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Kummer I, Reissigová J, Lukačišinová A, Ortner Hadžiabdić M, Stuhec M, Liperoti R, Finne-Soveri H, Onder G, van Hout H, Fialová D. Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents. Ann Med 2024; 56:2357232. [PMID: 38833339 DOI: 10.1080/07853890.2024.2357232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
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Affiliation(s)
- Ingrid Kummer
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Jindra Reissigová
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, The Czech Republic
| | - Anna Lukačišinová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Maja Ortner Hadžiabdić
- Center for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein van Hout
- Departments of General Practice and Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, The Czech Republic
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Wang Z, Liu T, Su Q, Luo H, Lou L, Zhao L, Kang X, Pan Y, Nie Y. Prevalence of Polypharmacy in Elderly Population Worldwide: A Systematic Review and Meta-Analysis. Pharmacoepidemiol Drug Saf 2024; 33:e5880. [PMID: 39135518 DOI: 10.1002/pds.5880] [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: 12/25/2023] [Revised: 05/07/2024] [Accepted: 07/11/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Polypharmacy (PP) is common in elderly population and associated with some adverse clinical outcomes and increases healthcare burdens. We performed this systemic review and meta-analysis to estimate worldwide prevalence of PP and explore associated factors in the elderly. METHODS The PubMed, Web of Science, Cochrane Library, and Ovid EMBASE databases were searched for studies published until May 30, 2022. We included observational studies representative of general patients aged ≥60 in which PP was defined as multiple drugs ≥5. Studies were excluded if only a particular group of the elderly population (e.g., with diabetes) were included. The primary outcome was the prevalence of PP. Random-effect models were employed to estimate the overall or variable-specific pooled estimates of PP. Secondary outcomes were hyperpolypharmacy (HPP, defined as multiple drugs ≥10) and PP prevalence based on different study years, genders, locations, populations, and so forth. RESULTS We included 122 original observational studies with an overall population of 57 328 043 individuals in the meta-analysis. The overall prevalence of PP and HPP in the elderly population worldwide was 39.1% (95% confidence interval [CI], 35.5%-42.7%) and 13.3% (95% CI, 10.4%-16.5%), respectively. The prevalence of PP in Europe, Oceania, North America, Asia, and South America was 45.8% (95% CI, 41.5%-50.2%), 45.5% (95% CI, 26.7%-64.3%), 40.8% (95% CI, 29.8%-51.6%), 29.0% (95% CI, 20.0%-38.0%), and 28.4% (95% CI, 24.0%-32.8%), respectively (p < 0.01). Multivariate meta-regressions showed geographical regions of Europe or North America, age ≥70, and residence from nursing homes were independently associated with higher PP prevalence. CONCLUSIONS Nearly 40% of the elderly population is exposed to PP. The prevalence of PP is significantly higher in elderly individuals aged 70 or older, in developed regions and in nursing homes. It is important to focus on avoiding inappropriate PP in this population to address the growing burden of PP.
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Affiliation(s)
- Zeyu Wang
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
| | - Tangyi Liu
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
| | - Qiaoyu Su
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
- Department of Gastroenterology, Xi'an Medical University, Xi An, Shaanxi, China
| | - Hui Luo
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
| | - Lijun Lou
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
| | - Lina Zhao
- Department of Radiotherapy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoyu Kang
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
| | - Yanglin Pan
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
| | - Yongzhan Nie
- Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China
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Rao A, Kim J, Lie W, Pang M, Fuh L, Dreyer KJ, Succi MD. Proactive Polypharmacy Management Using Large Language Models: Opportunities to Enhance Geriatric Care. J Med Syst 2024; 48:41. [PMID: 38632172 DOI: 10.1007/s10916-024-02058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Polypharmacy remains an important challenge for patients with extensive medical complexity. Given the primary care shortage and the increasing aging population, effective polypharmacy management is crucial to manage the increasing burden of care. The capacity of large language model (LLM)-based artificial intelligence to aid in polypharmacy management has yet to be evaluated. Here, we evaluate ChatGPT's performance in polypharmacy management via its deprescribing decisions in standardized clinical vignettes. We inputted several clinical vignettes originally from a study of general practicioners' deprescribing decisions into ChatGPT 3.5, a publicly available LLM, and evaluated its capacity for yes/no binary deprescribing decisions as well as list-based prompts in which the model was prompted to choose which of several medications to deprescribe. We recorded ChatGPT responses to yes/no binary deprescribing prompts and the number and types of medications deprescribed. In yes/no binary deprescribing decisions, ChatGPT universally recommended deprescribing medications regardless of ADL status in patients with no overlying CVD history; in patients with CVD history, ChatGPT's answers varied by technical replicate. Total number of medications deprescribed ranged from 2.67 to 3.67 (out of 7) and did not vary with CVD status, but increased linearly with severity of ADL impairment. Among medication types, ChatGPT preferentially deprescribed pain medications. ChatGPT's deprescribing decisions vary along the axes of ADL status, CVD history, and medication type, indicating some concordance of internal logic between general practitioners and the model. These results indicate that specifically trained LLMs may provide useful clinical support in polypharmacy management for primary care physicians.
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Affiliation(s)
- Arya Rao
- Harvard Medical School, Boston, MA, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA, 02114, USA
| | - John Kim
- Harvard Medical School, Boston, MA, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA, 02114, USA
| | - Winston Lie
- Harvard Medical School, Boston, MA, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michael Pang
- Harvard Medical School, Boston, MA, USA
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lanting Fuh
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA, 02114, USA
| | - Keith J Dreyer
- Harvard Medical School, Boston, MA, USA
- Data Science Office, Mass General Brigham, Boston, MA, USA
| | - Marc D Succi
- Harvard Medical School, Boston, MA, USA.
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA, 02114, USA.
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Bartošovič I, Bartošovičová II, Zrubáková K, Mikus P, Ochaba R, Goljerová I. Comparison of polypharmacy and pharmacotherapy among seniors in social institutions in 2001 and 2019. VNITRNI LEKARSTVI 2023; 69:4-9. [PMID: 37072260 DOI: 10.36290/vnl.2023.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Polypharmacy (polypharmacotherapy) is a serious problem among seniors. The aim of the work was to compare pharmacotherapy and polypharmacy among seniors in social facilities in 2001 and 2019. METHODOLOGY As of December 31, 2001, we collected data on the pharmacotherapy of 151 residents of two retirement homes (average age 75.1 years, 68.9% women). We compared the results with the pharmacotherapy of residents of two facilities for seniors as of October 31, 2019 (237 seniors, average age 80.5 years, 73.4% women). According to the medical records, we determined and compared the regularly used medicines of all residents, the use of medicines by age and sex, the use of 0-4 medicines, 5-9 medicines, 5 or more medicines, 10 or more medicines and the groups of medicines according to the ATC classification. For statistical processing, we used the t-test and chi-square test. RESULTS In 2001, residents regularly used a total of 891 medicines, 18 years later, they used a total of 2099 medicines. We observed a significant increase in the average number of regularly used medications per resident by more than a half (from 5.90 medications to 8.86 medications), in women from 6.11 drugs to 9.24 drugs and in men from 5.45 drugs to 7.81 drugs. The number of residents with polypharmacy (regular use of ≥ 5 drugs) increased by almost a quarter (from 70.2% to 87.3%), and the number of seniors with excessive polypharmacy (regular use of ≥ 10 drugs) increased 4.6 times (from 9, 3% to 43.5%). CONCLUSION Our work confirmed that over the course of 18 years, the number of medications used by seniors in social-type institutions has increased. It also points to the trend of increasing polypharmacy and excessive polypharmacy among seniors, especially at the age of 75+ and among women.
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Heinrich CH, McHugh S, McCarthy S, Donovan MD. Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland. PLoS One 2022; 17:e0274552. [PMID: 36520798 PMCID: PMC9754218 DOI: 10.1371/journal.pone.0274552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/31/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The prevalence of polypharmacy increases with age, increasing the exposure of older adults to potentially inappropriate medications (PIMs). Deprescribing has been shown to reduce PIMs for older residents in long-term care; however, deprescribing is not universally implemented. This study aims to identify the barriers and enablers to deprescribing in Irish long-term care facilities from the healthcare professionals' (HCPs) perspective. METHODS A qualitative descriptive approach was conducted using semi-structured interviews with HCPs working in long-term care (general practitioners, pharmacists and nurses). Purposive sampling with maximum variation was applied to select long-term care sites to identify HCPs, supplemented with convenience sampling of post-graduate HCPs from University College Cork. Data was thematically analysed and mapped to a framework of deprescribing barriers and enablers informed by the Theoretical Domains Framework. RESULTS Twenty-six HCPs participated from 13 long-term care facilities. The main barriers and enablers identified mapped to five domains. Barriers included insufficient resources, lack of co-ordination between healthcare settings and negative social influences. Additional barriers exist in private settings including deprescribing awareness, commitment and the need for incentives. Deprescribing enablers included interprofessional support and patient social influence. To encourage deprescribing, potential enablers include HCP education, pharmacist role expansion and tailored deprescribing guidelines within a structured process. CONCLUSION Interventions to support deprescribing should build on existing systems, involve stakeholders and utilise guidelines within a structured process. Any intervention must account for the nuanced barriers and enablers which exist in both public and private settings.
