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Vandenberg AE, Hwang U, Das S, Genes N, Nyamu S, Richardson L, Ezenkwele U, Legome E, Richardson C, Belachew A, Leong T, Kegler M, Vaughan CP. Scaling the EQUIPPED medication safety program: Traditional and hub-and-spoke implementation models. J Am Geriatr Soc 2024; 72:2184-2194. [PMID: 38259070 DOI: 10.1111/jgs.18746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/09/2023] [Accepted: 12/09/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence-informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (ED) providers to adults aged 65 and older at discharge. We aimed to scale-up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub-and-spoke implementation model at three new EDs within a health system that had previously implemented EQUIPPED (hub). We hypothesized that implementation speed would increase under the hub-and-spoke model without cost to PIM reduction or site engagement. METHODS We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12-month baseline to 12-month post-implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation. RESULTS The proportion of PIMs at all four sites declined significantly from pre- to post-EQUIPPED: at traditional site 1 from 8.9% (8.1-9.6) to 3.6% (3.6-9.6) (p < 0.001); at spread site 1 from 12.2% (11.2-13.2) to 7.1% (6.1-8.1) (p < 0.001); at spread site 2 from 11.3% (10.1-12.6) to 7.9% (6.4-8.8) (p = 0.045); and at spread site 3 from 16.2% (14.9-17.4) to 11.7% (10.3-13.0) (p < 0.001). Time to implement was equivalent at all sites across both models. Interview data, reflecting a wide scope of responsibilities for the champion at the traditional site and a narrow scope at the spoke sites, indicated disproportionate barriers to engagement at the spoke sites. CONCLUSIONS EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID-19 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real-world conditions. The hub-and-spoke model offers an effective way to scale-up EQUIPPED though a speed or quality advantage could not be shown.
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Affiliation(s)
- Ann E Vandenberg
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ula Hwang
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
- James J. Peters VA Medical Center GRECC, Bronx, New York, USA
| | - Shamie Das
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas Genes
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sylviah Nyamu
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ugo Ezenkwele
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Legome
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Belachew
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michelle Kegler
- Department of Behavioural, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Camille P Vaughan
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Birmingham/Atlanta VA GRECC, Atlanta, Georgia, USA
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Kegler MC, Rana S, Vandenberg AE, Hastings SN, Hwang U, Eucker SA, Vaughan CP. Use of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments. FRONTIERS IN HEALTH SERVICES 2022; 2:1053489. [PMID: 36925898 PMCID: PMC10012623 DOI: 10.3389/frhs.2022.1053489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
Background Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) is an effective quality improvement program initially designed in the Veterans Administration (VA) health care system to reduce potentially inappropriate medication prescribing for adults aged 65 years and older. This study examined factors that influence implementation of EQUIPPED in EDs from four distinct, non-VA academic health systems using a convergent mixed methods design that operationalized the Consolidated Framework for Implementation Research (CFIR). Fidelity of delivery served as the primary implementation outcome. Materials and methods Four EDs implemented EQUIPPED sequentially from 2017 to 2021. Using program records, we scored each ED on a 12-point fidelity index calculated by adding the scores (1-3) for each of four components of the EQUIPPED program: provider receipt of didactic education, one-on-one academic detailing, monthly provider feedback reports, and use of order sets. We comparatively analyzed qualitative data from focus groups with each of the four implementation teams (n = 22) and data from CFIR-based surveys of ED providers (108/234, response rate of 46.2%) to identify CFIR constructs that distinguished EDs with higher vs. lower levels of implementation. Results Overall, three sites demonstrated higher levels of implementation (scoring 8-9 of 12) and one ED exhibited a lower level (scoring 5 of 12). Two constructs distinguished between levels of implementation as measured through both quantitative and qualitative approaches: patient needs and resources, and organizational culture. Implementation climate distinguished level of implementation in the qualitative analysis only. Networks and communication, and leadership engagement distinguished level of implementation in the quantitative analysis only. Discussion Using CFIR, we demonstrate how a range of factors influence a critical implementation outcome and build an evidence-based approach on how to prime an organizational setting, such as an academic health system ED, for successful implementation. Conclusion This study provides insights into implementation of evidence-informed programs targeting medication safety in ED settings and serves as a potential model for how to integrate theory-based qualitative and quantitative methods in implementation studies.
