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Błeszyńska-Marunowska E, Jagiełło K, Wierucki Ł, Renke M, Grodzicki T, Kalarus Z, Zdrojewski T. Potentially Inappropriate Medications Involved in Drug-Drug Interactions in a Polish Population over 80 Years Old: An Observational, Cross-Sectional Study. Pharmaceuticals (Basel) 2024; 17:1026. [PMID: 39204131 PMCID: PMC11357612 DOI: 10.3390/ph17081026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
The clinical context of drug interactions detected by automated analysis systems is particularly important in older patients with multimorbidities. We aimed to provide unique, up-to-date data on the prevalence of potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) in the Polish geriatric population over 80 years old and determine the frequency and the most common PIMs involved in DDIs. We analyzed all non-prescription and prescription drugs in a representative national group of 178 home-dwelling adults over 80 years old with excessive polypharmacy (≥10 drugs). The FORTA List was used to assess PIMs, and the Lexicomp® Drug Interactions database was used for DDIs. DDIs were detected in 66.9% of the study group, whereas PIMs were detected in 94.4%. Verification of clinical indications for the use of substances involved in DDIs resulted in a reduction in the total number of DDIs by more than 1.5 times, as well as in a nearly 3-fold decrease in the number of interactions requiring therapy modification and drug combinations that should be strictly avoided. The most common PIMs involved in DDIs were painkillers, and drugs used in psychiatry and neurology. Special attention should be paid to DDIs with PIMs since they could increase their inappropriate character. The use of automated interaction analysis systems, while maintaining appropriate clinical criticism, can increase both chances for a good therapeutic effect and the safety of the elderly during treatment processes.
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Affiliation(s)
- Emilia Błeszyńska-Marunowska
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-516 Gdynia, Poland;
| | - Kacper Jagiełło
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (K.J.); (Ł.W.); (T.Z.)
| | - Łukasz Wierucki
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (K.J.); (Ł.W.); (T.Z.)
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-516 Gdynia, Poland;
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-107 Kraków, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Disease, 41-800 Zabrze, Poland;
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (K.J.); (Ł.W.); (T.Z.)
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Takeshima M, Yoshizawa K, Ogasawara M, Kudo M, Itoh Y, Ayabe N, Shibata N, Mishima K. Association between benzodiazepine anxiolytic polypharmacy and concomitant psychotropic medications in Japan: a retrospective cross-sectional study. Front Psychiatry 2024; 15:1405049. [PMID: 39026522 PMCID: PMC11254787 DOI: 10.3389/fpsyt.2024.1405049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Guidelines for various psychiatric disorders recommend short-term use of benzodiazepine anxiolytic monotherapy in few cases. Contrarily, benzodiazepine anxiolytic polypharmacy (BAP) is not recommended in any case. However, BAP is often used in real world. Therefore, this study aimed to determine the association between BAP and concomitant use of psychotropic medications. Method This retrospective cross-sectional study used claims data from the Japan Medical Data Center. Medical information of health insurance subscribers treated with benzodiazepine anxiolytics in June 2019 was extracted. Prescription of two or more benzodiazepine anxiolytics was defined as BAP. Binary logistic regression analysis was performed to investigate the factors associated with BAP, using age group, sex, type of subscriber, and number of concomitant hypnotics, antidepressants, and antipsychotics (none, one, and two or more) as covariates. Result The eligible participants were 104,796 adults who were prescribed benzodiazepine anxiolytics. Among them, 12.6% were prescribed two or more drugs. Logistic regression analysis revealed that BAP was significantly associated with those who received hypnotic monotherapy (adjusted odds ratio [aOR]: 1.04, 95% confidence interval [CI]: 1.001-1.09, p=0.04), antidepressant monotherapy and polypharmacy (aOR: 1.57, 95% CI: 1.51-1.63, p<0.001 and aOR: 1.98, 95% CI: 1.88-2.09, p<0.001, respectively), and antipsychotic monotherapy and polypharmacy (aOR: 1.12, 95% CI: 1.07-1.19, p<0.001 and aOR: 1.41, 95% CI: 1.30-1.54, p<0.001, respectively). Conversely, lower BAP was associated with those who received hypnotic polypharmacy (aOR: 0.86, 95% CI: 0.81-0.91, p<0.001). Discussion This study showed that the greater the number of concomitant antidepressants and antipsychotics, the greater the association with BAP. Since combination therapy with antidepressants or antipsychotics is generally not recommended, patients receiving combination therapy with these medications may be resistant to pharmacotherapy. Therefore, implementing the recommended non-pharmacological treatments may reduce BAP.
