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Waldron C, Hughes J, Wallace E, Cahir C, Bennett K. Contexts and mechanisms relevant to General Practitioner (GP) based interventions to reduce adverse drug events (ADE) in community dwelling older adults: a rapid realist review. HRB Open Res 2023; 5:53. [PMID: 38283368 PMCID: PMC10811420 DOI: 10.12688/hrbopenres.13580.2] [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] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
Background Older adults in Ireland are at increased risk of adverse drug events (ADE) due, in part, to increasing rates of polypharmacy. Interventions to reduce ADE in community dwelling older adults (CDOA) have had limited success, therefore, new approaches are required.A realist review uses a different lens to examine why and how interventions were supposed to work rather than if, they worked. A rapid realist review (RRR) is a more focused and accelerated version.The aim of this RRR is to identify and examine the contexts and mechanisms that play a role in the outcomes relevant to reducing ADE in CDOA in the GP setting that could inform the development of interventions in Ireland. Methods Six candidate theories (CT) were developed, based on knowledge of the field and recent literature, in relation to how interventions are expected to work. These formed the search strategy. Eighty full texts from 633 abstracts were reviewed, of which 27 were included. Snowballing added a further five articles, relevant policy documents increased the total number to 45. Data were extracted relevant to the theories under iteratively developed sub-themes using NVivo software. Results Of the six theories, three theories, relating to GP engagement in interventions, relevance of health policy documents for older adults, and shared decision-making, provided data to guide future interventions to reduce ADEs for CDOA in an Irish setting. There was insufficient data for two theories, a third was rejected as existing barriers in the Irish setting made it impractical to use. Conclusions To improve the success of Irish GP based interventions to reduce ADEs for CDOA, interventions must be relevant and easily applied in practice, supported by national policy and be adequately resourced. Future research is required to test our theories within a newly developed intervention.
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Affiliation(s)
- Catherine Waldron
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - John Hughes
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - Emma Wallace
- Department of General Practice, University College Cork, Cork, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - K. Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
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Waldron C, Hughes J, Wallace E, Cahir C, Bennett K. Contexts and mechanisms relevant to General Practitioner (GP) based interventions to reduce adverse drug events (ADE) in community dwelling older adults: a rapid realist review. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13580.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Older adults in Ireland are at increased risk of adverse drug events (ADE) due, in part, to increasing rates of polypharmacy. Interventions to reduce ADE in community dwelling older adults (CDOA) have had limited success, therefore, new approaches are required. A realist review uses a different lens to examine why and how interventions were supposed to work rather than if, they worked. A rapid realist review (RRR) is a more focused and accelerated version. The aim of this RRR is to identify and examine the contexts and mechanisms that play a role in the outcomes relevant to reducing ADE in CDOA in the GP setting that could inform the development of interventions in Ireland. Methods: Six candidate theories (CT) were developed, based on knowledge of the field and recent literature, in relation to how interventions are expected to work. These formed the search strategy. Eighty full texts from 633 abstracts were reviewed, of which 27 were included. Snowballing added a further five articles, relevant policy documents increased the total number to 45. Data were extracted relevant to the theories under iteratively developed sub-themes using NVivo software. Results: Of the six theories, three theories, relating to GP engagement in interventions, relevance of health policy documents for older adults, and shared decision-making, provided data to guide future interventions to reduce ADEs for CDOA in an Irish setting. There was insufficient data for two theories, a third was rejected as existing barriers in the Irish setting made it impractical to use. Conclusions: To improve the success of Irish GP based interventions to reduce ADEs for CDOA, interventions must be relevant and easily applied in practice, supported by national policy and be adequately resourced. Future research is required to test our theories within a newly developed intervention.
