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Nobili A, Mannucci PM. Drug prescription appropriateness in hospitalized older patients: 15-year results and lessons from a countrywide register. Intern Emerg Med 2024:10.1007/s11739-024-03645-0. [PMID: 38771425 DOI: 10.1007/s11739-024-03645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
The global increase of aging with the related increase of multiple noncommunicable diseases is inevitably accompanied by the associated issue of multimorbidity and polypharmacy. The latter is not without peculiar consequences on health, because it has been shown to be associated with drug-related adverse events, mainly due to poor prescription appropriateness and drug-drug interactions. To contribute to tackle this gigantic problem, a registry of drug dispensation in hospitalized older patient has been initiated in Italy in 2008. Through the last 15 years, data on nearly 11,000 older people have been accrued during their hospital stay in internal medicine and geriatric wards. This review article summarizes the main findings obtained, and how these data contribute to tackle the issue of appropriateness of drug prescription and the need of deprescribing in hospitalized older people affected by the most common noncommunicable diseases.
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Affiliation(s)
- Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Via Pace 9, 20122, Milan, Italy.
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Azab M, Novella A, Ianes A, Pasina L. Potentially Inappropriate Psychotropic Drugs in Nursing Homes: An Italian Observational Study. Drugs Aging 2024; 41:187-197. [PMID: 38036916 DOI: 10.1007/s40266-023-01083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Physicians often face difficulties in selecting appropriate medications for older adults with multiple comorbidities. As people age, they are more likely to be living with a number of chronic conditions (multimorbidity) and be prescribed a high number of medications (polypharmacy). Multimorbidity is frequent in nursing home (NH) residents and the use of potentially inappropriate medications, especially psychotropic drugs, is widespread. This retrospective cross-sectional cohort study examined the frequency of potentially inappropriate psychotropic drugs using the Beers, Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) and Fit fOR The Aged (FORTA) criteria, and their association with mortality. METHODS This retrospective cross-sectional cohort study was conducted on a sample of long-term care NHs across Italy. Of the 34 NHs with an electronic medical records system, 27 met the inclusion criteria, with complete web-based case report forms (CRFs). Residents under the age of 65 years were excluded. We calculated the prevalence of potentially inappropriate psychotropics drugs (antipsychotics, antidepressants and anxiolytics/hypnotics) according to three criteria for prescriptive appropriateness. Univariate and multivariate correlations were examined, taking into account age, sex, comorbidities, and the number of psychotropic drugs, to analyse the relationship between inappropriate psychotropic use and mortality rates. The rate of inappropriate psychotropic prescriptions was calculated with the prevalence of residents receiving potentially inappropriate psychotropic drugs according to the three criteria. We used a logistic model to check for a possible predictive relationship between inappropriate use of psychotropics and mortality. The study evaluated differences in prescriptive appropriateness among NHs by analysing the proportions of potentially inappropriately treated residents at the last visit. Differences were compared with the overall sample mean using confidence intervals (CIs) calculated using Wald's method. RESULTS This study involved 2555 residents, of whom 1908 (74.7% of the total) were treated with psychotropic drugs; 186 (7.3% of the total) were exposed to at least one psychotropic drug considered potentially inappropriate according to the FORTA criteria. Analysis using the Beers criteria showed that 1616 residents (63.2% of the total) received at least one psychotropic drug considered potentially inappropriate. In line with the Beers recommendation, patients receiving at least three psychotropic drugs were also included and 440 were identified (17.2% of the total sample). According to the STOPP criteria, 1451 residents (56.8% of the total sample) were prescribed potentially inappropriate psychotropic drugs. No correlation was found between potentially inappropriate use of psychotropic drugs and mortality, in either univariate analysis or in a multivariate model adjusted for age, sex and comorbidity index. CONCLUSIONS Different criteria for appropriate drug prescription identify very different percentages of patients in NHs exposed to psychotropics considered potentially inappropriate. The Beers and STOPP/START criteria identified a larger percentage of patients exposed in NHs than FORTA.