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Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mizuki Kudo
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoko Ayabe
- Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Nana Shibata
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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Dinh TS, Hanf M, Klein AA, Brueckle MS, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Klasing S, Muth C, Seidling H, Engler J, Mergenthal K, Voigt K, van den Akker M. Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study. PLoS One 2024; 19:e0300047. [PMID: 38573912 PMCID: PMC10996284 DOI: 10.1371/journal.pone.0300047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care. METHODS AND FINDINGS Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders' tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients' medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management. CONCLUSIONS The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding.
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Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Maria Hanf
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Astrid-Alexandra Klein
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Lisa Rietschel
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Sophia Klasing
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Christiane Muth
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of General Practice and Family Medicine, Medical School Westphalia, Bielefeld University, Bielefeld, Germany
| | - Hanna Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
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Anderssen-Nordahl E, Sánchez-Arcilla Rosanas M, Bosch Ferrer M, Sabaté Gallego M, Fernández-Liz E, San-José A, Barceló-Colomer ME. Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach. Front Pharmacol 2024; 15:1320490. [PMID: 38529187 PMCID: PMC10961593 DOI: 10.3389/fphar.2024.1320490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 03/27/2024] Open
Abstract
Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs. Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug-drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs. Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%. Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.
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Affiliation(s)
- Emilie Anderssen-Nordahl
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margarita Sánchez-Arcilla Rosanas
- Geriatric Unit, Internal Medicine Service, Vall d'Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bosch Ferrer
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mònica Sabaté Gallego
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eladio Fernández-Liz
- Primary Healthcare Barcelona, Management of Primary Care and the Community of Barcelona City, Catalan Institute of Health, Barcelona, Spain
- Foundation University Institute for Research in Primary Healthcare Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Antonio San-José
- Geriatric Unit, Internal Medicine Service, Vall d'Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Estrella Barceló-Colomer
- Primary Healthcare Barcelona, Management of Primary Care and the Community of Barcelona City, Catalan Institute of Health, Barcelona, Spain
- Foundation University Institute for Research in Primary Healthcare Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Hias J, Defieuw L, Vanassche T, Verhamme P, Van der Linden L. Therapy and guideline adherence at a multidisciplinary hypertension clinic: A prospective, observational study. Vascul Pharmacol 2024; 154:107271. [PMID: 38159830 DOI: 10.1016/j.vph.2023.107271] [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: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Hypertension is highly prevalent and remains one of the most frequent and preventable causes of cardiovascular morbidity and mortality. Yet, suboptimal blood pressure control is common. Hypertension clinics might play an important role in improving target attainment, by targeting drug therapy adherence, improving guideline compliance and by involving pharmacists. OBJECTIVES We aimed to characterize patient drug therapy adherence, prescriber guideline compliance and pharmacist interventions at the hypertension clinic. METHODS A prospective observational study was performed at the hypertension clinic of a large, academic hospital. Adult Dutch-speaking patients were eligible for inclusion. Following data were collected: patient demographics, medication use, patient adherence to prescribed antihypertensive drug therapies according to the BAASIS tool and prescriber compliance to the 2018 European Society of Cardiology (ESC) hypertension guidelines. RESULTS A cohort of 108 patients was included with 51.9% male and aged 65 (IQR: 52-75) years. In total, 104 patients took at least 1 antihypertensive drug and 46 patients (44.2%) were classified as non-adherent with regard to their antihypertensive treatment; 82 patients (78.8%) had suboptimal blood pressure control. Compliance with the ESC guidelines was 66.3% prior to the consultation at the clinic and significantly increased to 77.9% thereafter (p = 0.0015). The clinical pharmacist performed a medication review for 27 patients with a total of 44 recommendations and an acceptance rate of 59.1%. CONCLUSION A visit to the multidisciplinary hypertension clinic improved prescriber guideline compliance and the use of single pill combinations. Involvement of a clinical pharmacist could be beneficial to further improve patient drug therapy adherence and guideline compliance.