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Moreira T, Alvares-Teodoro J, Barbosa MM, Do Nascimento RCRM, Guerra Júnior AA, Acurcio FA. Polypharmacy among adult and older adult users of primary care services delivered through the Unified Health System in Minas Gerais, Brazil. Expert Rev Clin Pharmacol 2020; 13:1401-1409. [PMID: 33054470 DOI: 10.1080/17512433.2020.1836958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate the prevalence of polypharmacy (≥5 drugs) among adults and to analyze related factors. METHODS Cross-sectional study with 1,159 interviewees distributed across 104 cities and 253 primary healthcare services delivered through the Brazilian Unified Health System. Polypharmacy-related factors were identified using logistic regression model. RESULTS 949 (81.8%) interviewees were using at least one medication and were included in this analysis. The prevalence of polypharmacy among them was 13.7% (95%CI:11.7-16.0%) in the general population and 33.3%(95%CI:26.1-41.4%) in older adults(≥65 years). Polypharmacy was positively associated with age (45 to 64 years, OR=2.02; 95%CI:1.03-3.94; ≥65 years, OR=4.17; 95%CI:1.92-9.17) and the following chronic diseases: stroke (OR=4.20; 95%CI:1.53-11.55); diabetes mellitus (OR=4.03; 95%CI:2.43-6.68); heart disease (OR=3.18; 95%CI:1.92-5.29); depression (OR=2.85; 95%CI:1.80-4.53); hypertension (OR=2.13; 95%CI:1.17-3.86); and dyslipidemia (OR=1.73; 95%CI:1.07-2.80). CONCLUSION This study revealed that polypharmacy is a real concern in primary health care and affects older and middle-aged adults alike. Groups of patients that are more likely to experience polypharmacy were identified. Our findings emphasize the relevance of an appropriate approach to polypharmacy driven by aging and multimorbidity.
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Affiliation(s)
- Thais Moreira
- Postgraduate Program in Public Health, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - J Alvares-Teodoro
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - M M Barbosa
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | | | - A A Guerra Júnior
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - F A Acurcio
- Postgraduate Program in Public Health, Federal University of Minas Gerais , Belo Horizonte, Brazil.,Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
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Assari S, Wisseh C, Saqib M, Helmi H, Bazargan M. Polypharmacy and Depressive Symptoms in U.S.-Born Mexican American Older Adults. PSYCH 2019; 1:491-503. [PMID: 33205042 PMCID: PMC7668560 DOI: 10.3390/psych1010038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although some studies have suggested a link between polypharmacy and poor mental health, less is known about the association between polypharmacy and depressive symptomology among U.S.-born older Mexican Americans. AIM This study aimed to test the association between polypharmacy and depressive symptoms in U.S.-born older Latino Americans. MATERIALS AND METHODS Data came from the Sacramento Area Latino Study on Aging (SALSA 2008). A total of 691 U.S.-born older (age >= 65) Mexican Americans entered this analysis. Polypharmacy was the independent variable. Level of depressive symptoms was the outcome. Age, gender, socioeconomic status (education, income, and employment), retirement status, health (chronic medical conditions, self-rated health, and activities of daily living), language, acculturation, and smoking were the covariates. A linear regression model was used to analyze the data. RESULTS We found a positive association between polypharmacy and depressive symptoms, which was above and beyond demographic factors, socioeconomic status, physical health, health behaviors, language, acculturation, and health insurance. CONCLUSION Polypharmacy is linked to depressive symptoms in U.S.-born older Mexican Americans. More research is needed to test the effects of reducing inappropriate polypharmacy on mental well-being of first and second generation older Mexican Americans. There is also a need to study the role of drug-drug interaction in explaining the observed link between polypharmacy and depressive symptoms.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 91606, USA
| | - Mohammed Saqib
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hamid Helmi
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Assari S, Saqib M, Wisseh C, Bazargan M. Social Determinants of Polypharmacy in First Generation Mexican Immigrants in the United States. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2019; 7:86-90. [PMID: 31840027 PMCID: PMC6910246 DOI: 10.15171/ijtmgh.2019.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults. METHODS Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data. RESULTS Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs). CONCLUSION Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Mohammed Saqib
- Health Behavior and Health Education (HBHE), University of Michigan, Ann Arbor, MI, USA
| | - Cheryl Wisseh
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
- Department of Family Medicine, UCLA, Los Angeles, USA
