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Doffou E, Kamenan BA, Abrogoua DP. [Development of a tool to help optimizing drug prescriptions in pediatric units in Côte d'Ivoire: GOPP tool]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:340-362. [PMID: 34656545 DOI: 10.1016/j.pharma.2021.10.001] [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: 05/28/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to develop a tool for optimizing drug management related to clinical and therapeutic contexts of pediatric units in Côte d'Ivoire. METHODOLOGY A list of Inappropriate prescribings (IPs) was developed from prescription review of inpatients and outpatients aged 1 month to 15 years and followed in pediatric units at 4 Teaching Hospitals of Abidjan during 16 months. A two-round Delphi method was used to validate a qualitative list of IPs by experts according to their level of agreement on a six-point Likert scale of 0-5 (0, no opinion; 5, strongly agree). Only propositions obtaining the agreement (rating 4 or 5) of>70% of experts who gave a non-zero rating for the first round and 80% for the second round were retained. Each IP of final list associated with "rationale", (justifying the inappropriateness of prescribing), and "recommendations and/or therapeutic alternative", used to elaborate items of a tool for helping to optimize drug prescriptions in pediatrics (GOPP tool). RESULTS A qualitative list of 54 IPs was drawn up from 267 Drug related problems detected after prescription review of 4992 prescription lines for 881 patients. Twenty-three (23) experts rated IPs on this list during two-round Delphi survey. At the end of survey, final list of 52 IPs was retained for development GOPP tool items. Malaria (15%), rhinitis (12%) and bacterial infectious (8%) are mainly pathologies concerned by these items. CONCLUSION GOPP tool developed in this study should help to improve drug management of patients in pediatric units in Côte d'Ivoire.
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Affiliation(s)
- E Doffou
- Laboratoire de pharmacie clinique et thérapeutique, UFR sciences pharmaceutiques et biologiques, université Felix Houphouët-Boigny, Abidjan, Cote d'Ivoire; Service de pharmacie, centre hospitalier et universitaire de Cocody, Abidjan, Cote d'Ivoire.
| | - B A Kamenan
- Laboratoire de pharmacie clinique et thérapeutique, UFR sciences pharmaceutiques et biologiques, université Felix Houphouët-Boigny, Abidjan, Cote d'Ivoire; Service de pharmacie, centre hospitalier et universitaire de Cocody, Abidjan, Cote d'Ivoire
| | - D P Abrogoua
- Laboratoire de pharmacie clinique et thérapeutique, UFR sciences pharmaceutiques et biologiques, université Felix Houphouët-Boigny, Abidjan, Cote d'Ivoire; Service de pharmacologie clinique, centre hospitalier et universitaire de Cocody, Abidjan, Cote d'Ivoire
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Doffou E, Avi C, Yao KC, Abrogoua DP. Expert Consensus on a List of Inappropriate Prescribing after Prescription Review in Pediatric Units in Abidjan, Côte d'Ivoire. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:79-91. [PMID: 34476206 PMCID: PMC8407673 DOI: 10.2147/iprp.s322141] [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: 06/04/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Inappropriate prescribing (IP) includes inappropriate prescription and omission of prescription. IP can adversely affect the quality of health care in pediatric units. A list of IP taking into account frequently encountered drug-related problems (DRPs) can be useful to optimize prescriptions in pediatrics. The aim of this study was to validate by expert consensus a list of IP after a prescription review in pediatric units in Abidjan. Materials and Methods A list of IPs was developed from a prescription review of inpatients and outpatients aged 1 month to 15 years and followed in pediatric units at teaching hospitals of Abidjan during 16 months. A two-round Delphi method was used to validate a qualitative list of IPs by experts according to their level of agreement on a six-point Likert scale of 0–5 (0, no opinion; 5, strongly agree). Only propositions obtaining the agreement (rating 4 or 5) of >70% of experts who gave a non-zero rating for the first round and 80% for the second round were retained. Results A qualitative list of 54 IPs was drawn up from 267 DRPs detected after prescription review of 4,992 prescription lines for 881 patients. Our panel comprised 22 pediatricians (96%) and one clinical pharmacist (4%). Mean agreement ratings were 4.43/5 (95% CI 4.39–4.48) and 4.6/5 (95% CI 4.56–4.64), respectively, during the first Delphi round and the second (p<0.001). At the end of the first round, all items submitted (54) were retained, including 13 items that had been reworded. In the second round, 20 experts participated and two IPs (4%) were not retained for the final list. This list comprised 52 IPs (44 inappropriate prescriptions and eight omissions of prescription). Conclusion The list of IP validated in this study should help in the detection of DRPs and optimize prescriptions in pediatric units in Côte d’Ivoire.