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Affiliation(s)
- Julie Hias
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Hospital Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Lise Defieuw
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Hospital Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
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AlKhanbashi RO, AlNoamy Y, Ghandorah R, Awan RM, AlButi H. Assessment of clinical pharmacist interventions using a web-based application in a Saudi Arabian Tertiary Hospital. SAGE Open Med 2024; 12:20503121241233217. [PMID: 38410373 PMCID: PMC10896045 DOI: 10.1177/20503121241233217] [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: 07/01/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Objectives Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting. Methods A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process. Results A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%). Conclusions The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.
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Affiliation(s)
- Rana Omar AlKhanbashi
- Department of Pharmaceutical Services, Pharmacy Quality Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Yahya AlNoamy
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Reham Ghandorah
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Razan Mohammed Awan
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hala AlButi
- Department of Pharmaceutical Services, Pharmacy Clinical Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Zhu X, Zhang F, Zhao Y, Zhang W, Zhang Y, Wang J. Evaluation of potentially inappropriate medications for the elderly according to beers, STOPP, START, and Chinese criteria. Front Pharmacol 2024; 14:1265463. [PMID: 38235108 PMCID: PMC10791846 DOI: 10.3389/fphar.2023.1265463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024] Open
Abstract
Objective: Polypharmacy prevalence is increasing worldwide, and it is becoming more popular among the elderly. This study aimed to compare the prevalence of potentially inappropriate medications (PIMs) using the Beers criteria (2019 edition), criteria for potentially inappropriate medications for older adults in China (Chinese criteria), Screening Tool of Older Persons' Prescriptions (STOPP), and Screening Tool to Alert to Right Treatment (START) criteria and to identify risk factors associated with PIM use. Methods: This was a cross-sectional study with a sample of 276 inpatients aged ≥65 years old from January 2020 to June 2020. A cross-sectional study was conducted to analyze PIMs based on the Beers (2019 edition), Chinese, STOPP, and START criteria. PIMs use was analysed based on four different criteria and logistic regression analysis was used to investigate independent factors associated with PIM use. Results: The mean number of medications used by the elderly population was nine (range, 0-28). A total of 252 patients (accounting for 91.30%) took five or more medications and 120 patients (accounting for 43.48%) took 10 or more medications. The prevalence rates of PIMs were 66.30% (183/276), 55.07% (152/276), 26.45% (73/276), and 64.13% (177/276) determined by the Beers, Chinese, STOPP, and START criteria, respectively. The top PIMs screened using the Beers, Chinese, and STOPP criteria were proton pump inhibitors, clopidogrel, and benzodiazepines, respectively. Missed use of ACEI in patients with systolic heart failure and/or coronary artery disease was found to be the most common potential prescription omission (PPOs) analyzed using the START criteria. Logistic regression analysis showed that the strongest predictor of PIMs, as determined by all four criteria, was an increased number of medications (p < 0.001). Age was another risk factor for PIMs based on the STOPP criteria in our study (p < 0.05). Conclusion: Polypharmacy and PIMs were common in our study, and the risk of PIMs correlated with polypharmacy. Application of the Beers, Chinese, STOPP, and START criteria is a useful tool for detecting PIM use.
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Affiliation(s)
- Xiaojuan Zhu
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Feng Zhang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yong Zhao
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wen Zhang
- Department of Clinical Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yahui Zhang
- Department of Clinical Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianchun Wang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kosirova S, Urbankova J, Klimas J, Foltanova T. Assessment of potentially inappropriate medication use among geriatric outpatients in the Slovak Republic. BMC Geriatr 2023; 23:567. [PMID: 37715169 PMCID: PMC10504736 DOI: 10.1186/s12877-023-04260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is a highly prevalent problem among older people, making it challenging to improve patient safety. The aim of this study was to assess the use of PIMs among geriatric outpatients (OUTs) in the Slovak Republic according to the EU(7) PIM list and to identify the differences in PIM prescriptions among general practitioners (GPs), internists (INTs) and geriatricians (GERs). METHODS In total, 449 patients (65 years and older) from 4 medical centres who were in the care of GPs (32.5%), INTs (22.7%) or GERs (44.8%) were included in this retrospective analysis. Data were collected from 1.12.2019-31.3.2020. PIMs were identified according to the EU(7) PIM list from patients' records. PIM prescriptions by GPs, INTs and GERs were assessed. All obtained data were statistically analysed. RESULTS Polypharmacy (68.8% of patients), and PIM use (73% of patients) were observed. The mean number of all prescribed drugs was 6.7 ± 0.2 drugs per day/patient. The mean number of prescribed PIMs was 1.7 ± 0.1 PIMs per day/patient. Drugs from Anatomical Therapeutic Chemical (ATC) classes C, N and A accounted for the greatest number of PIMs. Significantly higher numbers of prescribed drugs as well as PIMs were prescribed by GPs than INTs or GERs. There were 4.2 times higher odds of being prescribed PIMs by GPs than by GERs (p < 0.001). CONCLUSIONS Polypharmacy and overprescription of PIMs were identified among geriatric patients in our study. We found a positive relationship between the number of prescribed drugs and PIMs. The lowest odds of being prescribed PIMs were observed among those who were in the care of a geriatrician. The absence of geriatricians and lack of information about PIMs among general practitioners leads to high rates of polypharmacy and overuse of potentially inappropriate medications in geriatric patients in the Slovak Republic.
