive geriatric assessment records. Based on a fall history in the last 12 months, subjects were grouped as fallers and non-fallers. Subjects treated with a psychoactive drug were identified. RESULTS: Among the total of 429 subjects, there were 184 (42.9%) fallers and 245 (57.1%) non-fallers. Of those, 33.3% were on psychoactive drug treatment. The proportion of psychoactive drug users was higher in the fallers group compared to non-fallers (45.1% vs. 24.5%, p<0.001). Multivariable logistic regression analysis showed age ≥75 years (OR=1.83;CI: 1.09–3.09; p=0.023), female gender (OR=2.70;CI: 1.6–4.50; p<0.001), and psychoactive drug use (OR=2.14;CI 1.32–3.48; p=0.002) as independent predictors of falls. CONCLUSION: We found that about one-third of geriatric outpatients were on psychoactive drug treatment in Turkey that was independently associated with the risk of falls.
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Forgerini M, Herdeiro MT, Galduróz JCF, Mastroianni PDC. Risk factors associated with drug therapy among elderly people with Alzheimer's disease: a cross-sectional study. SAO PAULO MED J 2020; 138:216-218. [PMID: 32578741 PMCID: PMC9671228 DOI: 10.1590/1516-3180.2019.0461.r2.19022020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improving knowledge and establishing strategies and policies for better patient safety are worldwide priorities. OBJECTIVE To evaluate drug safety among elderly people with Alzheimer's disease (AD). DESIGN AND SETTING Cross-sectional study among elderly people within the National AD Assistance Protocol (PCDTDA/MS) who were living in the municipality of Araraquara, Brazil, in 2017. METHODS Through interviews conducted with relatives/caregivers of elderly people with diagnoses of AD, the following variables were evaluated: comorbidities, drug therapy used, use of potentially inappropriate medications for the elderly (PIMs), presence of potentially inappropriate interactions (PIIs) and medication regimen complexity index. Factors associated with AD severity were also evaluated. Multivariate and simple logistic regressions were applied. RESULTS 143 elderly people enrolled in PCDTDA/MS were analyzed. The majority were women (67.1%); assisted only through the public healthcare system (75.5%); polymedicated (57.4%); using at least one PIM (63.6%); presenting at least one PII (63.6%); and under drug therapy of low to medium complexity (92.2%). No semi-annual monitoring of the effectiveness of PCDTDA/MS drugs was identified. The proportion using AD drug therapy at daily doses differing from those recommended by the World Health Organization was 75.6%. However, these doses were not associated with drug risk. CONCLUSION The data from this study raise the hypothesis that use of polypharmacy might show a correlation with severity of AD. The drug safety risk may be associated with comorbidities of the metabolic syndrome, anxiety and off-label use of PIMs, such as risperidone and quetiapine, and benzodiazepines (i.e. clonazepam and flunitrazepam).
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Affiliation(s)
- Marcela Forgerini
- Pharmacist and Doctoral Student, Department of Drugs and Medicines, School of Pharmaceutical Sciences, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil.
| | - Maria Teresa Herdeiro
- PhD. Pharmacist and Professor, Department of Medical Sciences, Universidade de Aveiro, Institute of Biomedicine (iBiMED), Aveiro, Portugal.
| | - José Carlos Fernandes Galduróz
- PhD. Adjunct Professor, Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Patrícia de Carvalho Mastroianni
- PhD. Pharmacist and Adjunct Professor, Department of Drugs and Medicines, Universidade Estadual Paulista (UNESP), Araraquara (SP), Brazil.