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Affiliation(s)
- Elisée Doffou
- Therapeutic and Clinical Pharmacy Laboratory, Faculty of Pharmaceutical and Biological Sciences, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire.,Department of Pharmacy, Teaching Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Christelle Avi
- Department of Pediatrics, Teaching Hospital of Bouaké, Bouaké, Côte d'Ivoire
| | | | - Danho Pascal Abrogoua
- Therapeutic and Clinical Pharmacy Laboratory, Faculty of Pharmaceutical and Biological Sciences, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire.,Department of Clinical Pharmacology, Teaching Hospital of Cocody, Abidjan, Côte d'Ivoire
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3
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Farhat A, Panchaud A, Al-Hajje A, Lang PO, Csajka C. Ability to detect potentially inappropriate prescribing in older patients: comparative analysis between PIM-Check and STOPP/STARTv2. Eur J Clin Pharmacol 2021; 77:1747-1756. [PMID: 34191107 PMCID: PMC8528795 DOI: 10.1007/s00228-021-03171-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
Purpose Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. Methods First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. Results The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. Conclusions By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.
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Affiliation(s)
- Akram Farhat
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. .,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland. .,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | | | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
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Roux B, Berthou-Contreras J, Beuscart JB, Charenton-Blavignac M, Doucet J, Fournier JP, de la Gastine B, Gautier S, Gonthier R, Gras V, Grau M, Noize P, Polard E, Rudelle K, Valnet-Rabier MB, Tannou T, Laroche ML. REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors (REMEDI[e]S): French implicit and explicit criteria. Eur J Clin Pharmacol 2021; 77:1713-1724. [PMID: 34115158 DOI: 10.1007/s00228-021-03145-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To establish a consensus on both explicit and implicit criteria in order to identify potentially inappropriate prescribing (PIP) in French older people aged 75 years and over or 65 years and over with multimorbidity. METHODS Fifteen experts in geriatrics, general practice, pharmacy, and clinical pharmacology were involved in a two-round Delphi survey to assess preliminary explicit and implicit criteria based on an extensive literature review and up-to-date evidence data. Experts were asked to rate their level of agreement using a 5-level Likert scale for inclusion of criteria and also for rationale and therapeutic alternatives. A consensus was considered as reached if at least 75% of the experts rated criteria as "strongly agreed" or "agreed." RESULTS The new tool included a seven-step algorithm (implicit criteria) encompassing the three main domains that define PIP (i.e. overprescribing, underprescribing, and misprescribing) and 104 explicit criteria. Explicit criteria were divided into 6 tables related to inappropriate drug duplications (n = 7 criteria), omissions of medications and/or medication associations (n = 16), medications with an unfavourable benefit/risk ratio and/or a questionable efficacy (n = 39), medications with an unsuitable dose (n = 4) or duration (n = 6), drug-disease (n = 13), and drug-drug interactions (n = 19). CONCLUSION The REMEDI[e]S tool (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors) is an original mixed tool, adapted to French medical practices, aimed at preventing PIP both at the individual level in clinical practice and the population level in large-scale studies. Therefore, its use could contribute to an improvement in healthcare professionals' prescribing practices and safer care in older adults.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. .,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.