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Affiliation(s)
- Clara H. Heinrich
- School of Pharmacy, University College Cork, Cork City, Co. Cork, Ireland
- * E-mail:
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork City, Co. Cork, Ireland
| | - Suzanne McCarthy
- School of Pharmacy, University College Cork, Cork City, Co. Cork, Ireland
| | - Maria D. Donovan
- School of Pharmacy, University College Cork, Cork City, Co. Cork, Ireland
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Lvovschi VE, Carrouel F, du Sartz de Vigneulles B, Lamure M, Motyka G, Fraticelli L, Dussart C. Knowledge, Attitudes and Practices Related to Medication, Antibiotics, and Vaccination among Public Service Population: National Survey Conducted in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14044. [PMID: 36360926 PMCID: PMC9654407 DOI: 10.3390/ijerph192114044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Medication, antibiotics, and immunization are three major and cost-effective medical interventions but their use is balanced. Knowledge, attitudes and practices (KAP) are a cornerstone. This retrospective study aims at analyzing KAP related to these concerns among the public service population in order to establish the basis for the implementation of selective preventive actions. From a cross-sectional anonymous online questionnaire-based survey among the insurees of a French mutual organization (Union Prévention Santé pour la Fonction publique, UROPS), 33 questions related to medication, antibiotics and vaccination were extracted to evaluate KAP. New variables were constituted: levels of knowledge, antibiotic misuse, proactive behavior and vaccinophobia. Multiple correspondence analysis was performed to identify respondents' homogenous groups. In addition, bivariate statistical comparisons were provided and logistic regressions were carried out to identify determinants of these new variables. Public service population (workers and retired) were highly exposed to polymedication (8.7% vs. 24.4%, p < 0.0001), hypnotics overtake (24.3% vs. 18.4%, p < 0.0001), and misuse antibiotics (33.2% vs. 22.6%, p < 0.0001) despite good levels of knowledge. Proportions of vaccinophobia was low (0.8% vs. 1.7%, p < 0.0001). However, workers have different KAP than retired, without shared determinants in the 3 health domains studied. Respondents were proactive (85.8% vs. 81.6%, p < 0.0001), used multiple sources of trustworthy information and seems to be ready for the delegation of health tasks. Thus, preventive actions related to antibiotics and polymedication should be a priority in vaccination education for mutual organizations such as UROPS. Studying their insurees longitudinally could be interesting to highlight the impact of selective prevention on behaviors, through trusted health professionals (general practitioners, pharmacists…).
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Affiliation(s)
- Virginie-Eve Lvovschi
- Emergency Department, Rouen University Hospital, 76031 Rouen, France
- Laboratory “Research on Healthcare Performance” (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
- Hospices Civils of Lyon, 69003 Lyon, France
| | - Florence Carrouel
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France
| | - Benjamin du Sartz de Vigneulles
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France
| | - Michel Lamure
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France
| | | | - Laurie Fraticelli
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France
| | - Claude Dussart
- Hospices Civils of Lyon, 69003 Lyon, France
- Laboratory “Health, Systemic, Process” (P2S), UR4129, University Claude Bernard Lyon 1, University of Lyon, 69008 Lyon, France
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Hjort Telhede E, Arvidsson S, Karlsson S, Ivarsson A. Weighted Blankets' Effect on the Health of Older People Living in Nursing Homes. Geriatrics (Basel) 2022; 7:geriatrics7040079. [PMID: 36005255 PMCID: PMC9408528 DOI: 10.3390/geriatrics7040079] [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: 06/17/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: An increasingly aging population is a global phenomenon. While considered a positive step forward, vulnerability to age-related health problems increases along with the ageing population. The aim of the study was to investigate weighted blankets’ effect on health regarding quality of life (QoL), sleep, nutrition, cognition, activities of daily living ADL and medication in older people living in nursing homes. Methods: In total, 110 older people were involved in an intervention with weighted blankets, and 68 older people completed the intervention. Measures before and after were performed regarding quality of life; QoL-AD, EQ-VAS, sleep; MISS, nutrition; MNA, cognition; S -MMSE (ADL) and medication. Comparative statistical analyses were applied. Results: After intervention with weighted blankets, health in general, such as QoL, improved. Sleep also improved significantly, especially with respect to waking up during the night. Nutrition was enhanced, health as a cognitive ability improved, and medication in the psychoanaleptic group decreased. The effect size varied between small and large. Conclusions: A weighted blanket seems to be an effective and safe intervention for older people in nursing homes, as several improvements were made regarding the health of older people.
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Tran ATQ, Soullier N, Ankri J, Herr M, Carcaillon-Bentata L. Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey. BMC Geriatr 2022; 22:602. [PMID: 35858861 PMCID: PMC9301842 DOI: 10.1186/s12877-022-03289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There are few studies reporting on self-medication, perceptions or difficulties older adults have with their medications. This study aimed to describe the uses and the perceptions of medications among older adults in France and to identify patient groups based on that information. METHODS We used data from the 2020 'French Health Barometer' - a nationally-representative cross-sectional survey. We assessed polypharmacy (five or more medications), self-medication, and patient perceptions of medications. Robust Poisson regression was used to investigate socio-demographic and health-related factors associated with the outcomes. Latent class analysis was used to identify patient groups classified by the use and the perceptions of medications. Factors associated with group assignment were investigated by multinomial logistic regression. All analyses were weighted. RESULTS The study sample comprised 1,623 respondents aged 70-85 years. Polypharmacy and self-medication were reported in 23.5 and 48.7% of the older population, respectively. Polypharmacy was associated with increasing age, low education, and impaired health status. Self-medication was associated with female sex and high education. Among individuals taking at least 1 medication, 8.2% reported not to understand all their medications, and 9.7% having difficulty taking medications as prescribed. Among individuals taking at least 2 medications, 23.2% thought that they took too many medications. Three patient groups were identified: 'Non-polypharmacy, positive perceptions' (62.5%), 'Polypharmacy, positive perceptions' (28.0%), and 'Negative perceptions' (9.5%). CONCLUSIONS Polypharmacy and self-medication are common in French older adults. One segment of people reported negative perceptions of their medications regardless of their polypharmacy status. This underlines the difference between the objective and perceived measures of polypharmacy.
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Affiliation(s)
- Anh Thi-Quynh Tran
- Anti-Infective Evasion and Pharmacoepidemiology, Université Paris-Saclay, UVSQ, INSERM, CESP, 78180, Montigny-le-Bretonneux, France
| | - Noémie Soullier
- Santé Publique France, French national public health agency, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Joël Ankri
- Anti-Infective Evasion and Pharmacoepidemiology, Université Paris-Saclay, UVSQ, INSERM, CESP, 78180, Montigny-le-Bretonneux, France
| | - Marie Herr
- Anti-Infective Evasion and Pharmacoepidemiology, Université Paris-Saclay, UVSQ, INSERM, CESP, 78180, Montigny-le-Bretonneux, France
- Epidemiology and Public Health Department, AP-HP, Université Paris-Saclay, Raymond-Poincaré Hospital, 92380, Garches, France
| | - Laure Carcaillon-Bentata
- Santé Publique France, French national public health agency, 12 rue du Val d'Osne, 94415, Saint-Maurice, France.
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Weinand S, Thürmann PA, Dröge P, Koetsenruijter J, Klora M, Grobe TG. [Potentially Inappropriate Medication of Nursing Home Residents: An Analysis of Risk Factors Based on National Claims Data (AOK) for 2017]. DAS GESUNDHEITSWESEN 2022; 84:448-456. [PMID: 33682911 PMCID: PMC11248649 DOI: 10.1055/a-1335-4512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY The aim of this study was to assess risk factors for prescription of potentially inappropriate medication (PIM) to nursing home residents using the PRISCUS list in 2017. METHODS Using claims data (AOK) we analysed insured nursing home residents aged 65 or older in 2017. The PRISCUS list was used to identify PIMs. A multivariate logistic regression analysis was performed to analyse risk factors. RESULTS The study population in 2017 included 259 328 nursing home residents, out of them 25.5% received at least one potentially inappropriate medication (women: 25.6%/men: 24.9%). Female and younger aged nursing home residents had a higher risk for at least one PRISCUS prescription. Polypharmacy, an increasing number of attending physicians, and hospital stays were additional risk factors for a PRISCUS prescription. Furthermore, regional (Bundesland) variations contributed to differences in PRISCUS prescriptions. CONCLUSION The frequent PIM prescriptions in nursing home residents are a relevant topic regarding drug therapy safety. Regional differences, which cannot be explained by nursing home resident characteristics, show options for modifications and the need for further research.
