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Thiruchelvam K, Byles J, Hasan SS, Kairuz T. Innovating medication reviews through a technology-enabled process. Res Social Adm Pharm 2022; 18:2700-2705. [PMID: 34326004 PMCID: PMC8847068 DOI: 10.1016/j.sapharm.2021.07.019] [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: 03/24/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 10/31/2022]
Abstract
Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom.
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
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Abstract
Polypharmacy characterizes ongoing prescription of multiple medications in a patient. Following the demographic change and growing number of elderly patients, polypharmacy is of major concern due to the associated risks and even mortality. Many causes made this geriatric syndrome more common in the past decade. First, the management of comorbidities is often lacking in disease-specific guidelines. Second, multimorbidity is rising due to the ageing population. Third, deprescribing methods are sparse, and results are conflicting. This mini review integrates the effects of polypharmacy on mortality and morbidity, the causes and confounders of polypharmacy, and presents a practical stepwise manual of deprescribing. The work is based on a literature search for randomized control trials and reviews in English and German from 2015 onwards in the PubMed database, with integration of relevant citations as a result of this search.
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Akhtar A, Hassali MAA, Zainal H, Ali I, Iqbal MS, Khan AH. Respiratory-tract infections among geriatrics: prevalence and factors associated with the treatment outcomes. Ther Adv Respir Dis 2021; 15:1753466620971141. [PMID: 33910420 PMCID: PMC8108383 DOI: 10.1177/1753466620971141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Geriatric individuals are more susceptible to different infections, especially respiratory-tract infections (RTIs) due to their compromised immune system. Hence, the objectives of the present study were to evaluate the prevalence, medication regimen complexity and factors associated with the treatment outcomes of different RTIs among geriatrics. Methods: A retrospective cross-sectional study (5 years) was conducted at the respiratory department, Hospital Pulau Pinang. Patients aged ⩾65 years with confirmed diagnosis of RTI were included in the study. Results: A total of 474 patients were included, and the most prevalent RTIs were community-acquired pneumonia (65.6%) followed by chronic obstructive pulmonary disease (20.7%), bronchitis (8.2%) and hospital-acquired pneumonia (5.5%). Amoxicillin/clavulanate (69.8%), ampicillin/sulbactam (9.1%) and cefuroxime (6.5%) are the most common antibiotics prescribed to treat RTIs among geriatrics. Smoking, alcohol consumption, polypharmacy and presence of other co-morbidities are statistically significant factors associated with treatment outcomes of RTIs among geriatrics. Conclusion: Prevalence of community-acquired pneumonia (65.6%) among older patients aged 65 years and older higher than other RTIs. Smoking, alcohol use, presence of polypharmacy and other co-morbidities are important factors associated with the treatment outcomes of RTIs. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Ali Akhtar
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang, Pulau Pinang, Malaysia
| | | | - Hadzliana Zainal
- Discipline of Clinical Pharmacy, Universiti Sains Malaysia, Palau Pinang, Malaysia
| | - Irfhan Ali
- Respiratory Department, Hospital Pulau Pinang, Ministry of Health, Palau Pinang, Malaysia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Pariseault CA. An Integrative Review of Methods of Measurement of Polypharmacy. J Nurs Meas 2019; 27:554-574. [PMID: 31871291 DOI: 10.1891/1061-3749.27.3.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this integrative review is to synthesize research on the measurement of polypharmacy. METHODS A comprehensive search of the literature databases Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed was conducted using a combination of terms/keywords to search existing studies to explore measures used to address polypharmacy. RESULTS Several methods of measuring the existence of polypharmacy have been used in research. In addition to screening tools, the number of medications taken was used as an indicator of polypharmacy. CONCLUSIONS Multiple methods of the measurement of polypharmacy have been used throughout the literature. Most methods related to the intended study objectives and population. The most frequently reported measure of screening was the Beers Criteria.
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Abstract
Introduction: Older people are at risk for polypharmacy due to multiple chronic diseases. Considering the lack of information in this regard, the aim of this study was to investigate the state of polypharmacy among the elderly in the city of Amirkola in northern part of Iran. Materials and Methods: This descriptive/analytical cross-sectional study is a part of Amirkola Health and Aging Project that was conducted on 1616 individuals aged 60 years and over. The data about medications were gathered through interviews and observation of prescriptions and medications consumed by patients. The data were analyzed by SPSS software version 18, and P ≤ 0.05 was regarded significant. Results: In this study, 1616 individuals including 883 men (54.6%) and 733 women (45.3%) were investigated. The average age of individuals was 69.37 ± 7.42. Among the investigated individuals, 526 including 368 men (41.7%) and 158 women (21.6%) consumed no medications. The prevalence of polypharmacy in this study was 23.1%, which was 32.7% in women and 15.2% in men (odds ratio = 1.51, 95% confidence interval: 1.10–1.93). The most prevalent group of medications used in both genders was cardiovascular drugs. Conclusions: Regarding the considerable prevalence of polypharmacy among the elderly, especially in aged women, serious efforts are required to manage polypharmacy. Provision of educational programs for physicians, personnel of pharmacies, and the staff of health-care centers in order for appropriate and safe consumption of medications in aged people is absolutely necessary.