| | - Julie Berthou-Contreras
- Department of Pharmacy, Clinical Pharmacy Unit, University Hospital of Besançon, Besançon, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | | | - Jean Doucet
- Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, 76031, Rouen Cedex, France
| | - Jean-Pascal Fournier
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Blandine de la Gastine
- Geriatric Department, Institut du Vieillissement, Hospices Civils de Lyon, Hôpital Pierre Garraud, Lyon, France
| | - Sophie Gautier
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Lille, Lille, France
| | - Régis Gonthier
- Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de La Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France
| | - Valérie Gras
- Centre of Pharmacovigilance, Department of Clinical Pharmacology, University Hospital of Amiens, Amiens, France
| | - Muriel Grau
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Pernelle Noize
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
| | - Elisabeth Polard
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Rennes, Rennes, France
| | - Karen Rudelle
- University Department of General Medicine, Faculty of Medicine, Limoges, France
| | - Marie-Blanche Valnet-Rabier
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Besançon, Besançon, France
| | - Thomas Tannou
- Geriatric Departement, University Hospital of Besançon, Besançon, France
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.,Laboratoire Vie-Santé (Vieillissement Fragilité Prévention, E-Santé), IFR GEIST, Université de Limoges, Limoges, France
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5
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Lüscher SC, Hersberger KE, Brühwiler LD. A survey on what pharmacists and physicians caring for nursing home residents expect of user-friendly lists of potentially inappropriate prescribing (PIP lists). ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 155:29-33. [PMID: 32826187 DOI: 10.1016/j.zefq.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Potentially inappropriate prescribing (PIP, including potentially inappropriate medication, PIM) is frequent. In research and practice, the use of PIP lists could optimize a patient's medication. However, they are barely used, possibly because of their limited user-friendliness. This study aimed at evaluating the opinions of pharmacists and physicians caring for nursing home residents on user-friendliness as well as knowledge and current use of PIP lists. METHODS Semi-structured telephone interviews and paper-based surveys were conducted with physicians and pharmacists who care for nursing home residents. Descriptive analysis and Fisher's exact test were performed. RESULTS A total of 30 practitioners participated in the survey, eight of whom were interviewed by phone. 43 % (13/30) of the participants had already heard of PIP lists, and 46 % (6/13) of them made use of a PIP list. Less experienced professionals had more often heard of PIP lists than more experienced ones. The most important aspects of user-friendliness were: time required to use the list, electronic availability, clear structure and provision of reasons why a medication is potentially inappropriate. Physicians preferred a PIP list adapted to the Swiss drug market more often than pharmacists. DISCUSSION Knowledge and current use of PIP lists are limited, which is partially consistent with the results of other studies. Participants with less professional experience have heard of PIP lists more frequently, opinions on user-friendliness differ between professions, and preferences seem to be, overall, highly individual. CONCLUSION In order for PIP lists to be used more frequently, the aspects of user-friendliness should be taken into account. Personalizable PIP lists could be an interesting development.