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Affiliation(s)
- Stanislava Kosirova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Jana Urbankova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Jan Klimas
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Tatiana Foltanova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic.
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Nguyen K, Subramanya V, Kulshreshtha A. Risk Factors Associated With Polypharmacy and Potentially Inappropriate Medication Use in Ambulatory Care Among the Elderly in the United States: A Cross-Sectional Study. Drugs Real World Outcomes 2023; 10:357-362. [PMID: 37233904 PMCID: PMC10491561 DOI: 10.1007/s40801-023-00358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Polypharmacy, defined as the concurrent use of multiple (commonly five or more) prescription drugs, is widely prevalent among the elderly. It is a preventable and significant contributor to morbidity and mortality among older people. It is linked to prescribing potentially inappropriate medications (PIMs), which have been shown to be associated with an increased risk of adverse drug interactions and reduced compliance, and in some cases result in prescribing cascades where more drugs are prescribed to manage adverse outcomes. This study aimed to examine risk factors associated with polypharmacy and PIMs among elderly patients in outpatient settings in the US. METHODS We conducted a cross-sectional analysis using the nationally representative National Ambulatory Medical Care Survey, between 2010 and 2016. We extracted data from all people aged 65 years or older and evaluated factors associated with polypharmacy and PIMs using multivariable logistic regression. Weights were applied to obtain national estimates. RESULTS During the study period, there were a total of 81,295 ambulatory visits among adults 65 years and older. Being a woman (compared with a man) was more likely to be associated with greater prevalence of PIMs (OR: 1.31, 95% CI 1.23-1.40), and living in rural areas were more likely to be associated with both polypharmacy (OR: 1.15, 95% CI 1.07-1.23) and PIMs (OR: 1.19, 95% CI 1.09-1.29), compared with living in urban areas. Older age was positively associated with polypharmacy (OR: 1.08, 95% CI 1.06-1.10), but negatively associated with PIMs (OR: 0.97, 95% CI 0.95-0.99). CONCLUSIONS Our study suggests age, being a woman, and living in rural areas are risk factors for both polypharmacy and PIMs usage. Aside from primary care providers' roles in managing polypharmacy, collaborative care with other specialty providers, such as clinical pharmacists, should also be considered as an approach to improving the quality of prescribing in geriatric patients. Future research should further explore reasons for polypharmacy and focus on deprescribing and quality improvement initiatives in primary care to lower polypharmacy among the elderly.
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Affiliation(s)
- Khue Nguyen
- Department of Epidemiology, Rollins School of Public Health, Emory University, 4500 North Shallowford Rd., Suite 134, Atlanta, GA, 30338, USA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, 4500 North Shallowford Rd., Suite 134, Atlanta, GA, 30338, USA
| | - Ambar Kulshreshtha
- Department of Epidemiology, Rollins School of Public Health, Emory University, 4500 North Shallowford Rd., Suite 134, Atlanta, GA, 30338, USA.
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA.