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Kindstedt J, Svahn S, Sjölander M, Glader EL, Lövheim H, Gustafsson M. Investigating the effect of clinical pharmacist intervention in transitions of care on drug-related hospital readmissions among the elderly: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e036650. [PMID: 32345700 PMCID: PMC7213854 DOI: 10.1136/bmjopen-2019-036650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Drug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety. We have designed a complex clinical pharmacist intervention that targets people ≥75 years of age undergoing transitions of care from hospital to home and primary care. The main objective is to investigate if the intervention can reduce the risk of unplanned drug-related readmission within the first 180 days after the person is discharged from hospital. METHODS AND ANALYSIS This is a randomised, controlled, superiority trial with two parallel arms. A total of 700 people ≥75 years will be assigned to either intervention or routine care (control). The intervention, which aims to find and manage DRPs, is initiated within a week of the person being discharged from hospital and combines repeated medical chart reviews, phone interviews and in some cases medication reviews. People in both study arms may have been the subject of a medication review during their ward stay. As the primary outcome, we will measure time until unplanned drug-related readmission within 180 days of leaving hospital and use log rank tests and Cox proportional hazard models to analyse differences between the groups. Further investigations of subgroup effects and adjustments of the regression models will be based on heart failure and cognitive impairment as prognostic factors. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethical Review Board in Umeå (registration numbers 2017-69-31M, 2018-83-32M and 2018-254-32M). We intend to publish the results with open access in international peer-reviewed journals and present our findings at international conferences. The trial is expected to result in more than one published article and form part of two PhD theses. TRIAL REGISTRATION NUMBER NCT03671629.
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Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Sofia Svahn
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy. J Geriatr Oncol 2020; 11:579-585. [PMID: 32199776 DOI: 10.1016/j.jgo.2020.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/27/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Polypharmacy (≥5 concurrent medications) is common among older patients with cancer (48%-80%) and associated with increased frailty, morbidity, and mortality. This study examined the relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous (IV) chemotherapy. MATERIALS AND METHODS The main data source was the Surveillance, Epidemiology, and End Results-Medicare linked files. Patients (≥65 years) were included if they were diagnosed with prostate (n = 1430), breast (n = 5490), or lung cancer (n = 7309) in 1991-2013 and received IV chemotherapy in 2011-2014. The number of medications during the six-month window pre-IV chemotherapy initiation determined polypharmacy status. Negative binomial models were used to assess the association between polypharmacy and post-chemotherapy inpatient hospitalization. The results were presented as incidence rate ratios. RESULTS We identified 13,959 patients with prostate, breast, or lung cancer treated with IV chemotherapy. The median number of prescription medications during the six-month window pre-IV chemotherapy initiation was high: ten among patients with prostate cancer, nine among patients with breast cancer, and eleven among patients with lung cancer. Compared to patients taking <5 prescriptions, post-chemotherapy hospitalization rate for patients with prostate cancer was 42%, 75%, and 114% higher among those taking 5-9, 10-14, and 15+ medications, respectively. Patients with breast and lung cancer demonstrated similar patterns. CONCLUSION This large population-based study found that polypharmacy during the six-month window pre-IV chemotherapy is highly predictive of post-chemotherapy inpatient hospitalization. Further studies are needed to evaluate whether medication management interventions can reduce post-chemotherapy inpatient hospitalization among older patients with cancer.
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Kilpatrick KA, Paton P, Subbarayan S, Stewart C, Abraha I, Cruz-Jentoft AJ, O'Mahony D, Cherubini A, Soiza RL. Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series. Maturitas 2020; 133:42-48. [PMID: 32005422 DOI: 10.1016/j.maturitas.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. METHODS A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. RESULTS Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. CONCLUSIONS There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.
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Affiliation(s)
- Kirsty A Kilpatrick
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Pamela Paton
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Dept of Geriatric Medicine, NHS Grampian, Aberdeen, United Kingdom
| | - Selvarani Subbarayan
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Carrie Stewart
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Iosief Abraha
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roy L Soiza
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Dept of Geriatric Medicine, NHS Grampian, Aberdeen, United Kingdom.
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DeAntonio JH, Leichtle SW, Hobgood S, Boomer L, Aboutanos M, Mangino MJ, Wijesinghe DS, Jayaraman S. Medication Reconciliation and Patient Safety in Trauma: Applicability of Existing Strategies. J Surg Res 2020; 246:482-489. [DOI: 10.1016/j.jss.2019.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022]
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Hailu BY, Berhe DF, Gudina EK, Gidey K, Getachew M. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatr 2020; 20:13. [PMID: 31931723 PMCID: PMC6958579 DOI: 10.1186/s12877-020-1413-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 01/09/2023] Open
Abstract
Background Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization. Methods A prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems. Results A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212–9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029–2.450, p = 0.037). Conclusions Drug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists’ intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists’ intervention was also substantially high.