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Affiliation(s)
- Simone C Lüscher
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland; Patient Safety Switzerland, Zurich, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
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Correard F, Montaleytang M, Costa M, Astolfi M, Baumstarck K, Loubière S, Amichi K, Auquier P, Verger P, Villani P, Honore S, Daumas A. Impact of medication review via tele-expertise on unplanned hospitalizations at 3 months of nursing homes patients (TEM-EHPAD): study protocol for a randomized controlled trial. BMC Geriatr 2020; 20:147. [PMID: 32312242 PMCID: PMC7169005 DOI: 10.1186/s12877-020-01546-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/02/2020] [Indexed: 01/03/2023] Open
Abstract
Background Inappropriate drug prescribing causes preventable drug-related adverse events that result in increased morbidity and mortality, additional costs and diminished quality of life. Numerous initiatives have been launched to improve the quality of drug prescribing and safeguard the security of drug administration processes in nursing homes. Against the backdrop of implementation of telemedicine services, the focus of the present work is to evaluate the impact of a telemedication review carried out by a hospital physician and pharmacist as part of the telemedicine offer. Methods The present study is a randomized controlled clinical trial. A total of 364 patients will be randomized into two groups: (1) an experimental group (182 patients) benefiting from a telemedication review using tele-expertise and (2) a control group (182 patients) receiving standard care. The primary endpoint will be rate of all-cause unplanned hospital admissions occurring within 3 months of randomization. The secondary endpoints will be rate of unplanned admissions at 6 months, patient quality of life, incidence of behavioral disturbances, number of falls, number of residents prescribed at least one inappropriate medication, nursing staff satisfaction, proposed medication reviews and their acceptability rate, characteristics of patients whose general practitioners have taken account of tele-expertise, efficacy of tele-expertise as compared to standard prescription and acceptability and satisfaction surveys of participating caregivers. Discussion In the literature, various studies have investigated the utility of structured medication review processes, but outcome measures are heterogeneous, and results vary widely. Medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Incremental cost-effectiveness ratios will be used to compare the cost and effectiveness of the experimental strategy and that of standard care. Our approach, involving the combination of an acceptability survey and a mixed-method (qualitative and quantitative) satisfaction survey, is particularly innovative. The results of this randomized trial are expected to confirm that medication review using tele-expertise has potential as a worthwhile care management strategy for nursing home residents. Trial registration Clinicaltrials.gov NCT03640845; registered August 21, 2018 (Clinicaltrials.gov NCT03640845).
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Affiliation(s)
- F Correard
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France. .,Aix-Marseille Univ, Marseille, France.
| | - M Montaleytang
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille Univ, Marseille, France
| | - M Costa
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - M Astolfi
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - K Baumstarck
- Aix-Marseille Univ, Marseille, France.,EA3279, Self-perceived Health Assessment Research Unit, Marseille, France
| | - S Loubière
- Aix-Marseille Univ, Marseille, France.,EA3279, Self-perceived Health Assessment Research Unit, Marseille, France
| | - K Amichi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, Marseille, France
| | - P Auquier
- Aix-Marseille Univ, Marseille, France.,EA3279, Self-perceived Health Assessment Research Unit, Marseille, France.,Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, Marseille, France
| | - P Verger
- Aix-Marseille Univ, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - P Villani
- Aix-Marseille Univ, Marseille, France.,Internal Medicine, Geriatrics and Therapeutics department, AP-HM, Marseille, France
| | - S Honore
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille Univ, Marseille, France
| | - A Daumas
- Aix-Marseille Univ, Marseille, France.,Internal Medicine, Geriatrics and Therapeutics department, AP-HM, Marseille, France
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Montaleytang M, Correard F, Delalande G, Bourriquen M, Daumas A. [Telemedicine and drug iatrogenesis in nursing homes]. SOINS. GERONTOLOGIE 2019; 24:30-36. [PMID: 31540719 DOI: 10.1016/j.sger.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inappropriate drug prescribing is an avoidable cause of adverse drug events, sources of an increase in morbimortality, excess spending and a decrease in quality of life. Many actions exist to improve prescribing quality and to secure the medication circuit in nursing homes. As part of the deployment of telemedicine, the benefit of a medico-pharmaceutical tele-expertise system for medication is evident.