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Affiliation(s)
- Sina Weinand
- Gesundheitsberichterstattung und Biometrie, aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
- Abteilung Allgemeinmedizin und Versorgungsforschung, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Petra A Thürmann
- Lehrstuhl für Klinische Pharmakologie, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
- Philipp Klee-Institut für Klinische Pharmakologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Deutschland
| | - Patrik Dröge
- Qualitäts- und Versorgungsforschung, Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland
| | - Jan Koetsenruijter
- Abteilung Allgemeinmedizin und Versorgungsforschung, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Mike Klora
- Gesundheitsberichterstattung und Biometrie, aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
| | - Thomas G Grobe
- Gesundheitsberichterstattung und Biometrie, aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
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Relation between drug therapy-based comorbidity indices, Charlson's comorbidity index, polypharmacy and mortality in three samples of older adults. Arch Gerontol Geriatr 2022; 100:104649. [PMID: 35149290 DOI: 10.1016/j.archger.2022.104649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/21/2022]
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Heinrich CH, Hurley E, McCarthy S, McHugh S, Donovan MD. Barriers and enablers to deprescribing in long-term care facilities: a 'best-fit' framework synthesis of the qualitative evidence. Age Ageing 2022; 51:6514232. [PMID: 35077555 DOI: 10.1093/ageing/afab250] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION older adults are at risk of adverse outcomes due to a high prevalence of polypharmacy and potentially inappropriate medications (PIMs). Deprescribing interventions have been demonstrated to reduce polypharmacy and PIMs. However, deprescribing is not performed routinely in long-term care facilities (LTCFs). This qualitative evidence synthesis aims to identify the factors which limit and enable health care workers' (HCWs) engagement with deprescribing in LTCFs. METHODS the 'best-fit' framework approach was used to synthesise evidence by using the Theoretical Domains Framework (TDF) as the a priori framework. Included studies were analysed qualitatively to identify LTCF barriers and enablers of deprescribing and were mapped to the TDF. Constructs within domains were refined to best represent the LTCF context. A conceptual model was created, hypothesising relationships between barriers and enablers. RESULTS of 655 records identified, 14 met the inclusion criteria. The 'best-fit' framework included 17 barriers and 16 enablers, which mapped to 11 of the 14 TDF domains. Deprescribing barriers included perceptions of an 'established hierarchy' within LTCFs, negatively affecting communication and insufficient resources which limited HCWs' engagement with deprescribing. Enablers included tailored deprescribing guidelines, interprofessional support and working with a patient focus, allowing the patients' condition to influence decisions. DISCUSSION this study identified that education, interprofessional support and collaboration can facilitate deprescribing. To overcome deprescribing barriers, change is required to a patient-centred model and HCWs need to be equipped with necessary resources and adequate reimbursement. The LTCF organisational structure must support deprescribing, with communication between health care systems.
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12
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Langenberger B, Baier N, Hanke FC, Fahrentholz J, Gorny C, Sehlen S, Reber KC, Liersch S, Radomski R, Haftenberger J, Heppner HJ, Busse R, Vogt V. The detection and prevention of adverse drug events in nursing home and home care patients: Study protocol of a quasi-experimental study. Nurs Open 2021; 9:1477-1485. [PMID: 34859616 PMCID: PMC8859083 DOI: 10.1002/nop2.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/21/2021] [Accepted: 11/16/2021] [Indexed: 11/11/2022] Open
Abstract
AIM To estimate the cost-effectiveness of an intervention facilitating the early detection of adverse drug events through the means of health professional training and the application of a digital screening tool. DESIGN Multi-centred non-randomized controlled trial from August 2018 to March 2020 including 65 nursing homes or home care providers. METHODS We aim to estimate the effect of the intervention on the rate of adverse drug events as primary outcome through a quasi-experimental empirical study design. As secondary outcomes, we use hospital admissions and falls. All outcomes will be measured on patient-month level. Once the causal effect of the intervention is estimated, cost-effectiveness will be calculated. For cost-effectiveness, we include all patient costs observed by the German statutory health insurance. RESULTS The results of this study will inform about the cost-effectiveness of the optimized drug supply intervention and provide evidence for potential reimbursement within the German statutory health insurance system.
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Affiliation(s)
- Benedikt Langenberger
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Natalie Baier
- Department of Global Health Economics, Kiel Institute for the World Economy, Kiel, Germany
| | | | - Jacqueline Fahrentholz
- Long-term Care Services Management, AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - Christina Gorny
- Long-term Care Services Management, AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - Stephanie Sehlen
- Health Services Management, AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | | | - Sebastian Liersch
- Health Services Management, AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - Ralf Radomski
- Department of Innovative Health Services, VIACTIV Krankenkasse, Bochum, Germany
| | - Jens Haftenberger
- Department of Contract Management, IKK Brandenburg und Berlin, Potsdam, Germany
| | - Hans Jürgen Heppner
- Department of Geriatrics, Universität Witten/Herdecke, Witten, Germany.,Clinic of Geriatrics, Helios Klinikum Schwelm, Schwelm, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Verena Vogt
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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13
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Barry HE, Hughes CM. An Update on Medication Use in Older Adults: a Narrative Review. CURR EPIDEMIOL REP 2021; 8:108-115. [PMID: 34306966 PMCID: PMC8294219 DOI: 10.1007/s40471-021-00274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. RECENT FINDINGS A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. SUMMARY Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.
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Affiliation(s)
- Heather E. Barry
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Carmel M. Hughes
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
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14
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No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before-after study. Aging Clin Exp Res 2021; 33:1599-1607. [PMID: 32748114 PMCID: PMC8203501 DOI: 10.1007/s40520-020-01670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/23/2020] [Indexed: 11/15/2022]
Abstract
Background Older persons are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. We aimed to evaluate the impact on medication consumption, of a booklet designed to aid physicians with prescriptions for elderly nursing home residents. Methods Among 519 nursing homes using an electronic pill dispenser, we recorded the daily number of times that a drug was administered for each resident, over a period of 4 years. The intervention group comprised 113 nursing homes belonging to a for-profit geriatric care provider that implemented a booklet delivered to prescribers and pharmacists and specifically designed to aid with prescriptions for elderly nursing home residents. The remaining 406 nursing homes where no such booklet was introduced comprised the control group. Data were derived from electronic pill dispensers. The effect of the intervention on medication consumption was assessed with multilevel regression models, adjusted for nursing home status. The main outcomes were the average daily number of times that a medication was administered and the number of drugs with different presentation identifier codes per resident per month. Results 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (− 0.05 and − 0.06). The booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99–1.02, P = .45). Conclusion We observed an overall decrease in medication consumption in both the control and intervention groups. Our analysis did not provide any evidence that this reduction was related to the use of the booklet. Other factors, such as national policy or increased physician awareness, may have contributed to our findings. Electronic supplementary material The online version of this article (10.1007/s40520-020-01670-5) contains supplementary material, which is available to authorized users.
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15
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Elli C, Novella A, Nobili A, Ianes A, Pasina L. Laxative Agents in Nursing Homes: An Example of Prescribing Cascade. J Am Med Dir Assoc 2021; 22:2559-2564. [PMID: 34023302 DOI: 10.1016/j.jamda.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Laxatives are among the most prescribed medications to nursing home (NH) patients, and we evaluated the hypothesis that laxative agents could be prescribed as a result of a prescribing cascade. The aims of the study are (1) to investigate the use of laxative drugs in a large sample of Italian NHs and (2) to assess the relationship between medications that can induce constipation and laxative use. DESIGN Retrospective cross-sectional multicenter study. SETTING AND PARTICIPANTS Individuals living in long-term care NHs. METHODS Study conducted in a sample of Italian long-term care NHs distributed throughout the country. Information on drug prescriptions, diseases and sociodemographic characteristics collected 4 times during 2018 and 2019. RESULTS Among the 2602 patients recruited from 27 NHs (mean age ± standard deviation: 88.4 ± 8.5; women: 1994, 76.6%), 1248 were receiving laxatives (48%). Parkinson disease, cerebrovascular disease, and hemiplegia were associated with laxative prescription, and diabetes was associated with a decrease. Benzodiazepines, anti-Parkinson dopaminergic agents, and antidepressants (tricyclic antidepressants and mirtazapine) were associated with laxative treatment in univariate and adjusted models. Tricyclic antidepressants users were 3 times more likely to be taking laxatives than nonusers (odds ratio 2.98, 95% confidence interval 1.31-6.77, P = .0093). A larger number of drugs that can induce constipation was associated with laxative use (P = .0003). In all, 2002 individuals had at least 2 different prescription times: from the first to the last visit laxative use rose from 46.1% to 49.9%. Time of stay was also associated with laxative use (P = .016). CONCLUSIONS AND IMPLICATIONS Laxatives are among the most prescribed medications in Italian NHs. Medications that can induce constipation, such as antidepressants, anti-Parkinson dopaminergic agents, and benzodiazepines, are often used together with laxatives, and combinations of these drugs further increase the use of laxatives. Optimizing the prescription of psychotropic drugs could help reduce the "prescribing cascade" with laxatives. The length of stay in NHs is often proportional to laxative use and chronic treatment is very common.