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Affiliation(s)
- Michelle C. Kegler
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Shaheen Rana
- School of Medicine, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | | | | | - Ula Hwang
- Yale University School of Medicine, New Haven, CT, United States
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Aida K, Azuma K, Mishima S, Ishii Y, Suzuki S, Oda J, Honma H. Potentially inappropriate medications at admission among elderly patients transported to a tertiary emergency medical institution in Japan. Acute Med Surg 2022; 9:e748. [PMID: 35386514 PMCID: PMC8976156 DOI: 10.1002/ams2.748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Potentially inappropriate medications (PIMs) have been reported to be associated with lower adherence, higher rates of adverse events, and higher health‐care costs in elderly patients with high comorbidity. However, inappropriate prescribing has not been adequately reported in studies of patients transported to tertiary care hospitals. In this study, we investigated PIMs at the time of admission, on the basis of the prescription status of elderly patients admitted to a tertiary emergency room (ER). Methods We included 316 patients (168 men and 148 women, aged 75–97 years) who were admitted to our ER from September 2018 to August 2019, whose prescriptions were available on admission. Drugs that met the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria version 2 were defined as PIMs. The primary outcome was the proportion of older adults taking at least one PIM at admission. Results The proportion of patients taking PIMs at admission was 57% (n = 179). The most common PIMs were benzodiazepines, proton pump inhibitors, and nonsteroidal anti‐inflammatory drugs. The total number of medications prescribed at admission, prescriptions from multiple institutions, and prescriptions from clinics were the risk factors for PIMs at admission (P < 0.01, P < 0.001, and P < 0.001, respectively). Conclusion We must be careful to avoid inappropriate prescribing for patients transported to tertiary care hospitals who have numerous prescriptions at the time of admission, patients who receive prescriptions from multiple medical institutions, and patients who receive prescriptions from clinics.
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Affiliation(s)
- Kenta Aida
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shiro Mishima
- Department of Medical Safety Management Tokyo Medical University Tokyo Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Shoji Suzuki
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Hiroshi Honma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Tokyo Japan
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Potier L, Magny E, Zerah L, Cohen-Bittan J, Verny M, Boddaert J, Baqué M. [A pragmatic approach to iatrogenic risk in the emergency room]. SOINS. GERONTOLOGIE 2021; 26:14-18. [PMID: 34462106 DOI: 10.1016/j.sger.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The links between the emergency department (ED) and drug-related harm are close. In practice, it is necessary to ask systematically if an iatrogenic accident is possible and to evaluate a new prescription carefully so as not to create iatrogenia during the visit to the emergency department. Any situation in which a nurse takes charge of an emergency room must be subject to precautions. Simple measures should be put in place during any hospitalisation of an elderly person.
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Affiliation(s)
- Lou Potier
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Emmanuelle Magny
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Lorène Zerah
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Judith Cohen-Bittan
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Marc Verny
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Jacques Boddaert
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Margaux Baqué
- Département de gériatrie, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.
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Park SK, Luu BT. Outcomes of adverse drug events reported with potentially inappropriate medications in older adults, 2004–2017. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sharon K. Park
- Notre Dame of Maryland University School of Pharmacy Baltimore MD USA
- Drug Information and Medication Use Policy, Department of Pharmacy The Johns Hopkins Hospital Baltimore MD USA
| | - Bao Tran Luu
- Philadelphia College of Osteopathic Medicine Philadelphia PA USA
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Bories M, Bouzillé G, Cuggia M, Le Corre P. Drug-Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study. Pharmaceutics 2021; 13:pharmaceutics13020266. [PMID: 33669162 PMCID: PMC7919637 DOI: 10.3390/pharmaceutics13020266] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/18/2023] Open
Abstract
Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.