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Atinga RA, Yarney L, Gavu NM. Factors influencing long-term medication non-adherence among diabetes and hypertensive patients in Ghana: A qualitative investigation. PLoS One 2018; 13:e0193995. [PMID: 29590156 PMCID: PMC5874015 DOI: 10.1371/journal.pone.0193995] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background Evidence remains limited on why diabetes and hypertensive patients admitted to long-term drug therapy miss doses or discontinue medication taking. We examined this phenomenon from the perspective of diabetes and hypertension patients at a Ghanaian teaching hospital. Methods Between July and December 2015, we conducted a qualitative study targeting caregivers and their patients with chronic diabetes and hypertensive on re-admission at the Korle Bu Teaching Hospital due to non-adherence to prescribed medication. Participants were sampled purposefully and taking through in-depth interviews using an interview guide. Notes and audio recordings of interviews were transcribed, managed and coded for themes guided by the thematic network analysis recommended by Attride-Stirling. Results Non-adherence was the result of perceptions that the medications are not effective for managing the conditions. Patients with these perceptions rejected the medications and turned to herbal medicines and spiritual healing as therapeutic alternatives, because of their easy accessibility, perceived efficacy and affordability. Other factors identified to influence non-adherence included polypharmacy practice; tight work schedules; social norms; poor prescription instruction by health providers; and knowledge and experience of medication. Conclusion Findings suggests the need for health providers to adopt therapeutic approaches that take into account patients’ beliefs, values and norms in administering medications. Sensitisation of patients and caregivers during admission on the implication of non-adherence, as well as interventions that monitor and provide feedback mechanisms on patients’ medication taking behaviour holds promise for maximising diabetes and hypertensive medication adherence.
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Affiliation(s)
- Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
- * E-mail:
| | - Lily Yarney
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Abrahamson K, Nazir A, Pressler K. A novel approach to deprescribing in long-term care settings: The SMART campaign. Res Social Adm Pharm 2017; 13:1202-1203. [DOI: 10.1016/j.sapharm.2016.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 11/16/2022]
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Abstract
Polypharmacy in older adults is a global problem that has recently worsened. Approximately 30% of adults aged 65 years and older in developed countries take 5 or more medications. Although prescribed and over-the-counter medications may improve a wide range of health problems, they also may cause or contribute to harm, especially in older adults. Polypharmacy in older adults is associated with worsening of geriatric syndromes and adverse drug events. Given the risks and burdens of polypharmacy and potentially inappropriate medications, nurses must use patient-centered approaches and nonpharmacologic strategies to treat common symptoms and to optimize patient function and quality of life.
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Affiliation(s)
- Jennifer Kim
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Abby Luck Parish
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
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Morrison D, Agur K, Mercer S, Eiras A, González-Montalvo JI, Gruffydd-Jones K. Managing multimorbidity in primary care in patients with chronic respiratory conditions. NPJ Prim Care Respir Med 2016; 26:16043. [PMID: 27629064 PMCID: PMC5024357 DOI: 10.1038/npjpcrm.2016.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 01/15/2023] Open
Abstract
The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams.
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Affiliation(s)
- Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karolina Agur
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stewart Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andreia Eiras
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Rainha D. Amélia Family Health Unit, Porto, Portugal
| | - Juan I González-Montalvo
- Geriatrics Department, IdiPaz Research Institute Hospital Universitario La Paz, Universidad Autónoma de Madrid, School of Medicine, Madrid, Spain
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Exemplars in advanced practice gerontological nursing: A GAPNA series – GAPNA Consensus Statement proficiencies 3 and 4. Geriatr Nurs 2016. [DOI: 10.1016/j.gerinurse.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Thompson K, Shi S, Kiraly C. Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes. Obstet Gynecol Clin North Am 2016; 43:367-79. [PMID: 27212097 DOI: 10.1016/j.ogc.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Older adults are the fastest growing segment of the US population and the majority of older adults are women. Primary care for the older adult patient requires a wide variety of skills, reflecting the complexity and heterogeneity of this patient population. Individualizing care through consideration of patients' goals, medical conditions, and prognosis is paramount. Quality care for the older adult patient requires familiarity with common geriatric syndromes, such as dementia, falls, and polypharmacy. In addition, developing the knowledge and communication skills necessary for complex care and end-of-life care planning is essential.
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Affiliation(s)
- Katherine Thompson
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA.
| | - Sandra Shi
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 7082, Chicago, IL 60637, USA
| | - Carmela Kiraly
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 7082, Chicago, IL 60637, USA
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