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Affiliation(s)
- Chiara Elli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Alessio Novella
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | - Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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16
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AlAli M, Alqubaisy M, Aljaafari MN, AlAli AO, Baqais L, Molouki A, Abushelaibi A, Lai KS, Lim SHE. Nutraceuticals: Transformation of Conventional Foods into Health Promoters/Disease Preventers and Safety Considerations. Molecules 2021; 26:molecules26092540. [PMID: 33925346 PMCID: PMC8123587 DOI: 10.3390/molecules26092540] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022] Open
Abstract
Nutraceuticals are essential food constituents that provide nutritional benefits as well as medicinal effects. The benefits of these foods are due to the presence of active compounds such as carotenoids, collagen hydrolysate, and dietary fibers. Nutraceuticals have been found to positively affect cardiovascular and immune system health and have a role in infection and cancer prevention. Nutraceuticals can be categorized into different classes based on their nature and mode of action. In this review, different classifications of nutraceuticals and their potential therapeutic activity, such as anti-cancer, antioxidant, anti-inflammatory and anti-lipid activity in disease will be reviewed. Moreover, the different mechanisms of action of these products, applications, and safety upon consumers including current trends and future prospect of nutraceuticals will be included.
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Affiliation(s)
- Mudhi AlAli
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
| | - Maream Alqubaisy
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
| | - Mariam Nasser Aljaafari
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
| | - Asma Obaid AlAli
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
| | - Laila Baqais
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
| | - Aidin Molouki
- Department of Avian Disease Research and Diagnostic, Razi Vaccine and Serum Research Institute, Agricultural Research Education and Extension Organization (AREEO), Karaj 31585-854, Iran;
| | - Aisha Abushelaibi
- Dubai Colleges, Higher Colleges of Technology, Dubai 16062, United Arab Emirates;
| | - Kok-Song Lai
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
| | - Swee-Hua Erin Lim
- Health Sciences Division, Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates; (M.A.); (M.A.); (M.N.A.); (A.O.A.); (L.B.); (K.-S.L.)
- Correspondence: or ; Tel.: +971-56-389-3757
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17
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Grill P, Marwick C, De Souza N, Burton JK, Hughes C, Guthrie B. The burden of psychotropic and anticholinergic medicines use in care homes: population-based analysis in 147 care homes. Age Ageing 2021; 50:183-189. [PMID: 32706851 DOI: 10.1093/ageing/afaa122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. METHODS anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. RESULTS 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23-1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51-0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20-1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56-0.79). There was no association with care-home regulator quality scores. CONCLUSION care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed.
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Affiliation(s)
- Paula Grill
- Undergraduate Medical Student, School of Medicine, University of Dundee, Dundee, UK
| | - Charis Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Nicosha De Souza
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Kirsty Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Bruce Guthrie
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, UK
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18
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Jungo KT, Mantelli S, Rozsnyai Z, Missiou A, Kitanovska BG, Weltermann B, Mallen C, Collins C, Bonfim D, Kurpas D, Petrazzuoli F, Dumitra G, Thulesius H, Lingner H, Johansen KL, Wallis K, Hoffmann K, Peremans L, Pilv L, Šter MP, Bleckwenn M, Sattler M, van der Ploeg M, Torzsa P, Kánská PB, Vinker S, Assenova R, Bravo RG, Viegas RPA, Tsopra R, Pestic SK, Gintere S, Koskela TH, Lazic V, Tkachenko V, Reeve E, Luymes C, Poortvliet RKE, Rodondi N, Gussekloo J, Streit S. General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatr 2021; 21:19. [PMID: 33413142 PMCID: PMC7792080 DOI: 10.1186/s12877-020-01953-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
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Affiliation(s)
| | - Sophie Mantelli
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Zsofia Rozsnyai
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Biljana Gerasimovska Kitanovska
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia
| | - Birgitta Weltermann
- Institute for General Practice, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Christian Mallen
- Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG,, United Kingdom
| | | | - Daiana Bonfim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wrocław, Poland
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Hans Thulesius
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
| | | | - Katharine Wallis
- Primary Care Clinical Unit, the University of Queensland, Brisbane, Australia
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lieve Peremans
- Department of Primary and Interdisciplinary Care, University Antwerp, Antwerp, Belgium.,Department of Nursing and Midwifery, University Antwerp, Antwerp, Belgium
| | - Liina Pilv
- Department of Family Medicine, University of Tartu, Tartu, Estonia
| | - Marija Petek Šter
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg City, Luxembourg
| | - Milly van der Ploeg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Bomberová Kánská
- Department of Social Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Raquel Gomez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg
| | - Rita P A Viegas
- Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006, Paris, France.,Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Sanda Kreitmayer Pestic
- Family Medicine Department, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sandra Gintere
- Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia
| | - Tuomas H Koskela
- Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Vanja Lazic
- Dom zdravlja Zagreb - Centar, Zagreb, Croatia
| | - Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Clare Luymes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,UWV (Employee Insurance Agency), Leiden, the Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
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19
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Costa M, Correard F, Montaleytang M, Baumstarck K, Loubière S, Amichi K, Villani P, Honore S, Daumas A, Verger P. Acceptability of a Novel Telemedication Review for Older Adults in Nursing Homes in France: A Qualitative Study. Clin Interv Aging 2021; 16:19-34. [PMID: 33442242 PMCID: PMC7800438 DOI: 10.2147/cia.s283496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In France, polypharmacy among older people living in nursing homes (NH) is a major public health concern. In this context, the randomized controlled trial TEM-EHPAD was recently launched in various NH in southern France to evaluate the impact of implementing a novel telemedication review (TMR) on hospital admission rates of NH residents at high risk of iatrogenic disease. A qualitative study was integrated into the main trial study to assess general practitioners' (GP) and other NH healthcare professionals' (HP) acceptability of the proposed TMR before its implementation. Material and Methods A qualitative study using face-to-face semi-structured interviews was conducted with 16 HP before the beginning of the intervention. A manual thematic analysis was performed on the transcribed interviews. Results Four main themes emerged from the thematic analysis: HP perceptions of the TMR, difficulties related to medication management for NH residents, HP perceptions of the roles of different professionals, and facilitators of good practices. Most participants were favorable to the TMR, but some GP expressed fears about loss of control over their prescription writing. Conclusion This study fulfilled its objective to assess pre-intervention acceptability by GP and other HP. Results provided important information about how to adapt the TMR intervention to make it more acceptable to HP who will be involved in TEM-EHPAD. One of the main recommendations is the importance of providing participating GP with the opportunity to take part in the process of reviewing prescriptions.
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Affiliation(s)
- Marie Costa
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Florian Correard
- AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France.,Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France
| | - Maeva Montaleytang
- AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France.,Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France
| | - Karine Baumstarck
- EA3279, Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille 13385, France
| | - Sandrine Loubière
- EA3279, Self-Perceived Health Assessment Research Unit, Aix-Marseille University, Marseille 13385, France
| | - Kahena Amichi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, Marseille 13354, France
| | - Patrick Villani
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille 13274, France
| | - Stephane Honore
- AP-HM, Service Pharmacie, Hôpital de la Timone, Marseille 13385, France.,Laboratoire de Pharmacie Clinique, faculté de pharmacie, Aix-Marseille Université, Marseille 13385, France.,Service de Pharmacie Clinique, Faculté de Pharmacie Timone, Aix-Marseille Université, Marseille F-13000, France
| | - Aurélie Daumas
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille 13274, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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20
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Mascarelo A, Bortoluzzi EC, Hahn SR, Alves ALS, Doring M, Portella MR. Prevalência e fatores associados à polifarmácia excessiva em pessoas idosas institucionalizadas do Sul do Brasil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Verificar a prevalência e os fatores associados à polifarmácia excessiva em pessoas idosas institucionalizadas. Método Estudo transversal com 478 pessoas idosas residentes em instituições de longa permanência para idosos. A variável dependente foi polifarmácia excessiva, definida como o uso concomitante de dez ou mais medicamentos. As variáveis independentes incluíram informações sociodemográficas e de saúde. Utilizou-se a regressão de Poisson com variância robusta para analisar o efeito das variáveis independentes em relação ao desfecho. Resultados A prevalência de polifarmácia excessiva foi de 29,3%, associada à cardiopatia (RP=1,40; IC95% 1,03-1,91), diabetes mellitus (RP=1,52; IC95% 1,15-2,01), depressão (RP=1,42; IC95% 1,08-1,87), internação hospitalar no último ano (RP=1,36; IC95% 1,02-1,80) e ao uso de medicamento potencialmente inapropriado para idosos (RP=2,13; IC95% 1,60-2,83). Conclusão A polifarmácia excessiva foi frequente entre pessoas idosas institucionalizadas. Os resultados sugerem que as doenças prevalentes entre pessoas idosas, a hospitalização e o uso de medicamentos potencialmente inapropriados são fatores para o uso de polifarmácia excessiva nessa população. Esses achados podem instruir ações com vistas à otimização da farmacoterapia prescrita às pessoas idosas.