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Affiliation(s)
- Maeva Montaleytang
- AP-HM, service pharmacie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France; Laboratoire de pharmacie clinique, faculté de pharmacie, Aix-Marseille Université, 27, boulevard Jean-Moulin, CS 30064, 13385 Marseille Cedex 5, France
| | - Florian Correard
- AP-HM, service pharmacie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France; Laboratoire de pharmacie clinique, faculté de pharmacie, Aix-Marseille Université, 27, boulevard Jean-Moulin, CS 30064, 13385 Marseille Cedex 5, France
| | | | | | - Aurélie Daumas
- AP-HM, service de médecine interne, gériatrie et thérapeutique, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
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[Assessment of medication prescribing in a geriatric follow-up care and rehabilitation]. SOINS. GÉRONTOLOGIE 2019; 24:39-43. [PMID: 31307689 DOI: 10.1016/j.sger.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to analyse the prescriptions and identify the factors associated with inappropriate prescribing (IP) and polypharmacy. Polypharmacy and IP concerned 80% of the 54 patients included in the study upon admission, and 78% upon discharge without a statistically significant reduction. A critical analysis of prescriptions would help to reduce inappropriate prescribing and polypharmacy in elderly patients.
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Abstract
Introduction: Combined antiretroviral therapy has transformed HIV infection into a chronic disease thus people living with HIV (PLWH) live longer. As a result, the management of HIV infection is becoming more challenging as elderly experience age-related comorbidities leading to complex polypharmacy and a higher risk for drug-drug or drug-disease interactions. Furthermore, age-related physiological changes affect pharmacokinetics and pharmacodynamics thereby predisposing elderly PLWH to incorrect dosing or inappropriate prescribing and consequently to adverse drug reactions and the subsequent risk of starting a prescribing cascade. Areas covered: This review discusses the demographics of the aging HIV population, physiological changes and their impact on drug response as well as comorbidities. Particular emphasis is placed on common prescribing issues in elderly PLWH including drug-drug interactions with antiretroviral drugs. A PubMed search was used to compile relevant publications until February 2019. Expert opinion: Prescribing issues are highly prevalent in elderly PLWH thus highlighting the need for education on geriatric prescribing principles. Adverse health outcomes potentially associated with polypharmacy and inappropriate prescribing should promote interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits for a given patient. A multidisciplinary team approach is recommended for the care of elderly PLWH.
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Affiliation(s)
- Catia Marzolini
- a Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital of Basel and University of Basel , Basel , Switzerland.,b Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool , UK
| | - Françoise Livio
- c Service of Clinical Pharmacology, Department of Laboratories , University Hospital of Lausanne , Lausanne , Switzerland
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Tannou T, Koeberle S, Manckoundia P, Aubry R. Multifactorial immunodeficiency in frail elderly patients: Contributing factors and management. Med Mal Infect 2019; 49:167-172. [DOI: 10.1016/j.medmal.2019.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 01/25/2019] [Indexed: 12/31/2022]
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Using a structured reconciliation medication form improves medication transition from hospital to community care and primary care physicians' adherence with medication adaptations and recommendations. Eur Geriatr Med 2019; 10:141-146. [PMID: 32720271 DOI: 10.1007/s41999-018-0125-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hospital admission and discharge are weakness points in the transition of care. OBJECTIVE To lower the risk of errors and improve medication information transfer to primary care physician (PCP), we conducted an experimental study using a structured medication reconciliation form (SMRF) in an Acute Care for Elders unit. RESULTS 1242 drugs of 173 patients were reconciliated at admission, optimized during the stay, and transmitted via the SMRF to the 143 corresponding PCPs. While the optimization led to 779 adaptations from admission to discharge, of which 39.0% were omissions, exposure to polypharmacy was reduced from 83.2 to 74.6% (P < 0.05). One-month post-discharge, with an answer rate of 62.2% among PCPs, the adherence to recommendations was high (85.0%) and the exposure to polypharmacy was further decreased (67.7%; P < 0.05). CONCLUSION These results provide elements to consider SMRF as an example of good practice for which the impact should be analyzed at larger scale.