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Mangin D, Lamarche L, Templeton JA, Salerno J, Siu H, Trimble J, Ali A, Varughese J, Page A, Etherton-Beer C. Theoretical Underpinnings of a Model to Reduce Polypharmacy and Its Negative Health Effects: Introducing the Team Approach to Polypharmacy Evaluation and Reduction (TAPER). Drugs Aging 2023; 40:857-868. [PMID: 37603255 PMCID: PMC10450010 DOI: 10.1007/s40266-023-01055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Polypharmacy, particularly among older adults, is gaining recognition as an important risk to health. The harmful effects on health arise from disease-drug and drug-drug interactions, the cumulative burden of side effects from multiple medications and the burden to the patient. Single-disease clinical guidelines fail to consider the complex reality of optimising treatments for patients with multiple morbidities and medications. Efforts have been made to develop and implement interventions to reduce the risk of harmful effects, with some promising results. However, the theoretical basis (or pre-clinical work) that informed the development of these efforts, although likely undertaken, is unclear, difficult to find or inadequately described in publications. It is critical in interpreting effects and achieving effectiveness to understand the theoretical basis for such interventions. OBJECTIVE Our objective is to outline the theoretical underpinnings of the development of a new polypharmacy intervention: the Team Approach to Polypharmacy Evaluation and Reduction (TAPER). METHODS We examined deprescribing barriers at patient, provider, and system levels and mapped them to the chronic care model to understand the behavioural change requirements for a model to address polypharmacy. RESULTS Using the chronic care model framework for understanding the barriers, we developed a model for addressing polypharmacy. CONCLUSIONS We discuss how TAPER maps to address the specific patient-level, provider-level, and system-level barriers to deprescribing and aligns with three commonly used models and frameworks in medicine (the chronic care model, minimally disruptive medicine, the cumulative complexity model). We also describe how TAPER maps onto primary care principles, ultimately providing a description of the development of TAPER and a conceptualisation of the potential mechanisms by which TAPER reduces polypharmacy and its associated harms.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada.
- Department of General Practice, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Larkin Lamarche
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jeffrey A Templeton
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Henry Siu
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Johanna Trimble
- Patient Voices Network of BC, 201-750 Pender Street West, Vancouver, BC, V6C 2T8, Canada
| | - Abbas Ali
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Jobin Varughese
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Amy Page
- School of Allied Health, University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Christopher Etherton-Beer
- Western Australia Centre for Health and Aging, School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
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11
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Shirazibeheshti A, Ettefaghian A, Khanizadeh F, Wilson G, Radwan T, Luca C. Automated Detection of Patients at High Risk of Polypharmacy including Anticholinergic and Sedative Medications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6178. [PMID: 37372763 DOI: 10.3390/ijerph20126178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Ensuring that medicines are prescribed safely is fundamental to the role of healthcare professionals who need to be vigilant about the risks associated with drugs and their interactions with other medicines (polypharmacy). One aspect of preventative healthcare is to use artificial intelligence to identify patients at risk using big data analytics. This will improve patient outcomes by enabling pre-emptive changes to medication on the identified cohort before symptoms present. This paper presents a mean-shift clustering technique used to identify groups of patients at the highest risk of polypharmacy. A weighted anticholinergic risk score and a weighted drug interaction risk score were calculated for each of 300,000 patient records registered with a major regional UK-based healthcare provider. The two measures were input into the mean-shift clustering algorithm and this grouped patients into clusters reflecting different levels of polypharmaceutical risk. Firstly, the results showed that, for most of the data, the average scores are not correlated and, secondly, the high risk outliers have high scores for one measure but not for both. These suggest that any systematic recognition of high-risk groups should consider both anticholinergic and drug-drug interaction risks to avoid missing high-risk patients. The technique was implemented in a healthcare management system and easily and automatically identifies groups at risk far faster than the manual inspection of patient records. This is much less labour-intensive for healthcare professionals who can focus their assessment only on patients within the high-risk group(s), enabling more timely clinical interventions where necessary.