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Affiliation(s)
- Mathilde Bories
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
| | - Guillaume Bouzillé
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Marc Cuggia
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Pascal Le Corre
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France
- Correspondence:
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Vandenberg AE, Kegler M, Hastings SN, Hwang U, Wu D, Stevens MB, Clevenger C, Eucker S, Genes N, Huang W, Ikpe-Ekpo E, Nassisi D, Previll L, Rodriguez S, Sanon M, Schlientz D, Vigliotti D, Vaughan CP. Sequential implementation of the EQUIPPED geriatric medication safety program as a learning health system. Int J Qual Health Care 2020; 32:470-476. [PMID: 32671390 DOI: 10.1093/intqhc/mzaa077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To present the three-site EQUIPPED academic health system research collaborative, which engaged in sequential implementation of the EQUIPPED medication safety program, as a learning health system; to understand how the organizations worked together to build resources for program scale-up. DESIGN Following the Replicating Effective Programs framework, we analyzed content from implementation teams' focus groups, local and cross-site meeting minutes and sites' organizational profiles to develop an implementation package. SETTING Three academic emergency departments that each implemented EQUIPPED over three successive years. PARTICIPANTS Implementation team members at each site participating in focus groups (n = 18), local meetings during implementation years, and cross-site meetings during all years of the projects. INTERVENTION(S) EQUIPPED provides Emergency Department providers with clinical decision support (education, order sets, and feedback) to reduce prescribing of potentially inappropriate medications to adults aged 65 years and older who received a prescription at time of discharge. MAIN OUTCOME MEASURE(S) Implementation process components assembled through successive implementation. RESULTS Each site had clinical and environmental characteristics to be addressed in implementing the EQUIPPED program. We identified 10 process elements and describe lessons for each. Lessons guided the compilation of the EQUIPPED intervention package or toolkit, including the EQUIPPED logic model. CONCLUSIONS Our academic health system research collaborative addressing medication safety through sequential implementation is a learning health system that can serve as a model for other quality improvement projects with multiple sites. The network produced an implementation package that can be vetted, piloted, evaluated, and finalized for large-scale dissemination in community-based settings.
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Affiliation(s)
| | - Michelle Kegler
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | - Ula Hwang
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniel Wu
- Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | | | - Stephanie Eucker
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nick Genes
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Wennie Huang
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Denise Nassisi
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laura Previll
- Duke University School of Medicine, Durham, NC 27710, USA
| | - Sandra Rodriguez
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martine Sanon
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Southerland LT, Stephens JA, Carpenter CR, Mion LC, Moffatt-Bruce SD, Zachman A, Hill M, Caterino JM. Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research. Implement Sci Commun 2020; 1:28. [PMID: 32885187 PMCID: PMC7427917 DOI: 10.1186/s43058-020-00015-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Older adults in the emergency department (ED) are at high risk for functional decline, unrecognized delirium, falls, and medication interactions. Holistic assessment by a multidisciplinary team in the ED decreases these adverse outcomes and decreases admissions, but there are many barriers to incorporating this type of care during the ED visit. METHODS This is a hybrid type II effectiveness-implementation study using a pre-/post-cohort design (n = 380) at a tertiary care academic ED with an ED observation unit (Obs Unit). The intervention is a two-step protocol of (step 1) ED nurses screening adult patients ≥ 65 years old for geriatric needs using the Delirium Triage Screen, 4-Stage Balance Test, and the Identifying Seniors at Risk score. Patients who have geriatric needs identified by this screening but who do not meet hospital admission criteria will (step 2) be placed in the Obs Unit for multidisciplinary geriatric assessment by the hospital's geriatric consultation team, physical therapists, occupational therapists, pharmacists, and/or case managers. Not all patients may require all elements of the multidisciplinary geriatric assessment. The Consolidated Framework for Implementation Research: Care Transitions Framework was used to identify barriers to implementation. Lean Six Sigma processes will be used to overcome these identified barriers with the goal of achieving geriatric screening rates of > 80%. Implementation success and associated factors will be reported. For the effectiveness aim, pre-/post-cohorts of adults ≥ 65 years old cared for in the Obs Unit will be followed for 90 days post-ED visit (n = 150 pre and 230 post). The primary outcome is the prevention of functional decline. Secondary outcomes include health-related quality of life, new geriatric syndromes identified, new services provided, and Obs Unit metrics such as length of stay and admission rates. DISCUSSION A protocol for implementing integrated multidisciplinary geriatric assessment into the ED setting has the potential to improve patient functional status by identifying and addressing geriatric issues and needs prior to discharge from the ED. Using validated frameworks and implementation strategies will increase our understanding of how to improve the quality of ED care for older adults in the acute care setting. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT04068311, registered 28 August 2019.