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21
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Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study. BJGP Open 2021; 5:BJGPO.2021.0167. [PMID: 34620596 PMCID: PMC9447292 DOI: 10.3399/bjgpo.2021.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Care home residents often have multiple cognitive and physical impairments, and are at high risk of adverse drug events (ADEs). AIM To describe excessive polypharmacy and potentially inappropriate prescribing predisposing care home residents to ADEs. DESIGN & SETTING A cross-sectional analysis of all dispensed prescriptions for 147 care home residents in Tayside and Fife, Scotland. METHOD Prevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted. RESULTS In total, 32.3% (n = 1444/4468) of residents had excessive polypharmacy, which was more common in residents aged 70-74 years (adjusted odds ratio [aOR] 1.86, 95% confidence interval [CI] = 1.04 to 3.34) and 80-84 years (aOR 1.75, 95% CI = 1.01 to 3.02), living in a residential care home (aOR 1.50, 95% CI = 1.19 to 1.88), and located in Fife (aOR 1.37, 95% CI = 1.09 to 1.71). Excessive polypharmacy was less common in residents with dementia (aOR 0.73, 95% CI = 0.64 to 0.84), and 8.9% (95% CI = 5.9% to 11.6%) of the variation was attributable to care home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories, with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%). CONCLUSION Excessive polypharmacy is common in care home residents and is associated with both individual and care home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADE categories is common. Research is needed to support and evaluate safe care home prescribing practices.
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22
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Pasina L, Novella A, Elli C, Nobili A, Ianes A. Inappropriate use of antiplatelet agents for primary prevention in nursing homes: An Italian multicenter observational study. Geriatr Gerontol Int 2020; 20:828-832. [PMID: 32716596 DOI: 10.1111/ggi.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
AIM The benefits of antiplatelets to prevent cardio- and cerebrovascular disease are recognized and appropriate only for "secondary prevention." This multicenter retrospective study was designed to (i) examine the prevalence of residents receiving antiplatelets for primary and secondary cardio- and cerebrovascular prevention, and (ii) evaluate the predictors of inappropriate antiplatelet prescription. METHODS This study was conducted in a sample of Italian long-term care nursing homes (NHs). Appropriate use of antiplatelets was defined in accordance with the strongest evidence-based indications. RESULTS Among the 2579 patients recruited from 27 long-term care NHs (age mean ± SD: 86.8 ± 7.3; women: 1995; 77.4%), 1092 were treated with antiplatelets (42.3%) and 619 (56.7%) were receiving antiplatelet agents for inappropriate primary prevention of cardio- or cerebrovascular atherothrombotic events. Age, dementia or cerebral atherosclerosis, congestive heart failure, peripheral vascular disease, diabetes without chronic complication and hypertension were predictors of inappropriate prescription of antiplatelets. Patients inappropriately treated with antiplatelets also had a higher risk of receiving proton pump inhibitors than those appropriately not treated in univariate (OR 95% CI = 2.79 (2.25-3.46, p < 0.0001) and multivariate models (OR 95% CI 2.71 (2.16-3.40, p < 0.0001). CONCLUSIONS Most patients receiving antiplatelet agents in NHs are being inappropriately treated for primary prevention of cardio- or cerebrovascular disease. NH residents with diagnosis of dementia or cerebral atherosclerosis, congestive heart failure, peripheral vascular disease, diabetes without chronic complication and hypertension seemed more likely to receive antiplatelets inappropriately. Patients without an evidence-based indication for antiplatelets also received proton-pump inhibitors in an unnecessary "prescribing cascade," which should be assessed for de-prescribing. Geriatr Gerontol Int 2020; 20: 828-832.
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Affiliation(s)
- Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessio Novella
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Elli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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23
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A nurse practitioner led protocol to address polypharmacy in long-term care. Geriatr Nurs 2020; 41:956-961. [PMID: 32718755 PMCID: PMC7380258 DOI: 10.1016/j.gerinurse.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/01/2022]
Abstract
Polypharmacy is common in long term care facilities and frequently associated with poor outcomes. A focus on decreasing polypharmacy as part of 60-day periodic review process in long term care facilities has the potential to improve resident outcomes and assist health care providers in improved medication management. To achieve success in decreasing polypharmacy, an interdisciplinary team with shared goals and communication is needed.
Polypharmacy is common in long term care facilities and frequently associated with poor outcomes. This study sought to determine if a medication management protocol completed at four month intervals by nurse practitioners (NP) could impact polypharmacy and administration times for long term care residents. The data was collected as part of a Centers for Medicare and Medicaid Services (CMS) “Initiative to Reduce Avoidable Hospitalization among Nursing Facility Residents” grant. Residents were recruited from participating long-term care facilities. NP completed a medication management protocol on admission to the program and at subsequent 4-month intervals or with an acute change in condition. A total of 2442 non-duplicated individuals were seen for at least 1 visit. Although the protocol did not result in a reduction of regularly scheduled medications, the number of scheduled medication administration times did significantly decrease. NP polypharmacy assessments and recommendations are important but were insufficient to decrease the medication burden.
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24
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Lin YN, Tsai HH, Huang HL, Chang YC, Shieh WY. Rethinking potentially inappropriate medication use in nursing homes within the Chinese population. Geriatr Nurs 2020; 41:724-729. [PMID: 32456974 DOI: 10.1016/j.gerinurse.2020.05.001] [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: 11/07/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
This study aimed to understand the prevalence of Chinese medicine and other potentially inappropriate medications and to examine if there are relationships with emergency room visits, hospital admissions, and falls in a Chinese nursing home population. This cross-sectional descriptive study was a secondary analysis of data from 531 nursing home residents in Taiwan. Cox proportional hazard regression models were used in the analysis. Use of Chinese medicine in combination with Western medicine was observed in approximately 1% of residents. For every additional Chinese medicine used, the hazard ratio was 3.09 (p=.26) for emergency room visits and 3.22 (p=.21) for hospital admissions. For every additional nonsteroidal antiinflammatory agent used, the hazard ratio for falls was 5.42 (p=.006). Further studies with larger sample sizes are required to understand the appropriate time intervals required between administration of Chinese and Western medicine as well as to understand the drug-drug interactions.
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Affiliation(s)
- Yu-Ning Lin
- Department of Nursing, Nurse Practitioner, Cheng Hsin General Hospital, Taipei, Republic of China
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 33302, Republic of China; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Republic of China.
| | - Hsiu-Li Huang
- College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Republic of China
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei city, Republic of China
| | - Wann-Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Tao-Yuan, Republic of China
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25
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Pasina L, Novella A, Cortesi L, Nobili A, Tettamanti M, Ianes A. Drug prescriptions in nursing home residents: an Italian multicenter observational study. Eur J Clin Pharmacol 2020; 76:1011-1019. [DOI: 10.1007/s00228-020-02871-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
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26
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Zhang N, Sundquist J, Sundquist K, Ji J. An Increasing Trend in the Prevalence of Polypharmacy in Sweden: A Nationwide Register-Based Study. Front Pharmacol 2020; 11:326. [PMID: 32265705 PMCID: PMC7103636 DOI: 10.3389/fphar.2020.00326] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
Aim Polypharmacy is becoming a global health problem. The aims of this study were to evaluate the temporal trends in the prevalence of polypharmacy in Sweden and to explore polypharmacy disparities by age, gender, education, and immigration status. Methods Polypharmacy and excessive polypharmacy were evaluated using data extracted from the Swedish Prescribed Drug Register between 2006 and 2014. Polypharmacy was defined as being exposed to five or more drugs and excessive polypharmacy was defined as being exposed to 10 or more drugs during 1 month respectively. Average annual percent change (AAPC) was calculated using Joinpoint Statistical Software. Results The prevalence of polypharmacy increased from 16.9% in 2006 to 19.0% in 2014 with an AAPC of 1.3; the prevalence of excess polypharmacy increased from 3.8% in 2006 to 5.1% in 2014 with an AAPC of 3.4. The prevalence of polypharmacy and excessive polypharmacy increased dramatically with age and peaked up to 79.6% and 36.4% in individuals aged 90 and above respectively. Females and individuals with lower education level were associated with a higher rate of polypharmacy and excessive polypharmacy. Immigrants from Middle-Eastern countries had the highest rate of polypharmacy and excessive polypharmacy, whereas individuals from Western Europe countries had the lowest rate. Conclusion The prevalence of polypharmacy has increased gradually in Sweden during the past decade. Individuals with older age, female sex, or lower education have a higher rate of polypharmacy and excessive polypharmacy. Immigrants from Middle-Eastern countries showed a higher rate of polypharmacy.