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Affiliation(s)
| | | | - Farbod Khanizadeh
- Operation & Information Management, Aston Business School, Birmingham B4 7UP, UK
| | - George Wilson
- School of Computing and Information Science, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | | | - Cristina Luca
- School of Computing and Information Science, Anglia Ruskin University, Cambridge CB1 1PT, UK
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12
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Kasanami Y, Yamamoto T, Miyamoto T, Matzno S, Sakakibara M, Iwaki M, Kawabata A. Characterization of Potentially Inappropriate Medications That Need Special Attention in the Elderly with Dementia by Analyzing Pharmacy Claims Data. Biol Pharm Bull 2023; 46:1699-1705. [PMID: 38044093 DOI: 10.1248/bpb.b23-00385] [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] [Indexed: 12/05/2023]
Abstract
Community pharmacists may play a key role in promoting deprescribing of potential inappropriate medications (PIMs) that are highly prevalent among community-dwelling elderly with dementia. To characterize PIMs categories that need a special attention for dementia patients, in the present study, we analyzed the anonymized pharmacy claims data of patients aged 65 years and older (n = 333869) who visited nationwide 905 community-based pharmacies of Sugi Pharmacy Co., Ltd. during December 1-31, 2019. A dementia group was defined as patients who received typical dementia medications marketed in Japan, i.e., donepezil, galantamine, memantine or rivastigmine, and a non-dementia group was defined as patients who received no such medications. After propensity score matching on the basis of patients' age, gender and home healthcare insurance usage, the data of 11486 patients in each group were subjected to logistic regression analyses, to identify PIMs categories particularly important for dementia patients. Univariate analysis indicated that the proportions of dementia patients who received 1 and 2≤ of PIMs were significantly (p < 0.001) greater than those of non-dementia patients (odds ratios were 1.35 and 1.47, respectively). Multivariate analyses identified 5 categories of PIMs that were significantly more frequently prescribed in dementia patients, i.e., 'H2 blockers,' 'drugs for overactive bladder,' 'anti-diabetes drugs' and 'sulpiride' listed as PIMs categories for non-specific cases (adjusted odds ratios (aORs): 1.29, 1.91, 1.17, and 1.38, respectively), in addition to 'antipsychotics' listed only for dementia patients (aOR: 4.29). These results provide useful information to establish strategies for pharmacist-led deprescribing of PIMs in dementia patients.
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Affiliation(s)
| | | | - Tomoyoshi Miyamoto
- Faculty of Pharmacy, Kindai University
- School of Pharmacy, Hyogo Medical University
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13
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Zhang Y, Chen Z, Tian F. Potentially inappropriate medications in older Chinese outpatients based on the Beers criteria and Chinese criteria. Front Pharmacol 2022; 13:991087. [PMID: 36249753 PMCID: PMC9561887 DOI: 10.3389/fphar.2022.991087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Polypharmacy increases the prevalence of potentially inappropriate drugs potentially inappropriate medications among older persons, lowering their quality of life. PIMs use can lead to higher mortality in older patients. This study aimed to compare the prevalence of PIMs in older Chinese outpatients according to the Beers criteria and the Chinese criteria and to analyze the risk factors. Second, we describe the differences between the two criteria, focusing on the inappropriate prescription of drugs in older outpatients.Methods: In Chengdu, Southwest China, a cross-sectional study was undertaken using electronic medical data from 9 general hospitals s. Outpatients above the age of 60 who were treated in the Geriatrics Center of these medical institutions were included. The 2019 Beers criteria and the 2017 Chinese criteria were used to evaluate the PIM status of older outpatients, and binary logistic regression was used to identify potential risk factors for PIMs.Results: There were 44,458 prescriptions from 2016 to 2018. The prevalence of PIMs among older outpatients was 30.05% (according to the Beers criteria) and 35.38% (according to the Chinese criteria), with statistical difference. Estazolam, hydrochlorothiazide and alprazolam were the top three PIMs in the Beers criteria, while the top three PIMs in the Chinese criteria were clopidogrel, estazolam and insulin. The prevalence of PIMs was associated with age, the number of diseases and the number of drugs. PIMs were shown to be more common in patients aged 70 and above, with more than 2 kinds of diseases and more than 4 kinds of drugs.Conclusion: PIMs were shown to be common among older outpatients in China, according to this study. The detection rate of the Chinese criteria was higher than that of the Beers criteria.