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Affiliation(s)
- Lauren T. Southerland
- Department of Emergency Medicine, The Ohio State Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH 43210 USA
| | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, OH USA
| | | | - Lorraine C. Mion
- College of Nursing, The Ohio State Wexner Medical Center, Columbus, OH USA
| | | | - Angela Zachman
- Department of Emergency Medicine, The Ohio State Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH 43210 USA
| | - Michael Hill
- Department of Emergency Medicine, The Ohio State Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH 43210 USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH 43210 USA
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Mekdad SS, Alsayed AA. Quality Improvement Project to Reduce Drug-Related Problems (DRPs) and Potentially Inappropriate Medications (PIMs) in Geriatrics Cardiac Clinic in Saudi Arabia. Can Geriatr J 2019; 22:49-54. [PMID: 31258827 PMCID: PMC6542580 DOI: 10.5770/cgj.22.338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Elderly people have a high risk of potentially inappropriate medications (PIMs) and drug-related problems (DRPs) due to polypharmacy, physical and mental limitations, pharmacokinetic, and pharmacodynamics changes. Purpose To determine the role of geriatric pharmacists in reducing drug-related problems and potentially inappropriate medication. Methods The observational study was conducted from October 2014 to October 2017 to show the prevalence of DRPs, and PIMs. A total of 375 geriatric cardiology patients (aged ≥ 65) were recruited from Geriatrics Cardiac Clinic in Saudi Arabia. AGS Beers Criteria 2012 and STOPP/START Criteria were used to view the impact of services directed by clinical pharmacists in decreasing DRPs and PIMs including medication review, intervention, and education to junior physicians during multi-disciplinary rounds (MDRs) and by sending e-mail alerts. Results DRPs were found in 29.6% of patients and PIMs were found in 19% of patients. After medication review, 25% required interventions and the majority (89%) of interventions were accepted by the managing team. DRPs were found in 14.9% of patients and PIMs were found in 9.6% of the patients. DRPs and PIMs were reduced almost by 50% by reviewing the files and educating the involved physicians. Conclusion This prospective study confirms a high prevalence of DRPs and PIMs in Saudi elderly cardiac patients.
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Affiliation(s)
- Sanaa S Mekdad
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alaa A Alsayed
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
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Lim D, Jung J. Racial-Ethnic Variations in Potentially Inappropriate Psychotropic Medication Use Among the Elderly. J Racial Ethn Health Disparities 2018; 6:436-445. [DOI: 10.1007/s40615-018-00541-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/18/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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Chang CB, Lai HY, Hwang SJ, Yang SY, Wu RS, Liu HC, Chan DC. Prescription of potentially inappropriate medication to older patients presenting to the emergency department: a nationally representative population study. Sci Rep 2018; 8:11727. [PMID: 30082816 PMCID: PMC6078949 DOI: 10.1038/s41598-018-30184-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/23/2018] [Indexed: 12/22/2022] Open
Abstract
Potentially inappropriate medication (PIM) was associated with adverse clinical outcomes and higher healthcare resource utilization among older patients. In order to investigate the prevalence of PIM use based on three different sets of criteria and their associated factors among older patients in the emergency department (ED) in Taiwan. The National Health Insurance Research Database was used for this cross-sectional study. Older patients who visited the ED at least once in 2009 were enrolled. PIMs were identified based on the Beers Criteria, PIM-Taiwan criteria, and PRISCUS criteria. Average patient age was 76.7 ± 7.4 years and patients visited the ED 1.8 ± 2.1 times in 2009. The prevalence and frequency of being prescribed at least one PIM at each visit were high according to all three sets of criteria. Performance of the PIM-Taiwan criteria was only inferior to that of the Beers Criteria. The most important factor associated with PIM was the number of medications prescribed in the ED, and PIM use was associated with higher annual health resource utilization in the ED. PIM use was a significant issue and was associated with higher annual emergency care resource utilization in the ED.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Internal Medicine, National Taiwan University Chu-Tung Branch, Hsin-Chu County, Taiwan.,Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Yun Lai
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Shu-Yu Yang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan
| | - Ru-Shu Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Superintedent Office, National Taiwan University Hospital Chu-Tung Branch, Hsin-Chu County, Taiwan.