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Affiliation(s)
- Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Derebew Fikadu Berhe
- Department of Pharmacology and Toxicology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mestawet Getachew
- Department of clinical pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Svahn S, Lövheim H, Isaksson U, Sandman PO, Gustafsson M. Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden. Eur J Clin Pharmacol 2020; 76:525-537. [PMID: 31915846 DOI: 10.1007/s00228-019-02778-y] [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: 06/12/2019] [Accepted: 09/26/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and 2013. Further, the aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure. METHODS Two questionnaire surveys were performed including 2494 people in 2007 and 1654 people in 2013 living in nursing homes in northern Sweden. Data were collected concerning drug use, functioning in activities of daily living (ADL) and cognition, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The use of different drugs and drug classes among people at four different levels of cognitive function in 2007 and 2013 were compared. RESULTS The proportion of people prescribed ASA and diuretics was significantly lower at all four levels of cognitive function in 2013 compared to 2007. Among people prescribed loop diuretics, the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs) increased from 37.8 to 45.6%, β-blockers from 36.0 to 41.8% and warfarin from 4.4 to 11.4%. The use of warfarin, ACEI/ARBs, β-blockers and mineralocorticoid receptor antagonists (MRAs) were less common among individuals with more severe cognitive impairment. CONCLUSION The results indicate that cardiovascular drug treatment has improved between 2007 and 2013, but there is room for further improvement, especially regarding adherence to guidelines for heart failure. Increasing cognitive impairment had an effect on treatment patterns for heart failure and atrial fibrillation.
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Affiliation(s)
- Sofia Svahn
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Ulf Isaksson
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.,Arctic Research Centre at Umeå University, SE-901 87, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-901 87, Umeå, Sweden
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Smeaton T, McElwaine P, Cullen J, Santos-Martinez MJ, Deasy E, Widdowson M, Grimes TC. A prospective observational pilot study of adverse drug reactions contributing to hospitalization in a cohort of middle-aged adults aged 45–64 years. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-019-00700-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Watson S, Caster O, Rochon PA, den Ruijter H. Reported adverse drug reactions in women and men: Aggregated evidence from globally collected individual case reports during half a century. EClinicalMedicine 2019; 17:100188. [PMID: 31891132 PMCID: PMC6933269 DOI: 10.1016/j.eclinm.2019.10.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are an important cause of morbidity and mortality. Reports on differences in reporting patterns between women and men exist nationally. The goal of the present study was to assess the global evidence on spontaneous post-marketing ADR reporting differences between reports for women and men. METHODS We analysed data collected within VigiBase, the WHO global database of individual case safety reports, between 1967-2 January 2018. VigiBase contains more than 18 million reports from the 131 member countries of the WHO Programme for International Drug Monitoring. FINDINGS Of the reports with information on sex, 9,056,566 (60.1%) concerned female and 6,012,804 (39.9%) male children and adults. More female ADR reports were submitted in all regions of the world and by all types of reporters. A higher proportion of female reports was seen in all age groups from the age group 12-17 years and older. The largest difference was observed in the age group of 18-44 years and could not be explained by hormonal contraceptive use. The proportion of serious and fatal reports was higher for male reports. INTERPRETATION Global post marketing surveillance data on spontaneous reports indicate that women, from puberty and onwards and especially in their reproductive years, report more ADRs than men. However, there is a higher proportion of serious and fatal ADRs among male reports. Our results suggest important underlying sex-related differences in ADRs. These findings highlight the importance of considering sex throughout the entire life-cycle of drug development and surveillance and understanding the underlying reasons for reporting ADRs.
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Affiliation(s)
- Sarah Watson
- Uppsala Monitoring Centre, Box 1050, Uppsala S-751 40, Sweden
- Corresponding author.
| | - Ola Caster
- Uppsala Monitoring Centre, Box 1050, Uppsala S-751 40, Sweden
| | - Paula A Rochon
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto. Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Hester den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
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Woodford HJ, Fisher J. New horizons in deprescribing for older people. Age Ageing 2019; 48:768-775. [PMID: 31595290 DOI: 10.1093/ageing/afz109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/14/2022] Open
Abstract
Deprescribing has gained interest recently, driven by an ageing population seeing an increasing number living with multiple long-term conditions. This, coupled with disease-specific guidelines derived from clinical trials in younger people, has led to an increase in exposure to polypharmacy and the associated therapeutic burden. Older people, especially those living with frailty, tend to experience lower efficacy of these medications along with a higher risk of drug adverse effects. Explanations for these differences include the physiological effects of frailty, drug-drug interactions, drug-disease interactions and reduced medication adherence. Adverse drug reactions often go unnoticed and can trigger further prescribing. Certain medications have been recognised as potentially inappropriate for people with frailty, yet their use remains common. Evidence suggests that many older people are open to the concept of reducing medications. Deprescribing should be based around a shared decision-making approach. Trials to date have suggested that it can often be achieved without harm. To date, there are few data to support improvements in hospitalisation or mortality rates. However, there is some evidence that it may reduce polypharmacy, improve medication adherence, reduce financial costs and improve quality of life. In the future, it will be necessary to grow the evidence base and improve public and clinician awareness of the potential benefits of deprescribing. It will require excellent team working and communication between all of those involved in the prescribing and administration of medications, also supported by improved healthcare informatics. Non-pharmacological approaches will need to be promoted. Fewer drugs is not less care.