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Hatano M, Mizuno T, Arakawa Y, Inagaki R, Kato A, Matsuzaki H, Mizokami F, Koseki T, Yamada S. Efficacy of a Pharmacist Team Clinical Medication Review in Older Adults: A Prospective and Retrospective Observational Study. Biol Pharm Bull 2022; 45:1166-1171. [DOI: 10.1248/bpb.b22-00245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Masakazu Hatano
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Tomohiro Mizuno
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Yuki Arakawa
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Risa Inagaki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Arisa Kato
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Haruna Matsuzaki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology
| | - Takenao Koseki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine
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15
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Clinical pharmacist interventions in ambulatory psychogeriatric patients with excessive polypharmacy. Sci Rep 2022; 12:11387. [PMID: 35794225 PMCID: PMC9259566 DOI: 10.1038/s41598-022-15657-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Psychogeriatric primary care patients are frequently treated with excessive polypharmacy (≥ 10 medications), leading to complications and increased costs. Such cases are rarely included in treatment guidelines and randomized controlled trials. This paper evaluates the impact of clinical pharmacist medication reviews on the quality of pharmacotherapy in primary care psychogeriatric patients with excessive polypharmacy. The retrospective observational multicentric pre-post study included patients (aged 65 or above) treated with at least one psychotropic and ten or more medications. Clinical pharmacists’ recommendations were retrieved from medication review forms for the period 2012–2014. The study outcome measures were the number of medications, potentially inappropriate medications in the elderly (PIMs), potential drug-drug interactions which should be avoided (pXDDIs), and adherence to treatment guidelines. The study included 246 patients receiving 3294 medications, of which 14.6% were psychotropics. The clinical pharmacists proposed 374 interventions in psychopharmacotherapy. The general practitioners accepted 45.2% of them (169). Accepting clinical pharmacist recommendations reduced the total number of medications by 7.5% from 13.4 to 12.4 per patient (p < 0.05), the total number of prescribed PIMs by 21.8% from 312 to 244 (p < 0.05), the number of pXDDIs by 54.9% from 71 to 31 (p < 0.05) and also improved treatment guidelines adherence for antidepressants and antipsychotics (p < 0.05). Clinical pharmacist interventions significantly improved the quality of psychopharmacotherapy by reducing the total number of medications, PIMs, and pXDDIs. Accepting clinical pharmacist interventions led to better treatment guidelines adherence.
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Iqbal N, Huynh C, Maidment I. Systematic literature review of pharmacists in general practice in supporting the implementation of shared care agreements in primary care. Syst Rev 2022; 11:88. [PMID: 35546411 PMCID: PMC9091138 DOI: 10.1186/s13643-022-01933-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising demand for healthcare continues to impact all sectors of the health service. As a result of the growing ageing population and the burden of chronic disease, healthcare has become more complex, and the need for more efficient management of specialist medication across the healthcare interface is of paramount importance. With the rising number of pharmacists working in primary care in clinical roles, is this a role that pharmacists could support to ensure the successful execution of shared care agreement (SCA) in primary care for these patients? AIM OF THE REVIEW Systematic review to identify activities and assess the interventions provided by pharmacists in primary care on SCA provision and how it affects health-related quality of life (HRQoL) for patients. METHOD Primary studies in English which tested the intervention or obtained views of stakeholders related to pharmacist input to shared care agreement within primary care were included. The following electronic databases were systematically searched from the date of inception to November 2021: AMED®, CINAHL®, Cochrane Database of Systematic Reviews (CDSR), EMBASE®, EMCARE®, Google Scholar, HMIC®, MEDLINE®, PsycINFO®, Scopus and Web of Science®. Grey literature sources were also searched. The search was adapted according to the respective database-specific search tools. It was searched using a combination of Medical Subject Heading terms (MeSH), free-text search terms and Boolean operators. RESULTS A total of 5244 titles/abstracts were screened after duplicates were removed, and 64 full articles were assessed for eligibility. On examination of full text, no studies met the inclusion criteria for this review. CONCLUSION This review highlights the need for further research to evaluate how pharmacists in general practice can support the safe and effective integration of specialist medication in primary care with the use of SCA. SYSTEMATIC REVIEW REGISTRATION NIHR PROSPERO No: 2020 CRD42020165363 .