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Kim M, Kaplan SJ, Mitchell SH, Gatewood M, Bentov I, Bennett KA, Crawford CA, Sutton PR, Matsuwaka D, Damodarasamy M, Reed MJ. The Effect of Computerized Physician Order Entry Template Modifications on the Administration of High-Risk Medications in Older Adults in the Emergency Department. Drugs Aging 2018; 34:793-801. [PMID: 28956283 DOI: 10.1007/s40266-017-0489-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults. OBJECTIVE The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED). METHODS This was a before-after comparison of the frequency of the recommended starting doses of high-risk medications to adults aged 65 years and older. Computerized records were queried for the administration of the above medication classes in two academic EDs over two similar 4-month periods in 2015 and 2016. Between study periods, the doses of high-risk medications on ED CPOE templates were adjusted for older adults based on established pharmacy guidelines and expert consensus. RESULTS There was a significant improvement in the rate of recommended dose administration of all medications of interest (27.3 vs. 32.5%, p < 0.001). Not surprisingly, the medications that were maximally impacted were also those most frequently prescribed, with a significant increase in the recommended dosing of opioids (29.0 vs. 35.2%, p < 0.001) accounting for the majority of the change. Although there were no differences in BZDs as a group, there were significant differences in selected BZDs such as midazolam and diazepam. Changes in the recommended dosing of NSAIDs could not be determined due to low numbers of administered doses in both phases of the study. CONCLUSION Simple changes in the CPOE template resulted in increased administration of the recommended starting doses of high-risk medications to older adults in the ED.
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Affiliation(s)
- Mitchell Kim
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA.
| | - Stephen J Kaplan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA.,Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Steven H Mitchell
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA
| | - Medley Gatewood
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Katherine A Bennett
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | | | - Paul R Sutton
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Diane Matsuwaka
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Mamatha Damodarasamy
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
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Redston MR, Hilmer SN, McLachlan AJ, Clough AJ, Gnjidic D. Prevalence of Potentially Inappropriate Medication Use in Older Inpatients with and without Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2018; 61:1639-1652. [DOI: 10.3233/jad-170842] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mitchell R. Redston
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Sarah N. Hilmer
- Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J. McLachlan
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Alexander J. Clough
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Danijela Gnjidic
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Kim M, Mitchell SH, Gatewood M, Bennett KA, Sutton PR, Crawford CA, Bentov I, Damodarasamy M, Kaplan SJ, Reed MJ. Older adults and high-risk medication administration in the emergency department. Drug Healthc Patient Saf 2017; 9:105-112. [PMID: 29184448 PMCID: PMC5685141 DOI: 10.2147/dhps.s143341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Older adults are susceptible to adverse effects from opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines (BZDs). We investigated factors associated with the administration of elevated doses of these medications of interest to older adults (≥65 years old) in the emergency department (ED). PATIENTS AND METHODS ED records were queried for the administration of medications of interest to older adults at two academic medical center EDs over a 6-month period. Frequency of recommended versus elevated ("High doses" were defined as doses that ranged between 1.5 and 3 times higher than the recommended starting doses; "very high doses" were defined as higher than high doses) starting doses of medications, as determined by geriatric pharmacy/medicine guidelines and expert consensus, was compared by age groups (65-69, 70-74, 75-79, 80-84, and ≥85 years), gender, and hospital. RESULTS There were 17896 visits representing 11374 unique patients >65 years of age (55.3% men, 44.7% women). A total of 3394 doses of medications of interest including 1678 high doses and 684 very high doses were administered to 1364 different patients. Administration of elevated doses of medications was more common than that of recommended doses. Focusing on opioids and BZDs, the 65-69-year age group was much more likely to receive very high doses (1481 and 412 doses, respectively) than the ≥85-year age groups (relative risk [RR] 5.52, 95% CI 2.56-11.90), mainly reflecting elevated opioid dosing (RR 8.28, 95% CI 3.69-18.57). Men were more likely than women to receive very high doses (RR 1.47, 95% CI 1.26-1.72), primarily due to BZDs (RR 2.12, 95% CI 2.07-2.16). CONCLUSION Administration of elevated doses of opioids and BZDs in the older population occurs frequently in the ED, especially to the 65-69-year age group and men. Further attention to potentially unsafe dosing of high-risk medications to older adults in the ED is warranted.