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Affiliation(s)
- Henry J Woodford
- Department of Geriatric Medicine, Northumbria Healthcare, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK
| | - James Fisher
- Department of Geriatric Medicine, Northumbria Healthcare, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK
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Masnoon N, Shakib S, Kalisch Ellett L, Caughey GE. Rationalisation of polypharmacy in practice: a survey of physicians and pharmacists. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
- Department of Pharmacy Royal Adelaide Hospital Adelaide Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School University of Adelaide Adelaide Australia
- Department of Clinical Pharmacology Royal Adelaide Hospital Adelaide Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
| | - Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences University of South Australia Adelaide Australia
- Discipline of Pharmacology, Adelaide Medical School University of Adelaide Adelaide Australia
- Department of Clinical Pharmacology Royal Adelaide Hospital Adelaide Australia
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Digmann R, Thomas A, Peppercorn S, Ryan A, Zhang L, Irby K, Brock J. Use of Medicare Administrative Claims to Identify a Population at High Risk for Adverse Drug Events and Hospital Use for Quality Improvement. J Manag Care Spec Pharm 2019; 25:402-410. [PMID: 30816813 PMCID: PMC10397735 DOI: 10.18553/jmcp.2019.25.3.402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A system using administrative claims to monitor medication use patterns and associated adverse events is not currently available. Establishment of a standardized method to identify Medicare beneficiaries at high risk for adverse events, by assessing Medicare Part D medication claim patterns and associated outcomes, including outpatient adverse drug events (ADEs) and hospital use, enhances prevention efforts and monitoring for quality improvement efforts. OBJECTIVES To (a) demonstrate that Medicare claims data can be used to identify a population of beneficiaries at high risk for adverse events for quality improvement and (b) define trends associated with adverse health outcomes in identified high-risk beneficiaries for quality improvement opportunities. METHODS We used Medicare fee-for-service Part D claims data to identify a population at high risk for adverse events by evaluating medication use patterns. This population was taking at least 3 medications, 1 of which was an anticoagulant, an opioid, or an antidiabetic agent. Next, we used associated Part A claims to calculate rates of outpatient ADEs, looking for specific ICD-9-CM or ICD-10-CM codes in the principal diagnosis code position. Rates of hospital use (inpatient hospitalization, observation stays, emergency department visits, and 30-day rehospitalizations) were also evaluated for the identified high-risk population. The data were then shared for targeted quality improvement. RESULTS We identified 8,178,753 beneficiaries at high risk for adverse events, or 20.7% of the total eligible fee-for-service population (time frame of October 2016-September 2017). The overall rate of outpatient ADEs for beneficiaries at high risk was 46.28 per 1,000, with anticoagulant users demonstrating the highest rate of ADEs (68.52/1,000), followed by opioid users (42.11/1,000) and diabetic medication users (20.72/1,000). As expected, the primary setting for beneficiaries at high risk to seek care for outpatient ADEs was the emergency department, followed by inpatient hospitalizations and observation stays. CONCLUSIONS Medicare claims are an accessible source of data, which can be used to establish for quality improvement a population at high risk for ADEs and increased hospital use. Using medication use patterns to attribute risk and associated outcomes, such as outpatient ADEs and hospital use, is a simple process that can be readily implemented. The described method has the potential to be further validated and used as a foundation to monitor population-based quality improvement efforts for medication safety. DISCLOSURES This work was performed under contract HHSM-500-2014-QINNCC, Modification No. 000004, funded by Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. CMS did not have a role in the analysis. At the time of this analysis, Digmann, Peppercorn, Zhang, Irby, and Brock were employees of Telligen, which was awarded the National Coordinating Center-Quality Improvement Organization contract from CMS, which supported the work. Ryan was an employee at Qsource, which was awarded the Quality Innovation Network-Quality Improvement Organization contract from CMS, which supported the work. Thomas was employed by CMS. The content is solely the responsibility of the authors and does not necessarily represent the official views or policies of the CMS. This work is posted on the QIOprogram.org website, as recommended in the Common Rule ( https://www.hhs.gov/ohrp/regulations-and-policy/regulations/common-rule/index.html ).