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Affiliation(s)
- Naveed Iqbal
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Ian Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
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Adem L, Tegegne GT. Medication Appropriateness, Polypharmacy, and Drug-Drug Interactions in Ambulatory Elderly Patients with Cardiovascular Diseases at Tikur Anbessa Specialized Hospital, Ethiopia. Clin Interv Aging 2022; 17:509-517. [PMID: 35464156 PMCID: PMC9020506 DOI: 10.2147/cia.s358633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Limi Adem
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Gobezie T Tegegne, Email
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Mahlknecht A, Wiedermann CJ, Sandri M, Engl A, Valentini M, Vögele A, Schmid S, Deflorian F, Montalbano C, Koper D, Bellmann R, Sönnichsen A, Piccoliori G. Expert-based medication reviews to reduce polypharmacy in older patients in primary care: a northern-Italian cluster-randomised controlled trial. BMC Geriatr 2021; 21:659. [PMID: 34814835 PMCID: PMC8609829 DOI: 10.1186/s12877-021-02612-0] [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: 08/17/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical benefits for older patients (aged 75+) by means of evidence-based reduction of polypharmacy (defined as ≥8 prescribed drugs) and inappropriate prescribing in general practice. METHODS The cluster-randomised controlled trial involved general practitioners and patients in a northern-Italian region. The intervention consisted of a review of patient's medication regimens by three experts who gave specific recommendations for drug discontinuation. Main outcome measures were non-elective hospital admissions or death within 24 months (composite primary endpoint). Secondary outcomes were drug numbers, hospital admissions, mortality, falls, fractures, quality of life, affective status, cognitive function. RESULTS Twenty-two GPs/307 patients participated in the intervention group, 21 GPs/272 patients in the control group. One hundred twenty-five patients (40.7%) experienced the primary outcome in the intervention group, 87 patients (32.0%) in the control group. The adjusted rates of occurrence of the primary outcome did not differ significantly between the study groups (intention-to-treat analysis: adjusted odds ratio 1.46, 95%CI 0.99-2.18, p = 0.06; per-protocol analysis: adjusted OR 1.33, 95%CI 0.87-2.04, p = 0.2). Hospitalisations as single endpoint occurred more frequently in the intervention group according to the unadjusted analysis (OR 1.61, 95%CI 1.03-2.51, p = 0.04) but not in the adjusted analysis (OR 1.39, 95%CI 0.95-2.03, p = 0.09). Falls occurred less frequently in the intervention group (adjusted OR 0.55, 95%CI 0.31-0.98; p = 0.04). No significant differences were found regarding the other outcomes. Definitive discontinuation was obtained for 67 (16.0%) of 419 drugs rated as inappropriate. About 6% of the prescribed drugs were PIMs. CONCLUSIONS No conclusive effects were found regarding mortality and non-elective hospitalisations as composite respectively single endpoints. Falls were significantly reduced in the intervention group, although definitive discontinuation was achieved for only one out of six inappropriate drugs. These results indicate that (1) even a modest reduction of inappropriate medications may entail positive clinical effects, and that (2) focusing on evidence-based new drug prescriptions and prevention of polypharmacy may be more effective than deprescribing. TRIAL REGISTRATION Current Controlled Trials (ID ISRCTN: 38449870), date: 11/09/2013.
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy. .,Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Christian J Wiedermann
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy.,UMIT - Private University for Health Sciences, Medical Informatics and Technology - Tyrol, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Marco Sandri
- Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy
| | - Martina Valentini
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Anna Vögele
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Sara Schmid
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Felix Deflorian
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Carmelo Montalbano
- Genomedics S.r.L. Health Care Consultants, Via Sestese 61, 50141, Florence, Italy
| | - Dara Koper
- Salzburger Gesundheitsfonds, Sebastian Stief-Gasse 2, 5020, Salzburg, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Medical Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Peter-Anich- Street 35, 6020, Innsbruck, Austria
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy
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Stuhec M. Clinical pharmacist consultant in primary care settings in Slovenia focused on elderly patients on polypharmacy: successful national program from development to reimbursement. Int J Clin Pharm 2021; 43:1722-1727. [PMID: 34228266 DOI: 10.1007/s11096-021-01306-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022]
Abstract
Clinical pharmacists in most primary care settings across Europe do not offer a reimbursed medication review service. This paper describes the development, implementation, and evaluation of a program in Slovenia that allows all general practitioners to refer patients to clinical pharmacists in primary care settings for a medication review. Between 2012 and 2015, the Health Insurance Institute of Slovenia proposed, funded and evaluated a pilot trial and recommended that the service be extended to all public health insurance beneficiaries in Slovenia. Following successful negotiations, the program (Pharmacist Consultant) has been available in all Slovenian primary care settings since 2018. It was evaluated internally with various questionnaires and externally with three studies that reported fewer medication-related problems, fewer drug-drug interactions, cost effectiveness, better treatment guidelines adherence and better humanistic clinical outcomes. The results demonstrate that including clinical pharmacists in primary care settings is particularly beneficial for patients with multiple diseases and medications, who are often elderly people. Future research should examine the service with improved methodologies (e.g., prospective studies with a larger sample size, measures of clinical outcomes and long-term follow-up). In the context of Slovenia, studies should also examine the effects of further integration of clinical pharmacists in patient care (e.g., through patient monitoring, dependent or independent prescribing and medication reviews in hospitals).
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Affiliation(s)
- Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia. .,Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ptujska Cesta 33, 2270, Ormoz, Slovenia. .,Faculty of Pharmacy, University of Ljubljana, Askerceva Cesta 7, 1000, Ljubljana, Slovenia.
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