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Affiliation(s)
- Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Nursing Care Research Center, Babol University of Medical Sciences, Babol, Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Intervention to Improve Appropriate Prescribing and Reduce Polypharmacy in Elderly Patients Admitted to an Internal Medicine Unit. PLoS One 2016; 11:e0166359. [PMID: 27902720 PMCID: PMC5130196 DOI: 10.1371/journal.pone.0166359] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/25/2016] [Indexed: 11/20/2022] Open
Abstract
Background Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice. Objective To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy. Methods We assessed the efficacy and safety of a 5-point checklist to be used by all physicians on the internal medicine wards of a Swiss hospital by comparing outcomes in 450 consecutive patients aged ≥65 years hospitalized after the introduction of the checklist, and in 450 consecutive patients ≥65 years hospitalized before the introduction of the checklist. The main measures were the proportion of patients with prescription of potentially inappropriate medications (PIMs) at discharge, according to STOPP criteria, and the number of prescribed medications at discharge, before and after the introduction of the checklist. Secondary outcomes were the prevalence of polypharmacy (≥ 5 drugs) and hyperpolypharmacy (≥ 10 drugs), and the prevalence of potentially inappropriate prescribing omissions (PPOs) according to START criteria. Results At admission 59% of the 900 patients were taking > 5 drugs, 13% ≥ 10 drugs, 37% had ≥ 1 PIM and 25% ≥ 1 PPO. The introduction of the checklist was associated with a significant reduction by 22% of the risk of being prescribed ≥ 1 PIM at discharge (adjusted risk ratios [RR] 0.78; 95% CI: 0.68–0.94), but not with a reduction of at least 20% of the number of drugs prescribed at discharge, nor with a reduction of the risk of PPOs at discharge. Conclusions The introduction of an easy-to-use 5-point checklist aimed at supporting therapeutic reasoning of physicians on internal medicine wards significantly reduced the risk of prescriptions of inappropriate medications at discharge.
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Choosing wisely in case of hypertension, diabetes and hyperlipidemia in older patients. Wien Med Wochenschr 2016; 166:166-72. [DOI: 10.1007/s10354-015-0426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
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Sarcopenia in cases of chronic and acute illness. Z Gerontol Geriatr 2015; 49:100-6. [DOI: 10.1007/s00391-015-0986-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/02/2015] [Accepted: 11/04/2015] [Indexed: 01/06/2023]
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Gillette C, Prunty L, Wolcott J, Broedel-Zaugg K. A new lexicon for polypharmacy: Implications for research, practice, and education. Res Social Adm Pharm 2014; 11:468-71. [PMID: 25280463 DOI: 10.1016/j.sapharm.2014.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/17/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
Abstract
Previous research suggests that polypharmacy is a significant challenge for health care systems. However, polypharmacy has been defined in at least 24 distinct ways, which has understandably caused confusion among researchers, educators, and students in health care. Previous definitions of polypharmacy capture what could be both inappropriate therapy, i.e. too many medications, as well as evidence-based therapy that is appropriate. Previous research has tried to focus on the number of medications a patient is prescribed to define polypharmacy; however only focusing on the number of medications a patient is taking may be of limited value in determining whether that patient will experience an adverse event. This paper proposes a lexicon change for polypharmacy. It suggests that in future research, polypharmacy be defined as patients going to more than one pharmacy for their prescriptions. The authors also proffer a new term, 'extraordinary prescribing,' to define patients who are taking medications that are either grossly excessive or not beneficial for that patient. This definition is different than the current use of polypharmacy because the number of medications a patient is taking is irrelevant, especially if that patient has multiple chronic diseases. This paper is meant to start a dialog within the health services research community to inform future research that examines why inefficient prescribing may harm patients and the broader health care system.
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Affiliation(s)
- Chris Gillette
- Marshall University School of Pharmacy, Department of Pharmacy Practice, Administration, and Research, 1 John Marshall Dr., Huntington, WV 25755, USA.
| | - Leesa Prunty
- Marshall University School of Pharmacy, Department of Pharmacy Practice, Administration, and Research, 1 John Marshall Dr., Huntington, WV 25755, USA
| | - Janet Wolcott
- Marshall University School of Pharmacy, Department of Pharmacy Practice, Administration, and Research, 1 John Marshall Dr., Huntington, WV 25755, USA
| | - Kimberly Broedel-Zaugg
- Marshall University School of Pharmacy, Department of Pharmacy Practice, Administration, and Research, 1 John Marshall Dr., Huntington, WV 25755, USA
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