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Affiliation(s)
| | - Anita Thomas
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
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48
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DeAntonio JH, Nguyen T, Chenault G, Aboutanos MB, Anand RJ, Ferrada P, Goldberg S, Leichtle SW, Procter LD, Rodas EB, Rossi AP, Whelan JF, Feeser VR, Vitto MJ, Broering B, Hobgood S, Mangino M, Wijesinghe DS, Jayaraman S. Medications and patient safety in the trauma setting: a systematic review. World J Emerg Surg 2019; 14:5. [PMID: 30815027 PMCID: PMC6377727 DOI: 10.1186/s13017-019-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/03/2019] [Indexed: 02/17/2023] Open
Abstract
Background Medication errors account for the most common adverse events and a significant cause of mortality in the USA. The Joint Commission has required medication reconciliation since 2006. We aimed to survey the literature and determine the challenges and effectiveness of medication reconciliation in the trauma patient population. Materials and methods We conducted a systematic review of the literature to determine the effectiveness of medication reconciliation in trauma patients. English language articles were retrieved from PubMed/Medline, CINAHL, and Cochrane Review databases with search terms "trauma OR injury, AND medication reconciliation OR med rec OR med rek, AND effectiveness OR errors OR intervention OR improvements." Results The search resulted in 82 articles. After screening for relevance and duplicates, the 43 remaining were further reviewed, and only four articles, which presented results on medication reconciliation in 3041 trauma patients, were included. Two were retrospective and two were prospective. Two showed only 4% accuracy at time of admission with 48% of medication reconciliations having at least one medication discrepancy. There were major differences across the studies prohibiting comparative statistical analysis. Conclusions Trauma medication reconciliation is important because of the potential for adverse outcomes given the emergent nature of the illness. The few articles published at this time on medication reconciliation in trauma suggest poor accuracy. Numerous strategies have been implemented in general medicine to improve its accuracy, but these have not yet been studied in trauma. This topic is an important but unrecognized area of research in this field.
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Affiliation(s)
- Jonathan H. DeAntonio
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Department of Surgery, VCU School of Medicine, VCU Health System, Virginia Commonwealth University, Richmond, Virginia USA
| | - Tammy Nguyen
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Gregory Chenault
- VCU Health Department of Pharmacy Services, Critical Care, Richmond, Virginia USA
| | - Michel B. Aboutanos
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Rahul J. Anand
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Paula Ferrada
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stephanie Goldberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stefan W. Leichtle
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Levi D. Procter
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Edgar B. Rodas
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Alan P. Rossi
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - James F. Whelan
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - V. Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Michael J. Vitto
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Beth Broering
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Sarah Hobgood
- Division of Geriatrics, Department of Internal Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Martin Mangino
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Dayanjan S. Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences and Laboratory of Pharmacometabolomics and Companion Diagnostics, Virginia Commonwealth University School of Pharmacy, VCU Health, Richmond, Virginia USA
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- VCU School of Medicine, Richmond, Virginia USA
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Meyer-Massetti C, Hofstetter V, Hedinger-Grogg B, Meier CR, Guglielmo BJ. Medication-related problems during transfer from hospital to home care: baseline data from Switzerland. Int J Clin Pharm 2018; 40:1614-1620. [PMID: 30291577 DOI: 10.1007/s11096-018-0728-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