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Affiliation(s)
- Naiqi Zhang
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
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27
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Hasan SS, Chang SH, Thiruchelvam K, Chong DWK, Babar ZU. Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. S. Hasan
- Department of Pharmacy University of Huddersfield Huddersfield UK
| | - S. H. Chang
- Department of Pharmacy Practice International Medical University Kuala Lumpur Malaysia
| | - K. Thiruchelvam
- Department of Pharmacy Practice International Medical University Kuala Lumpur Malaysia
| | - D. W. K. Chong
- Department of Pharmacy Practice International Medical University Kuala Lumpur Malaysia
| | - Z. U. Babar
- Department of Pharmacy University of Huddersfield Huddersfield UK
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28
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Leguelinel-Blache G, Castelli C, Rolain J, Bouvet S, Chkair S, Kabani S, Jalabert B, Rouvière S, Choukroun C, Richard H, Kinowski JM. Impact of pharmacist-led multidisciplinary medication review on the safety and medication cost of the elderly people living in a nursing home: a before-after study. Expert Rev Pharmacoecon Outcomes Res 2020; 20:481-490. [PMID: 31899986 DOI: 10.1080/14737167.2020.1707082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objectives: Adverse drug events (ADE) are a common cause of morbidity and mortality in elderly patients. In this study, we assessed the impact of multidisciplinary medication review (MMR) for nursing home residents on patient safety and costs incurred by the hospital and the national health service. Methods: Medical files of residents were retrospectively assessed for medications prescribed in the previous six months. A pharmacist reviewed the prescriptions and suggested modifications to the patient's medical team. Patients were followed for six months. Trivalle's ADE geriatric risk score was calculated before and after MMR, as were number of potentially inappropriate medications, and economic impact from the perspective of the health care system and the nursing home. Results: Forty-nine patients were recruited. ADE score dropped one risk level (median score of 4 before versus 1 after, p < 0.0001). The number of patients taking at least one potentially inappropriate medication decreased from 30.6% before to 6.1% after MMR (p = 0.005). A mean saving of €232 per patient was made from the nursing home perspective following MMR (p = 0.008). Conclusion: The MMR reduced the iatrogenic drug risk for elderly residents and costs from the nursing home perspective, particularly drug expenditure.
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Affiliation(s)
- Géraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier , Nimes, France.,UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier , Montpellier, France.,Department of Law and Health Economics, Faculty of Pharmacy, University of Montpellier , Montpellier, France
| | - Christel Castelli
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier , Montpellier, France.,Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Jérémy Rolain
- Department of Pharmacy, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Sophie Bouvet
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier , Montpellier, France.,Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Sihame Chkair
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier , Montpellier, France.,Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Sarah Kabani
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Bernadette Jalabert
- Department of Gerontology and Aging Prevention, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Sabine Rouvière
- Department of Gerontology and Aging Prevention, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Chloé Choukroun
- Department of Pharmacy, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Hélène Richard
- Department of Pharmacy, Nimes University Hospital, University of Montpellier , Nimes, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, Nimes University Hospital, University of Montpellier , Nimes, France.,UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier , Montpellier, France
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Resnick B, Boltz M, Galik E, Holmes S, Fix S, Zhu S. Gender Differences in Function, Physical Activity, Falls, Medication Use, and Life Satisfaction Among Residents in Assisted Living Settings. Res Gerontol Nurs 2020; 13:31-40. [PMID: 31584687 PMCID: PMC6980912 DOI: 10.3928/19404921-20190930-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/06/2019] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to test for gender differences among residents living in assisted living settings. This was a secondary data analysis using data from the first 64 facilities participating in the ongoing Function Focused Care for Assisted Living study using the Evidence Integration Triangle (FFC-AL-EIT). A total of 593 residents were recruited. Differences by gender with regard to function, physical activity, falls, total number of medications, and satisfaction with assisted living were tested using multivariate analysis of variance. There were 166 (28%) men and 427 (72%) women with a mean age of 88 (SD = 7.5 years). Participants had five (SD = 2) comorbidities and took on average 6.88 medications (SD = 3.47). Participants had moderate functional impairment with a mean of 64.13 (SD = 19.09) on the Barthel Index and engaged in 43.8 (SD = 76.12) minutes daily of moderate level physical activity. Women reported higher satisfaction with activities (4.32 [SD = 1.14]) than men (3.85 [SD = 1.51]), and women received more medications than men (7.09 [SD = 3.51] vs. 6.34 [SD = 3.31]). Current study findings suggest that deprescribing may be particularly important for women versus men and focusing on expanding activity options to include those preferred by men should be considered in assisted living settings. [Research in Gerontological Nursing, 13(1), 31-40.].
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30
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Guillot J, Maumus-Robert S, Bezin J. Polypharmacy: A general review of definitions, descriptions and determinants. Therapie 2019; 75:407-416. [PMID: 31732240 DOI: 10.1016/j.therap.2019.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/05/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
Polypharmacy is considered as the administration of many drugs. It is a major public health concern, which is growing worldwide. The identification of polypharmacy relies on drug count on a given time window. Polypharmacy exists if this count exceeds a predefined threshold. Although there is no consensus among scientists, five is the most frequently used number. Depending on the time-windows, polypharmacy can be qualified as simultaneous, cumulative, or continuous. Drugs can be selected according to the duration or the recurrence of their use thereby introducing the concept of chronic polypharmacy. This general review aimed to compile data from the literature regarding descriptions and determinants of polypharmacy, according to used definitions and studied populations. The prevalence of polypharmacy varied according to the definition used (from 4% to 57%). It was high in elderly people but was also non negligible in younger subjects such as middle aged. Cardiovascular, digestive and metabolism drugs were among the most frequent drugs involved in polypharmacy. The determinants of polypharmacy included factors linked to the patient (sociodemographic parameters such as age, sex, income, and place of residence, ethnicity, behaviour), factors linked to the disease (certain diseases such as cardiovascular or metabolic disease, multiple comorbidity status), as well as factors linked to the healthcare system or to the physician. Finally, to date, little data is available regarding polypharmacy appropriateness, although these data are needed to have clinically important information beyond a quantitative estimation. Further research is warranted to fill this gap.
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Affiliation(s)
- Jordan Guillot
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France; Service de Pharmacologie Médicale, CHU de Bordeaux, Bordeaux, France.
| | - Sandy Maumus-Robert
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
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31
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Schjøtt J, Schjøtt P, Assmus J. Analysis of consensus among drug interaction databases with regard to combinations of psychotropics. Basic Clin Pharmacol Toxicol 2019; 126:126-132. [PMID: 31468698 DOI: 10.1111/bcpt.13312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
Drug interaction databases are important tools in today's clinical decision support. However, there is great variation with regard to classification and presentation of interactions among databases. The present study aimed to investigate consensus among databases with regard to combinations of psychotropics. A database integrated in Norwegian computerised clinical decision support systems and three international recommended subscription databases were compared. Combinations of psychotropics (two or more) prescribed to patients 65 years or older on a single day from three nursing homes in Bergen, Norway 16 years apart (2000 and 2016) were studied. The databases were compared in a common analysis with the following questions: interaction (no, not contraindicated or contraindicated), type (pharmacodynamic or pharmacokinetic), the total number of interactions, and the first ranked interaction among several in each patient. Consensus among the four drug interaction databases was associated with pharmacokinetic interactions involving mainly older psychotropics in the common analysis. The qualities that best characterised interactions with consensus was primarily the evidence including a description of manageability. There was a surprising lack of consensus with regard to contraindicated interactions, even when older psychotropics were involved. Lack of consensus decreased with the number of psychotropics in the combinations. This was mainly because the highest ranked interactions in the respective databases involved different drugs. We propose evidence and manageability as core factors when ranking and presenting interactions in clinical decision support.
