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Anderssen-Nordahl E, Sánchez-Arcilla Rosanas M, Bosch Ferrer M, Sabaté Gallego M, Fernández-Liz E, San-José A, Barceló-Colomer ME. Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach. Front Pharmacol 2024; 15:1320490. [PMID: 38529187 PMCID: PMC10961593 DOI: 10.3389/fphar.2024.1320490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 03/27/2024] Open
Abstract
Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs. Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug-drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs. Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%. Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.
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Affiliation(s)
- Emilie Anderssen-Nordahl
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margarita Sánchez-Arcilla Rosanas
- Geriatric Unit, Internal Medicine Service, Vall d'Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bosch Ferrer
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mònica Sabaté Gallego
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eladio Fernández-Liz
- Primary Healthcare Barcelona, Management of Primary Care and the Community of Barcelona City, Catalan Institute of Health, Barcelona, Spain
- Foundation University Institute for Research in Primary Healthcare Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Antonio San-José
- Geriatric Unit, Internal Medicine Service, Vall d'Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Estrella Barceló-Colomer
- Primary Healthcare Barcelona, Management of Primary Care and the Community of Barcelona City, Catalan Institute of Health, Barcelona, Spain
- Foundation University Institute for Research in Primary Healthcare Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Zito S, Poluzzi E, Pierantozzi A, Onder G, Da Cas R, Ippoliti I, Lunghi C, Cangini A, Trotta F. Medication use in Italian nursing homes: preliminary results from the national monitoring system. Front Pharmacol 2023; 14:1128605. [PMID: 37266155 PMCID: PMC10229842 DOI: 10.3389/fphar.2023.1128605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/21/2023] [Indexed: 06/03/2023] Open
Abstract
Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies. Objectives: This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs). Methods: Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used. Results: In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses-DDDs/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs/100 days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs/100 days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs/100 days of NH stay. Conclusion: The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness.
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Affiliation(s)
- S. Zito
- Italian Medicine Agency (AIFA), Rome, Italy
| | - E. Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - G. Onder
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacral Heart, Rome, Italy
| | - R. Da Cas
- National Centre for Drug Research and Evaluation, Pharmacoepidemiology Unit, Italian National Institute of Health, Rome, Italy
| | - I. Ippoliti
- National Centre for Drug Research and Evaluation, Pharmacoepidemiology Unit, Italian National Institute of Health, Rome, Italy
| | - C. Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A. Cangini
- Italian Medicine Agency (AIFA), Rome, Italy
| | - F. Trotta
- Italian Medicine Agency (AIFA), Rome, Italy
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3
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Borza T, Selbæk G, Lichtwarck B, Benth JŠ, Bergh S. The Course of Depressive Symptoms Over 36 Months in 696 Newly Admitted Nursing Home Residents. J Am Med Dir Assoc 2022; 23:1838-1844.e2. [PMID: 36116536 DOI: 10.1016/j.jamda.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the course of depressive symptoms in newly admitted nursing home (NH) residents and how resident characteristics were associated with the symptoms. To identify groups of residents following the same symptom trajectory. DESIGN An observational, multicenter, longitudinal study over 36 months with 7 biannual assessments. SETTING AND PARTICIPANTS Representing 47 Norwegian NHs, 696 residents were included at admission to a NH. METHODS Depressive symptoms were assessed with the Cornell Scale for Depression in Dementia (CSDD). We selected severity of dementia, functional impairment, physical health, pain, use of antidepressants, age, and sex as covariates. Time trend in CSDD score was assessed by a linear mixed model adjusting for covariates. Next, a growth mixture model was estimated to investigate whether there were groups of residents following distinct trajectories in CSDD scores. We estimated a nominal regression model to assess whether the covariates at admission were associated to group membership. RESULTS There was a nonlinear trend in CSDD score. More severe dementia, a lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher CSDD scores. Growth mixture model identified 4 groups: (1) persistent mild symptoms (32.6%), (2) persistent moderate symptoms (50.8%), (3) increasing symptoms (5.1%), and (4) severe but decreasing symptoms (11.6%). A lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher odds for belonging to the severe but decreasing symptoms group compared with the persistent mild symptoms group. CONCLUSIONS AND IMPLICATIONS Most NH residents were in trajectory groups with persistent mild or moderate depressive symptoms. Residents with more severe dementia, lower levels of functioning, poor physical health, severe pain, younger age at admittance, and who are using antidepressants should be monitored closely and systematically with respect to depression. Taking actions toward a more personalized treatment for depression in NHs is a priority and should be investigated in future studies.