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Affiliation(s)
- Mitchell Kim
- Department of Emergency Medicine, University of Washington
| | | | | | - Katherine A Bennett
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| | - Paul R Sutton
- Division of General Internal Medicine, Department of Medicine, University of Washington
| | | | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington
| | - Mamatha Damodarasamy
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
| | - Stephen J Kaplan
- Section of General, Thoracic and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - May J Reed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington
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Osei EK, Berry-Cabán CS, Haley CL, Rhodes-Pope H. Prevalence of Beers Criteria Medications Among Elderly Patients in a Military Hospital. Gerontol Geriatr Med 2016; 2:2333721416637790. [PMID: 28138491 PMCID: PMC5119808 DOI: 10.1177/2333721416637790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 12/23/2015] [Accepted: 02/09/2016] [Indexed: 11/24/2022] Open
Abstract
Objective: This study aims to examine potentially inappropriate medication (PIM) prevalence and factors that affect the use of PIMs in a military treatment facility. Method: Admission and discharge medication lists of 60 patients aged ≥65 years were retrospectively reviewed by a clinical pharmacist and a member of the study team for the presence of PIM using the 2012 Beers Criteria. Patients included were those discharged between December 2012 and September 2013 from the Womack Army Medical Center, Internal Medicine unit. Results: Among the 60 patients evaluated, 44 (73%) were on at least one PIM at admission, whereas the prevalence of PIM at discharge (30 patients) was 50% (p < .001). The top three classes of PIM at admission were antihistamines (11, 15.3%), nonsteroidal anti-inflammatory drugs (10, 13.9%), and benzodiazepines (6, 8.3%). Patients on >10 medications at admission (37, 62%) were 4 times more likely to have a PIM (p < .001). Conclusion: Data showed a high and a previously unknown PIM prevalence among older adults in a U.S. military treatment facility.
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Affiliation(s)
- Edward K Osei
- Baumholder/Kaiserslautern Army Health Clinic, Baumholder, Germany
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Momin TG, Pandya RN, Rana DA, Patel VJ. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria. Indian J Pharmacol 2014; 45:603-7. [PMID: 24347769 PMCID: PMC3847251 DOI: 10.4103/0253-7613.121372] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/23/2013] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives: To detect the prevalence and pattern of use of Potentially inappropriate medications (PIMs) in hospitalized elderly patients of a tertiary care teaching hospital using Beers 2012 criteria and to compare the same with Beers 2003 criteria. Materials and Methods: Prescriptions of the elderly patients aged 65 years and above were collected from the medicine ward and analyzed. PIMs were identified with help of Beers 2003 and Beers 2012 criteria and comparison was made between the two criteria. Predictors associated with use of PIM were identified using bivariate and multivariate logistic regression analysis. Results: A total of 210 patients received 2,267 drugs. According to Beers 2003 criteria, 60 (28.57%) elderly patients received at least one PIM and 2.9% drugs were prescribed inappropriately. According to Beers 2012 criteria, 84 (40%) elderly received at least one PIM while 22 (10.47%) received multiple PIMs and about 5% drugs were prescribed inappropriately. The most commonly prescribed PIM was mineral oil-liquid paraffin (30, 14.3%) followed by spironolactone (25, 11.9%), digoxin (19, 9%), and benzodiazepines (14, 6.7%). There was a significant association between the number of patients receiving more than six drugs and the use of PIMs (P < 0.01). Use of more than 10 drugs was a significant predictor for use of PIMs in the elderly. Conclusion: The study shows high prevalence of prescribing PIMs in hospitalized elderly patients. Beers 2012 criteria are more effective in identifying PIMs than Beers 2003 criteria.