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Affiliation(s)
- Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
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32
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Borges CL, Fernandes BKC, Cavalcante MLSN, Barbosa RGB, Peixoto Junior AA, Menezes LCGD. Fatores de risco para incontinência urinária em idosos institucionalizados. ESTIMA 2019. [DOI: 10.30886/estima.v16.726_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Analisar os fatores de risco para incontinência urinária (IU) em idosos institucionalizados. Métodos: Estudo transversal, analítico, documental realizado por coleta em 203 prontuários de uma instituição de longa permanência no nordeste do Brasil. Foram utilizados um instrumento para caracterização sociodemográfica e de saúde e os valores do Mini Exame do Estado Mental (MEEM). Os dados foram analisados a partir da estatística descritiva, inferencial e por regressão logística múltipla. Resultados: A prevalência de IU foi de 42,36% e maior em mulheres (66,28%), mais velhos (média: 79,62 anos) e dependentes (89,53%). Houve associação entre idade (p = 0,01), sexo (p = 0,024), estado civil (p = 0,007), religião (p = 0,015), com quem residia antes da institucionalização (p = 0,033), grau de dependência (p < 0,001), valores do MEEM (p < 0,001) e doenças cardiovasculares (p < 0,001) e neurológicas (p < 0,001). Os fatores de risco para IU foram quantidade de doenças [odds ratio (OR) = 1,17; intervalo de confiança de 95% (IC95%) = 1,02-1,34], consumo de cinco a nove medicamentos (OR = 4,07; IC95% = 1,14-14,52), ser solteiro (OR = 2,09; IC95% = 1,30-8,01), dependente (OR = 3,27; IC95% = 1,33-8,04) e ter baixa pontuação no MEEM (OR = 0,88; IC95% = 0,85-0,93). Conclusão: Os resultados revelam a importância de estudar IU nessa população para identificar precocemente os fatores de risco passíveis de prevenção.
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Borges CL, Fernandes BKC, Cavalcante MLSN, Barbosa RGB, Peixoto Junior AA, Menezes LCGD. Risk factors for urinary incontinence in institutionalized elderly. ESTIMA 2019. [DOI: 10.30886/estima.v16.726_in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: To analyze the risk factors for urinary incontinence (UI) in institutionalized elderly. Methods: Cross-sectional, analytical, documentary study done by collection in 203 medical records of a long-stay institution in northeastern Brazil. An instrument for sociodemographic and health characterization and the values of the Mini Mental State Examination (MMSE) were used. The data were analyzed from the descriptive, inferential and multiple logistic regression. Results: The prevalence of UI was 42.36% and higher in women (66.28%), older (mean: 79.62 years) and dependent (89.53%). There was an association between age (p = 0.01), sex (p = 0.024), marital status (p = 0.007), religion (p = 0.015), with whom resided before institutionalization (p = 0.033), degree of dependency (p < 0.001), MMSE values (p < 0.001) and cardiovascular (p < 0.001) and neurological diseases (p < 0,001). The risk factors for UI were number of diseases (OR = 1.17; 95%CI = 1.02-1.34), consumption of five to nine medications (OR = 4.07, 95% CI = 1.14-14.52), single (OR = 2.09, 95% CI = 1.30-8.01),dependent (OR = 3.27, 95% CI = 1.33-8.04) and had a low MMSE score (OR = 0.88, 95% CI= 0.85-0.93). Conclusion: The results reveal the importance of studying UI in this population to identify early risk factors that can be prevented.
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A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators. BMC Med Inform Decis Mak 2019; 19:102. [PMID: 31142298 PMCID: PMC6542081 DOI: 10.1186/s12911-019-0821-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
Background Inappropriate prescribing of psychotropics is a persistent and prevalent problem in nursing homes. The present study compared inappropriate prescribing of psychotropics in nursing homes 16 years apart with prescribing quality indicators. The purpose was to identify any change in inappropriate prescribing of relevance for medical informatics. Methods Three Norwegian nursing homes were audited in 2000 and 2016 with regard to prescribing quality. Psychotropics among 386 patients in 2000, and 416 patients in 2016, included combinations of antidepressants, antipsychotics, anxiolytics-hypnotics, and antiepileptics. Prescribing quality indicators included psychotropic polypharmacy (defined as concurrent use of three or more psychotropics) and potential inappropriate psychotropic substances or combinations. Furthermore, potential clinically relevant psychotropic interactions were classified as pharmacodynamic or pharmacokinetic using an interaction database. The first ranked (most important) interaction in each patient was selected with the following importance of categories in the database; recommended action > documentation > severity. Three levels (from low to high) within each category were used for ranking. Results From 2000 to 2016, psychotropic polypharmacy increased from 6.2 to 29.6%, potential inappropriate psychotropic substances was reduced from 17.9 to 11.3% and potential inappropriate psychotropic combinations increased from 7.8 to 27.9%. Changes in polypharmacy and combinations were predominantly associated with prescribing of anxiolytics-hypnotics. Sixty-three patients (16.3%) had psychotropic interactions in 2000 increasing to 146 patients (35.1%) in 2016. The increase in interactions was associated with prescribing of antidepressants. First ranked interactions, more than 60% of all interactions in both years, were increasingly pharmacodynamic, from 69.9 to 91.0%. Interactions in 2016 were associated with a lower level of recommended action and documentation, but not severity compared to 2000. The inappropriate prescribing of antipsychotics and antiepileptics was reduced in 2016 compared to 2000. Conclusions Using prescribing quality indicators we observed the importance of antidepressants and anxiolytics-hypnotics for inappropriate prescribing in 2016 while the role of antipsychotics and antiepileptics were reduced compared to 2000. A change to mainly pharmacodynamic interactions that lack good documentation was also observed. The present findings can be used for medical informatics-based approaches to address specific problems with prescribing, and prescribing quality indicators, in Norwegian nursing homes.
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Pont LG, Raban MZ, Jorgensen ML, Georgiou A, Westbrook JI. Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use. Int J Qual Health Care 2019; 30:810-816. [PMID: 29889231 DOI: 10.1093/intqhc/mzy098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 05/22/2018] [Indexed: 12/26/2022] Open
Abstract
Objective The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. Design A cross-sectional analysis of eMAR data. Setting 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Participants Permanent residents living in a participating facility on 1 October 2015. Intervention None. Main Outcome Measures Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. Results The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Conclusions Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.
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Affiliation(s)
- Lisa G Pont
- Faculty of Medicine and Health Science, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW Australia.,Graduate School of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Magda Z Raban
- Faculty of Medicine and Health Science, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW Australia
| | - Mikaela L Jorgensen
- Faculty of Medicine and Health Science, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW Australia
| | - Andrew Georgiou
- Faculty of Medicine and Health Science, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW Australia
| | - Johanna I Westbrook
- Faculty of Medicine and Health Science, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW Australia
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The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Braillon A. Reader response: Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2018; 91:373. [PMID: 30126884 DOI: 10.1212/wnl.0000000000006038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cool C, Cestac P, McCambridge C, Rouch L, de Souto Barreto P, Rolland Y, Lapeyre‐Mestre M. Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention. Br J Clin Pharmacol 2018; 84:1598-1610. [PMID: 29607568 PMCID: PMC6005629 DOI: 10.1111/bcp.13598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/12/2018] [Accepted: 03/02/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Potentially inappropriate drug prescribing (PIDP) is frequent in nursing home (NH) residents. We aimed to investigate whether a geriatric intervention on quality of care reduced PIDP. METHODS We performed an ancillary study within a multicentric individually-tailored controlled trial (IQUARE trial). All NH received a baseline and 18-month audit regarding drug prescriptions and other quality of care indicators. After the initial audit, NHs of the intervention group benefited of an in-site intervention (geriatric education for NH staff) provided by a geriatrician from the closest hospital. The analysis included 629 residents of 159 NHs. The main outcome was PIDP, defined as the presence of at least one of the following criteria: (i) drug with an unfavourable benefit-to-risk ratio; (ii) with questionable efficacy; (iii) absolute contraindication; (iv) significant drug-drug interaction. Multivariable multilevel logistic regression models were performed including residents and NH factors as confounders. RESULTS PIDP was 65.2% (-3.6% from baseline) in the intervention group (n = 339) and 69.9% (-2.3%) in the control group (n = 290). The intervention significantly decreased PIDP [odds ratio (OR) = 0.63; 95% confidence interval 0.40-0.99], as a special care unit in NH (OR = 0.60; (0.42 to 0.85)), and a fall in the last 12 months (OR = 0.63; 0.44-0.90). Charlson Comorbidity Index [ORCCI = 1 vs. 0 = 1.38; 0.87-2.19, ORCCI ≥ 2 vs. 0 = 2.01; (1.31-3.08)] and psychiatric advice and/or hospitalization in a psychiatric unit (OR = 1.53; 1.07-2.18) increased the likelihood of PIDP. CONCLUSION This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient level.