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Affiliation(s)
- Marina Azab
- Laboratory of Clinical Pharmacology and Appropriateness of Drug Prescription, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Alessio Novella
- Laboratory of Clinical Pharmacology and Appropriateness of Drug Prescription, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | | | - Luca Pasina
- Laboratory of Clinical Pharmacology and Appropriateness of Drug Prescription, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
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Abukhalil AD, Al-Imam S, Yaghmour M, Abushama R, Saad L, Falana H, Naseef HA. Evaluating Inappropriate Medication Prescribing Among Elderly Patients in Palestine Using the STOPP/ START Criteria. Clin Interv Aging 2022; 17:1433-1444. [PMID: 36193223 PMCID: PMC9526426 DOI: 10.2147/cia.s382221] [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: 07/14/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Elderly patients suffer from chronic diseases and are prone to polypharmacy and potentially inappropriate prescribing (PIP). This study aimed to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients in a tertiary care hospital setting and to estimate the prevalence of polypharmacy. Methods This multicenter retrospective observational study reviewed patient data from two major Palestinian hospitals. The collected data included patient demographics, comorbidities, and medications administered during hospitalization and discharge. The study included 247 patients aged ≥ 65 years hospitalized between January 2019 and December 2019. The STOPP/START criteria version 2 was used to identify the prevalence of PIMs and PPOs. Clinical pharmacists verified the data, and SPSS was used for data analysis. Descriptive statistics, one-tailed bivariate correlations, and Pearson’s test were applied to the variables of interest to examine their association with the STOPP/START criteria. Results A total of 247 patients were included in the study, and 50.2% were females. As a result, 165 (66.8%) participants were identified with PIPs, including 30 patients with PPOs, 91 with PIMs, and 44 with both. Furthermore, the prevalence of PIP during hospitalization and discharge was 56.29% and 64.39%, respectively. Polypharmacy (5–9 medications) was 44.5% and 52.1% during hospitalization and discharge, respectively, and excessive polypharmacy (ten medications or more) was 33.6% and 16.4% during hospitalization and discharge, respectively. Moreover, 47.3% of the patients had a comorbidity index of ≥ 5. Conclusion This study identified a high prevalence of PIPs among elderly patients during hospital admission and discharge. In addition, more than half of the geriatric patients in this study had PIP and a high prevalence of polypharmacy. Therefore, this study emphasizes the importance of adapting evidence-based tools, such as the STOPP/START criteria, to optimize patient medication therapy and guide prescribers in identifying and resolving PIMs and PPOs.
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Affiliation(s)
- Abdallah Damin Abukhalil
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
- Correspondence: Abdallah Damin Abukhalil; Hiba Falana, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine, Tel +970-5-98204036; +970-5-9519486, Fax +970-2-2982017, Email ;
| | - Siham Al-Imam
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Mohammad Yaghmour
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Raghad Abushama
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Laith Saad
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Hiba Falana
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Hani A Naseef
- Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
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Troncoso‐Mariño A, López‐Jiménez T, Roso‐Llorach A, Villén N, Amado‐Guirado E, Guisado‐Clavero M, Fernández‐Bertolin S, Pons Vigues M, Foguet‐Boreu Q, Violán C. Medication-related problems in older people in Catalonia: A real-world data study. Pharmacoepidemiol Drug Saf 2021; 30:220-228. [PMID: 33026123 PMCID: PMC7839740 DOI: 10.1002/pds.5149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to determine medication-related problems (MRPs) in primary care patients over 65 years of age. METHODS Cross-sectional study based on the electronic health records of patients (65-99 years of age) visited in 284 primary health care centers during 2012 in Catalonia. VARIABLES age, sex, sociodemographic variables, number of drugs, kidney and liver function and MRPs (duplicate therapy, drug-drug interactions, potentially inappropriate medications [PIMs] and drugs contraindicated in chronic kidney disease and in liver diseases). Unconditional logistic regression models were used to identify the factors associated with MRPs in patients with multimorbidity. RESULTS 916 619 older people were included and 853 085 of them met the criteria for multimorbidity. Median age was 75 years and 57.7% of them were women. High percentages of MRPs were observed: PIMs (62.8%), contraindicated drugs in chronic kidney disease (12.1%), duplicate therapy (11.1%), contraindicated drugs in liver diseases (4.2%), and drug-drug interactions (1.0%). These numbers were higher in the subgroup of patients with ≥10 diseases. The most common PIMs were connected to drugs that increase the risk of fall (66.8%), antiulcer agents without criteria for gastroprotection (40.6%), and the combination of drugs with anticholinergic effects (39.7%). In the multivariate analysis, the variables associated with all MRPs among the patients with multimorbidity were the number of drugs and the number of visits. CONCLUSIONS The coexistence of multimorbidity and polypharmacy is associated with an elevated risk of MRPs in older people. Medication safety for older patients constitutes a pressing concern for health services.
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Affiliation(s)
- Amelia Troncoso‐Mariño
- Àrea del Medicament i Servei de Farmàcia, Gerència Territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
- Department of Clinical SciencesUniversity of Barcelona and IDIBELL. L'Hospitalet de LlobregatBarcelonaSpain
| | - Tomás López‐Jiménez
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Albert Roso‐Llorach
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Noemí Villén
- Àrea del Medicament i Servei de Farmàcia, Gerència Territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
| | - Ester Amado‐Guirado
- Àrea del Medicament i Servei de Farmàcia, Gerència Territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
| | - Marina Guisado‐Clavero
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Sergio Fernández‐Bertolin
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Mariona Pons Vigues
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
- Àrea de Serveis AssistencialsServei Català de la SalutBarcelonaSpain
| | - Quintí Foguet‐Boreu
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
- Department of PsychiatryVic University HospitalBarcelonaSpain
- Department of Basic and Methodological Sciences, Faculty of Health Sciences and WelfareUniversity of Vic‐Central University of Catalonia (UVic‐UCC)VicSpain
| | - Concepción Violán
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
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Mannucci PM, Nobili A, Pasina L. Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med 2018; 13:1191-1200. [PMID: 30171585 DOI: 10.1007/s11739-018-1941-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/27/2018] [Indexed: 01/24/2023]
Abstract
As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, Via Pace, 9, 20122, Milan, Italy.
| | - Alessandro Nobili
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
| | - Luca Pasina
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
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