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Affiliation(s)
- Tom Borza
- Research Center for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.
| | - Geir Selbæk
- Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Bjørn Lichtwarck
- Research Center for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- Research Center for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Research Center for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Gedde MH, Husebo BS, Mannseth J, Naik M, Selbaek G, Vislapuu M, Berge LI. The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial. BMC Med 2022; 20:186. [PMID: 35614509 PMCID: PMC9132600 DOI: 10.1186/s12916-022-02382-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers. METHODS LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD's regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change. RESULTS Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not. CONCLUSIONS Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population. TRIAL REGISTRATION ClinicalTrials.gov : NCT04043364 ; registered 15/03/2019.
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Affiliation(s)
- Marie H Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. .,Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Janne Mannseth
- Section for Epidemiology and Medical Statistic, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Selbaek
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line Iden Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
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Callegari E, Šaltytė Benth J, Selbæk G, Grønnerød C, Bergh S. Do prescription rates of psychotropic drugs change over three years from nursing home admission? BMC Geriatr 2021; 21:496. [PMID: 34530728 PMCID: PMC8447606 DOI: 10.1186/s12877-021-02437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. METHODS We used data from the Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. RESULTS PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001). CONCLUSIONS PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01920100 .
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Affiliation(s)
- Enrico Callegari
- grid.412938.50000 0004 0627 3923Østfold Hospital Trust, Sykehuset Østfold HF, postboks 300, 1714 Grålum, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway ,grid.412929.50000 0004 0627 386XResearch Centre for Age-related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway ,grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway ,grid.55325.340000 0004 0389 8485Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Cato Grønnerød
- grid.412938.50000 0004 0627 3923Østfold Hospital Trust, Sykehuset Østfold HF, postboks 300, 1714 Grålum, Norway ,grid.5510.10000 0004 1936 8921Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- grid.412929.50000 0004 0627 386XResearch Centre for Age-related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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6
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Sandvik MK, Watne LO, Brugård A, Wang-Hansen MS, Kersten H. Association between psychotropic drug use and handgrip strength in older hospitalized patients. Eur Geriatr Med 2021; 12:1213-1220. [PMID: 34033072 PMCID: PMC8626357 DOI: 10.1007/s41999-021-00511-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Handgrip strength is an indicator of frailty and longevity in older adults. The association between psychotropic drug use and handgrip strength in older hospitalized patients was investigated in this study. METHODS A total of 488 patients were included in this retrospective cross-sectional study, 333 women and 155 men, from two different cohorts of older (mean age 84 years) hospitalized in-patients. We used multiple linear regression models to explore the association between psychotropic drug use and handgrip strength. We adjusted for factors known to affect handgrip strength: Age, gender, body mass index (BMI) and comorbidity (Charlson comorbidity index). RESULTS Both unadjusted and adjusted analyses showed that psychotropic drug use was associated with handgrip strength (β = - 0.183, p < 0.0001). The relationship was of a linear character, with no clear threshold value, but with the greatest reduction in handgrip strength between zero and two psychotropic drugs. CONCLUSION An increasing number of psychotropic drugs were significantly associated with reduced handgrip strength in a linearly pattern. Hence, it is timely to question the guided threshold value of avoidance of three or more psychotropic drugs in older people. Psychotropic drug use should be kept as low as possible in treatment of older patients.
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Affiliation(s)
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anniken Brugård
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Marte Sofie Wang-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
| | - Hege Kersten
- Department of Research, Telemark Hospital Trust, Skien, Norway.,Department of Pharmaceutical Bioscience, School of Pharmacy, University of Oslo, Oslo, Norway
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Sloane PD, Brandt NJ, Cherubini A, Dharmarajan TS, Dosa D, Hanlon JT, Katz P, Koopmans RTCM, Laird RD, Petrovic M, Semla TP, Tan ECK, Zimmerman S. Medications in Post-Acute and Long-Term Care: Challenges and Controversies. J Am Med Dir Assoc 2020; 22:1-5. [PMID: 33253638 DOI: 10.1016/j.jamda.2020.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Nicole J Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento. IRCCS INRCA, Ancona, Italy
| | - T S Dharmarajan
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, Bronx, NY, USA
| | | | - Joseph T Hanlon
- Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Raymond T C M Koopmans
- Radboud University Medical Center and Joachim en Anna Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Rosemary D Laird
- AdventHealth Maturing Minds Memory Disorder Clinic, Winter Park, FL, USA
| | - Mirko Petrovic
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Todd P Semla
- Departments of Medicine, and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edwin C K Tan
- University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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