Background The shift from inpatient to ambulatory care has resulted in an increase in home care patients. Little is known regarding medication safety associated with patient transfer from hospital to home care. Objective To evaluate medication-related problems in patients transferring from hospital to home care in Switzerland. Setting A non-for-profit home care organization in the city of Lucerne/Switzerland. Methods We conducted a prospective observational study, including patients aged ≥ 64 years and receiving ≥ 4 medications at hospital discharge. Two structured questionnaires assessing the transfer process were completed by home care nurses. Prescription quality was assessed using a PCNE Type 2b Medication Review. Main outcome measures The quality of the transfer process was measured comparing agreed-upon with reported parameters. Prescription quality was analyzed assessing the unambiguity of the prescription. Potentially inappropriate medications (Priscus® list), contraindications, duplications and interactions, and clinical pharmacist-identified potential medication-related problems were collected. Results Study patients (n = 100) received 8.6 ± 3.5 regularly administered medications. Only 5/100 patients had a complete set of written discharge information. At the time of the first visit, 13/100 patients had no written medication information available. Discharge medication prescriptions were clear to nurses in 62% of patients. In 20 patients, the required medications were unavailable, resulting in 19 medication errors. Assessment by a clinical pharmacist revealed only 33/100 patients had a clear discharge prescription. Of a total of 984 prescribed drugs, 16% were considered to be ambiguous, 22 (2.2%) were potentially inappropriate. 7/984 drugs were contraindicated, 8 were duplicates. Conclusion In addition to the known risk factors in patients transferring from hospital to home care (age, polymedication, multiple providers), 3 major problems impacted upon medication safety: fragmented communication, unreliable medication availability and a poor prescription quality. Clinical pharmacists are an important option to improve medication safety ass.
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Affiliation(s)
- Carla Meyer-Massetti
- Clincal Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
- Hospital Pharmacy, University Hospital of Basel, Spitalstrasse 26, 4031, Basel, Switzerland.
| | - Vera Hofstetter
- Clincal Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - Christoph R Meier
- Clincal Pharmacy & Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Hospital Pharmacy, University Hospital of Basel, Spitalstrasse 26, 4031, Basel, Switzerland
| | - B Joseph Guglielmo
- School of Pharmacy, University of California San Francisco, San Francisco, USA
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Schosserer M, Banks G, Dogan S, Dungel P, Fernandes A, Marolt Presen D, Matheu A, Osuchowski M, Potter P, Sanfeliu C, Tuna BG, Varela-Nieto I, Bellantuono I. Modelling physical resilience in ageing mice. Mech Ageing Dev 2018; 177:91-102. [PMID: 30290161 PMCID: PMC6445352 DOI: 10.1016/j.mad.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
Geroprotectors, a class of drugs targeting multiple deficits occurring with age, necessitate the development of new animal models to test their efficacy. The COST Action MouseAGE is a European network whose aim is to reach consensus on the translational path required for geroprotectors, interventions targeting the biology of ageing. In our previous work we identified frailty and loss of resilience as a potential target for geroprotectors. Frailty is the result of an accumulation of deficits, which occurs with age and reduces the ability to respond to adverse events (physical resilience). Modelling frailty and physical resilience in mice is challenging for many reasons. There is no consensus on the precise definition of frailty and resilience in patients or on how best to measure it. This makes it difficult to evaluate available mouse models. In addition, the characterization of those models is poor. Here we review potential models of physical resilience, focusing on those where there is some evidence that the administration of acute stressors requires integrative responses involving multiple tissues and where aged mice showed a delayed recovery or a worse outcome then young mice in response to the stressor. These models include sepsis, trauma, drug- and radiation exposure, kidney and brain ischemia, exposure to noise, heat and cold shock.
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Affiliation(s)
- Markus Schosserer
- University of Natural Resources and Life Sciences, Vienna, Department of Biotechnology, Vienna, Austria
| | - Gareth Banks
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, United Kingdom
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Peter Dungel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Adelaide Fernandes
- Neuron-Glia Biology in Health and Disease, iMed.ULisboa, Research Institute for Medicines, Department of Biochemistry and Human Biology, Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - Darja Marolt Presen
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Ander Matheu
- Oncology Department, Biodonostia Research Institute, San Sebastián, Spain
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Paul Potter
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, United Kingdom
| | - Coral Sanfeliu
- Institute of Biomedical Research of Barcelona (IIBB) CSIC, IDIBAPS, CIBERESP, Barcelona, Spain
| | - Bilge Guvenc Tuna
- Department of Medical Biophysics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | | | - Ilaria Bellantuono
- MRC/Arthritis Research-UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Department of Oncology and Metabolism, The Medical School, Beech Hill Road, Sheffield, S10 2RX, United Kingdom.
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