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Lang PO, Bourgue C, Csajka C. Détection des prescriptions inappropriées, les critères STOPP/START. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blanc AL, Spasojevic S, Leszek A, Théodoloz M, Bonnabry P, Fumeaux T, Schaad N. A comparison of two tools to screen potentially inappropriate medication in internal medicine patients. J Clin Pharm Ther 2017; 43:232-239. [PMID: 28990244 DOI: 10.1111/jcpt.12638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN Potentially inappropriate medication (PIM) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. OBJECTIVE To compare two PIM-screening tools-STOPP/START and PIM-Check-applied to internal medicine patients. A second objective was to compare the use of PIMs in readmitted and non-readmitted patients. METHOD A retrospective observational study, in the general internal medicine ward of a Swiss non-university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex- and age-matched patients who were not readmitted. PIMs were screened using the STOPP/START tool, developed for geriatric patients, and the PIM-Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIMs involving readmitted and non-readmitted patients were compared. RESULTS Across the whole population, PIM-Check and STOPP/START detected 1348 and 537 PIMs, respectively, representing 13.5 and 5.4 PIMs/patient. Screening time was substantially shorter with PIM-Check than with STOPP/START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIMs detected using PIM-Check and STOPP/START, respectively, were clinically relevant to individual patients' cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non-readmitted patients. WHAT IS NEW AND CONCLUSION Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly half of the PIMs detected were judged to be non-clinically relevant, however, potentially overalerting the prescriber. These tools can, nevertheless, be considered useful in daily practice. Furthermore, the relevance of any PIM detected by these tools should always be carefully evaluated within the clinical context surrounding the individual patient.
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Affiliation(s)
- A-L Blanc
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,Pharmacie Interhospitalière de la Côte, Morges, Switzerland.,School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - S Spasojevic
- School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - A Leszek
- Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland
| | - M Théodoloz
- Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - P Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - T Fumeaux
- Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - N Schaad
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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14
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Desnoyer A, Blanc AL, Pourcher V, Besson M, Fonzo-Christe C, Desmeules J, Perrier A, Bonnabry P, Samer C, Guignard B. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. BMJ Open 2017; 7:e016070. [PMID: 28760793 PMCID: PMC5642656 DOI: 10.1136/bmjopen-2017-016070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection. DESIGN Five-step study involving selection of medical domains, literature review and 17 semistructured interviews, a two-round Delphi survey, a forward/back-translation process and an electronic tool development. SETTING 22 University and general hospitals from Canada, Belgium, France and Switzerland. PARTICIPANTS 40 physicians and 25 clinical pharmacists were involved in the study.Agreement with the checklist statements and their usefulness for healthcare professional training were evaluated using two 6-point Likert scales (ranging from 0 to 5). PRIMARY AND SECONDARY OUTCOME MEASURES Agreement and usefulness ratings were defined as: >65% of the experts giving the statement a rating of 4 or 5, during the first Delphi-round and >75% during the second. RESULTS 166 statements were generated during the first two steps. Mean agreement and usefulness ratings were 4.32/5 (95% CI 4.28 to 4.36) and 4.11/5 (4.07 to 4.15), respectively, during the first Delphi-round and 4.53/5 (4.51 to 4.56) and 4.36/5 (4.33 to 4.39) during the second (p<0.001). The final checklist includes 160 statements in 17 medical domains and 56 pathologies. An algorithm of approximately 31 000 lines was developed including comorbidities and medications variables to create the electronic tool. CONCLUSION PIM-Check is the first electronic prescription-screening checklist designed to detect PIM in internal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety.
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Affiliation(s)
- Aude Desnoyer
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anne-Laure Blanc
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Hôpitaux de l’Est Lémanique, Vevey, Switzerland
| | - Valérie Pourcher
- Department of Infectious and Tropical Diseases, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- UMR996—Inflammation, Chemokines and Immunopathology, Inserm, Clamart, France
| | - Marie Besson
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Jules Desmeules
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Arnaud Perrier
- Department of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pascal Bonnabry
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Caroline Samer
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Bertrand Guignard
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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15
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The exercise in applying STOPP/START.v2 in vulnerable very old patients: Towards patient tailored prescribing. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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