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Affiliation(s)
- Taufik G Momin
- Department of Pharmacology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, Gujarat, India
| | - Rushi N Pandya
- Department of Pharmacology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, Gujarat, India
| | - Devang A Rana
- Department of Pharmacology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, Gujarat, India
| | - Varsha J Patel
- Department of Pharmacology, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, Gujarat, India
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Al Balushi KA, Al-Shibli S, Al-Zakwani I. Drug utilization patterns in the emergency department: A retrospective study. J Basic Clin Pharm 2014; 5:1-6. [PMID: 24808681 PMCID: PMC4012701 DOI: 10.4103/0976-0105.128226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to assess the prescribing trends and costs of drugs in the emergency department (ED) at Sultan Qaboos University Hospital (SQUH), a tertiary care hospital, in Muscat, the Sultanate of Oman. Materials and Methods: This was a retrospective cross-sectional study of all patients (n = 300) who attended the ED at SQUH in May 2012. Analyses were performed using descriptive and univariate statistics. Results: The average age of patients was 34 ± 19 years. The average number of drugs prescribed per patients was 3.2 ± 1.9 and the majority of the patients (n = 78; 26%) received two drugs. The most common route of drug administration was the oral route (n = 481; 51%) followed by parenterally (n = 357; 38%). Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly prescribed class of drugs (38%) followed by the gastro-intestinal tract drugs (19%) and central nervous system drugs (13%). The average cost per prescription was 242 ± 632 US$. Morphine had the highest cost (1885 US$) followed by cefuroxime (1404 US$) and filgrastim (939 US$) over the 1-month period. There was a significant positive correlation between hospital cost and age (P < 0.001), duration of stay at the ED (P = 0.008) and emergency types (P < 0.001). Conclusion: NSAIDs were the most frequent class of drugs administered to patients. Highest number of drugs was prescribed for cardiovascular diseases followed by respiratory and gastrointestinal diseases. Anti-infective drugs cost was the highest among all other classes. The results of the present study are attempts to highlight the importance of strategies that have to be implemented to optimize medication use at the ED.
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Affiliation(s)
- K A Al Balushi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khod, Oman
| | - S Al-Shibli
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khod, Oman
| | - I Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khod, Oman ; Gulf Health Research, Muscat, Oman
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Lin JJ, Yeh TY, Lau HL. Elderly patients with inappropriate medication correlations with adverse drug events or unexpected illnesses in long-term care institutions. Aging Male 2013; 16:173-6. [PMID: 23991675 DOI: 10.3109/13685538.2013.832193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The elderly are subject to natural aging and the health problems caused by the recession of physical and mental functions. Elderly patients are also more susceptible to adverse reactions of medication, drug interactions and other drug problems than the young. We then investigated patients with adverse drug events (ADEs) or unexpected illnesses transferred to our hospital during the whole year of 2010. METHODS We analyzed the medicine of elderly patients in long-term care institutions. Four long-term care institutions with different types and sizes located near Fong-Yuan Hospital in downtown Fong-Yuan were investigated. In this study, the researchers divided potentially inappropriate medications (PIMs) into two categories: (a) those with or without the drug-drug interaction (DDI) and (b) those with narrow therapeutic index drugs. Variables were reclassified as inferential statistics for analysis by using the independent t-test or Mantel-Haenszel test. RESULTS The data for age, gender, presence or absence of dementia, brain damage and Parkinson's disease were divided into two groups for those patients with or without PIMs. There were no statistically significant differences among the groups. However, the numbers of chronic diseases for the group with PIMs were higher, and the numbers of drug items with PIMs were also higher. In addition, we investigated the presence or absence of PIMs for patients transferred to our hospital with ADEs and unexpected illnesses. The results showed no statistically significant differences among the groups. CONCLUSIONS Our results showed that elderly patients who had consultations with doctors and the hidden problems about medication were detected by pharmacists in the privileged hospital had no direct risk with DDI or narrow therapeutic index drugs. However, other potential drug risks remain to be further analyzed and more samples should be surveyed.