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Affiliation(s)
- Charlène Cool
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philippe Cestac
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Cécile McCambridge
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Laure Rouch
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
- UMR 7268 Aix‐Marseille, Laboratoire d'Anthropologie bioculturelle, droit, éthique et santéFrance
| | - Yves Rolland
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
| | - Maryse Lapeyre‐Mestre
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Service de Pharmacologie Médicale et Clinique, CIC Inserm 1436CHU de Toulouse37 Allées Jules GuesdeF 31000ToulouseFrance
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Koria LG, Zaidi TS, Peterson G, Nishtala P, Hannah PJ, Castelino R. Impact of medication reviews on inappropriate prescribing in aged care. Curr Med Res Opin 2018; 34:833-838. [PMID: 29301404 DOI: 10.1080/03007995.2018.1424624] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inappropriate prescribing (IP) is prevalent among elderly people in aged care facilities. Little has been published on the effect of pharmacists performing residential medication management reviews (RMMRs) in aged care on the appropriateness of prescribing. RMMRs represents a key strategy for achieving quality use of medicines, by assisting residents in aged care facilities and their carers to better manage their medicines. However, the structure of RMMR has moved from annual to every two years for each resident. OBJECTIVES The primary objective of this study was to investigate the impact of pharmacists performing RMMRs on medication use appropriateness, as measured by the Medication Appropriateness Index (MAI). METHODS Retrospective analysis of RMMRs pertaining to 223 aged care residents aged ≥65 years in Sydney, Australia. The MAI was applied on two RMMR cohorts; newer cohort (n = 111, 2015) i.e. following the recent changes to the RMMR funding and older cohort (n = 112, 2012) at baseline, after pharmacists' recommendations (assuming all pharmacists' recommendations were accepted by the General Practitioner [GP]), and after the actual uptake of pharmacists' recommendations by the GP. Differences in inappropriate prescribing were measured using the Wilcoxon sign rank test. RESULTS Overall, all patients in the study (n = 223) had at least one inappropriate rating at baseline (median MAI score of 26 for the old cohort and 27 for the newer cohort). The median cumulative MAI scores were significantly lower after the RMMRs by pharmacists (15.5 and 20 for the old and new cohort respectively, p < .001) and following the uptake of recommendations by the GP, indicating an increased appropriateness of drug regimen after the medication review (20 and 22 for the old and new cohort respectively, p < .001). CONCLUSION This study shows that pharmacist-led medication reviews are effective in reducing inappropriate prescribing among aged care residents, as demonstrated by the reduction in MAI scores. Future studies should focus on the impact of such a decrease on patient outcomes.
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Affiliation(s)
- Linda Ghali Koria
- a Department of Pharmacy , University of Tasmania , Hobart , Tasmania , Australia
| | - Tabish Syed Zaidi
- a Department of Pharmacy , University of Tasmania , Hobart , Tasmania , Australia
| | - Gregory Peterson
- a Department of Pharmacy , University of Tasmania , Hobart , Tasmania , Australia
| | - Prasad Nishtala
- b Department of Pharmacy , University of Otago , Dunedin , New Zealand
| | - Paul J Hannah
- c Meditrax , Annandale , New South Wales , Australia
| | - Ronald Castelino
- a Department of Pharmacy , University of Tasmania , Hobart , Tasmania , Australia
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Odberg KR, Hansen BS, Aase K, Wangensteen S. Medication administration and interruptions in nursing homes: A qualitative observational study. J Clin Nurs 2018; 27:1113-1124. [PMID: 29076582 DOI: 10.1111/jocn.14138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? BACKGROUND Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. DESIGN A qualitative observational study design was applied. METHODS Data were collected using partial participant observations. An inductive content analysis was performed. RESULTS Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. CONCLUSIONS A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. RELEVANCE TO CLINICAL PRACTICE Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.
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Affiliation(s)
- Kristian Ringsby Odberg
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Britt Saetre Hansen
- Faculty of Health Studies, University of Stavanger, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- Faculty of Health Studies, University of Stavanger, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Sigrid Wangensteen
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Abstract
By the turn of the twenty-first century, the use of nutraceuticals became increasingly popular in both humans and animals due to their easy access, cost-effectiveness, and tolerability with a wide margin of safety. While some nutraceuticals are safe, others have a toxic potential. For a large number of nutraceuticals, no toxicity/safety data are available due to a lack of pharmacological/toxicological studies. The safety of some nutraceuticals can be compromised via contamination with toxic plants, metals, mycotoxins, pesticides, fertilizers, drugs of abuse, etc. Knowledge of pharmacokinetic/toxicokinetic studies appears to play a pivotal role in safety and toxicity assessment of nutraceuticals. Interaction studies are essential to determine efficacy, safety, and toxicity when nutraceuticals and therapeutic drugs are used concomitantly. This chapter describes various aspects of nutraceuticals, particularly their toxic potential, and the factors influencing their safety.
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Axmon A, Sandberg M, Ahlström G, Midlöv P. Prescription of potentially inappropriate medications among older people with intellectual disability: a register study. BMC Pharmacol Toxicol 2017; 18:68. [PMID: 29070067 PMCID: PMC5657112 DOI: 10.1186/s40360-017-0174-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people have a greater disease burden and are more likely than younger to be prescribed medications. They are also more sensitive to adverse effects. With this in mind, a range of medications have been suggested inappropriate in this population. People with intellectual disability (ID) have a higher disease burden than the general population, putting them at even greater risk of prescription of such medications. The aim of this study was to describe prescription of potentially inappropriate medications among older people with ID in relation to prescriptions among their age peers in the general population. METHODS We established an administrative cohort of people with ID (ID cohort; n = 7936), using a Swedish national register. A referent cohort from the general population (gPop) was matched one-to-one by sex and year of birth. Data regarding prescription of potentially inappropriate medications were collected from the Swedish prescribed drug register for the years 2006-2012. RESULTS People with ID were more likely than the general population to be prescribed medications with anticholinergic effects, intermediate- or long-acting benzodiazepines, and antipsychotics at least once during the study period, and also had more number of years with prescription. Except for benzodiazepines, those in the ID cohort with at least one prescription had larger amounts prescribed than those in the gPop cohort. People in the ID cohort were less likely than the general population to be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Among those with at least one prescription of NSAIDs, those in the ID cohort had prescriptions during fewer years and in lower amounts than those in the gPop cohort. CONCLUSIONS Although prescription of potentially inappropriate medications overall is more common among people with ID than in the general population, the opposite pattern is found for medications for pain management. This may be a result of pain being under-recognized and under-treated in this population. Thus, there is a need for training as well as increased knowledge and awareness among care and health care professionals regarding signs of adverse effects and the need of continuous evaluation of treatment in this vulnerable group.
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Affiliation(s)
- Anna Axmon
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, SE, Sweden. .,Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden.
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, 221 00, Lund, SE, Sweden
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Health status and drug use 1 year before and 1 year after skilled nursing home admission during the first quarter of 2013 in France: a study based on the French National Health Insurance Information System. Eur J Clin Pharmacol 2017; 74:109-118. [PMID: 28975381 DOI: 10.1007/s00228-017-2343-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/25/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE Changes in prescribing practices following skilled nursing home (SNH) admission have not been clearly described in France. The study aimed to evaluate health status and drug use 1 year before and 1 year after admission to SNH. METHOD People ≥ 65 years old admitted to SNH in the first quarter of 2013, covered by the national health insurance general scheme (69% of the population of this age) and still alive 1 year after admission were identified in a specific database (Resid-ehpad). Linking with the National Health Insurance Information System (SNIIRAM) allowed analysis of their health status, identified by algorithms, and changes in their use of reimbursed drugs. RESULTS In a population of 11,687 residents (mean age: 86 years, women: 76%), the most prevalent diseases were cardiovascular/neurovascular diseases (45%) and dementias (35%). The use of certain chronic treatments (≥ 3 reimbursements/year) increased significantly (p < 0.001) after nursing home admission: antidepressants: 34 to 46%, anxiolytics: 32 to 42%, hypnotics/sedatives: 18 to 24%, antipsychotics: 10 to 21% (14 to 30% in patients with dementia). The use of lipid-modifying agents and agents acting on the renin-angiotensin system decreased significantly (33 to 24% and 44 to 37%, respectively, p < 0.001). The use of antibacterials (≥ 1 reimbursement/year) increased also significantly (p < 0.001): 45 to 61%, including quinolones (13 to 20%) and third-generation cephalosporins (10 to 18%). CONCLUSION These results reveal increased prescribing of psychotropic drugs and antibacterials in SNH, requiring the development or sustainability of actions designed to improve prescribing practices in older people targeted by these treatments.
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