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Affiliation(s)
- Jiun-Jie Lin
- Department of Pharmacy, Fong-Yuan Hospital, Taichung , Taiwan , R.O.C
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Vieira de Lima TJ, Garbin CAS, Garbin AJÍ, Sumida DH, Saliba O. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes. BMC Geriatr 2013; 13:52. [PMID: 23718678 PMCID: PMC3679980 DOI: 10.1186/1471-2318-13-52] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. METHODS We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. RESULTS Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). CONCLUSIONS The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.
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Affiliation(s)
- Thaís Jaqueline Vieira de Lima
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
| | - Cléa Adas Saliba Garbin
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
| | - Artênio José Ísper Garbin
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
| | - Dóris Hissako Sumida
- Department of Basic Sciences, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), Araçatuba, SP, Brazil
| | - Orlando Saliba
- Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil
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Carpenter CR. Which medications are associated with incident delirium? Ann Emerg Med 2011; 59:321-2. [PMID: 21839541 DOI: 10.1016/j.annemergmed.2011.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/20/2011] [Accepted: 05/24/2011] [Indexed: 11/27/2022]
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Schnitker L, Martin-Khan M, Beattie E, Gray L. Negative health outcomes and adverse events in older people attending emergency departments: A systematic review. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.aenj.2011.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zaveri HG, Mansuri SM, Patel VJ. Use of potentially inappropriate medicines in elderly: A prospective study in medicine out-patient department of a tertiary care teaching hospital. Indian J Pharmacol 2011; 42:95-8. [PMID: 20711374 PMCID: PMC2907023 DOI: 10.4103/0253-7613.64499] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 10/12/2009] [Accepted: 04/30/2010] [Indexed: 11/19/2022] Open
Abstract
Objective: The present study was undertaken with the aim to detect extent of drug use in elderly at medicine outpatient department at tertiary care hospital and to evaluate inappropriate prescribing with the help of Beers' criteria 2002. Materials and Methods: The study was carried out at medicine out patient department of our hospital. 407 geriatric patients were included during the study period of three and half months. The data was collected in a proforma which included the patients' details and the prescriptions. Results: The results reveal that 7.42% of total drugs were prescribed in an inappropriate manner and 23.59% of total patients received at least one inappropriate drug prescription. Administration of a drug which is avoided in elderly forms a common category of inappropriate drug use. Antihistamines, anticholinergic, sedatives and hypnotics and cardiac glycosides are the most common drug groups prescribed in inappropriate manner. Conclusion: To conclude, this study shows high prevalence of inappropriate use of drugs in geriatric practice suggesting urgent need for sincere efforts to improve the situation.
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Affiliation(s)
- H G Zaveri
- Department of Pharmacology, NHL Municipal Medical College, Ahmedabad, India
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Maio V, Del Canale S, Abouzaid S. Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study. J Clin Pharm Ther 2010; 35:219-29. [PMID: 20456742 DOI: 10.1111/j.1365-2710.2009.01094.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria. METHODS A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals >or=65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. RESULTS AND DISCUSSION A total of 23 662 elderly in the cohort (25.8%) had at least one PIP. Of these, 14.1% received prescriptions for two medications of concern, and 2.0% for three or more. Using the expert panel's categories, 59.2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33.9% for rarely appropriate drugs, and 19.1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35.7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17.6%), doxazosin (15.5%), and amiodarone (13.6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. CONCLUSION Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy.
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Affiliation(s)
- V Maio
- Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Abstract
The definition of "polypharmacy" ranges from the use of a large number of medications; the use of potentially inappropriate medications, which can increase the risk for adverse drug events; medication underuse despite instructions to the contrary; and medication duplication. Older adults are particularly at risk because they often present with several medical conditions requiring pharmacotherapy. Cancer-related therapy adds to this risk in older adults, but few studies have been conducted in this patient population. In this review, we outline the adverse outcomes associated with polypharmacy and present polypharmacy definitions offered by the geriatrics literature. We also examine the strengths and weaknesses of these definitions and explore the relationships among these definitions and what is known about the prevalence and impact of polypharmacy.
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Affiliation(s)
- Ronald J Maggiore
- Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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