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Page AT, Potter K, Lee G, Almutairi H, Lee K, Wang K, Ailabouni N, Etherton-Beer C. Medicines Regimens Charted for Older People Living in Residential Aged Care: A Repeated Cross-Sectional Study Describing the Number of Medicines, Regimen Complexity, High-Risk Prescribing, and Potential Underprescribing. J Am Med Dir Assoc 2024; 25:104944. [PMID: 38428832 DOI: 10.1016/j.jamda.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE We aimed to explore medicines regimens charted for older people living in residential aged care facilities (RACFs). DESIGN Repeated cross-sectional study using routinely collected data sampled in a cross-sectional manner at 11 time points (day of admission, then at 1, 3, 7, 14, and 30 days, and 3, 6, 12, 18, and 24 months post admission). SETTING AND PARTICIPANTS The cohort is set in 34 RACFs managed by a single Australasian provider. People aged ≥65 years admitted to permanent care between January 1, 2017, and October 1, 2021, with medicines charted on the date of admission. METHODS Medicines charted were evaluated for potentially suboptimal prescribing including number of medicines, high-risk prescribing (eg, potentially inappropriate medicines, anticholinergic burden), and potential underprescribing. RESULTS The 3802 residents in the final cohort had a mean age of 84.9 ± 7.2 years at admission. At least 1 example of suboptimal prescribing was identified in 3479 (92%) residents at admission increasing to 1410 (97%) at 24 months. The number of medicines charted for each resident increased over time from 6.0 ± 3.8 regular and 2.8 ± 2.7 as required medicines at admission to 8.9 ± 4.1 regular and 8.1 ± 3.7 as required medicines at 24 months. Anticholinergic drug burden increased from 1.6 ± 2.4 at admission to 3.0 ± 2.8 at 24 months. Half the residents (2173; 57%) used at least 1 potentially inappropriate medicine at admission, which rose to nearly three-quarters (1060; 73%) at 24 months admission. CONCLUSION AND IMPLICATIONS The total number of medicines charted for older adults living in RACFs increases with length of stay, with charted as required medicines nearly tripling. Effective interventions to optimize medicines use in this vulnerable population are required.
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Affiliation(s)
- Amy Theresa Page
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.
| | | | - Georgie Lee
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Hend Almutairi
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kate Wang
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia; School of Health and Biomedical Sciences, RMIT, Melbourne, Australia
| | - Nagham Ailabouni
- PACE, School of Pharmacy, Health and Behavioural Sciences Faculty, University of Queensland
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Das A. The art of undiagnosis: navigating the complexity of diagnostic revision in functional neurological disorder (FND). Neurol Sci 2024; 45:2935-2937. [PMID: 38311652 DOI: 10.1007/s10072-024-07373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/27/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Abhijit Das
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
- University of Central Lancashire, Preston, UK.
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Okafor CE, Keramat SA, Comans T, Page AT, Potter K, Hilmer SN, Lindley RI, Mangin D, Naganathan V, Etherton-Beer C. Cost-Consequence Analysis of Deprescribing to Optimize Health Outcomes for Frail Older People: A Within-Trial Analysis. J Am Med Dir Assoc 2024; 25:539-544.e2. [PMID: 38307120 DOI: 10.1016/j.jamda.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES The structured, clinically supervised withdrawal of medicines, known as deprescribing, is one strategy to address inappropriate polypharmacy. This study aimed to evaluate the costs and consequences of deprescribing in frail older people living in residential aged care facilities (RACFs) in Australia. DESIGN A within-trial cost-consequence analysis of a deprescribing intervention-Opti-Med. The Opti-Med double-blind randomized controlled trial of deprescribing included 3 groups: blinded control, blinded intervention, and an open intervention group. SETTING AND PARTICIPANTS Seventeen RACFs in Western Australia and New South Wales. Participants were 303 older people living in participating RACFs from March 2014 to February 2019. METHODS Analysis was conducted from the health sector perspective. Health economic outcomes assessed include cost saved from deprescribed medicines and the incremental quality-adjusted life-years. Costs were presented in 2022 Australian dollars. RESULTS The total cost of the Opti-Med intervention was $239.13 per participant. The costs saved through deprescribed medicines over 12 months after adjusting for mortality within the trial period was $328.90 per participant in the blinded intervention group and $164.00 per participant in the open intervention group. On average, the cost of the intervention was more than offset by the cost saved from deprescribed medicines. Extrapolating these findings to the Australian population suggests a potential net cost saving of about $1 to $16 million per annum for the health system nationally. The incremental quality-adjusted life-years were very similar across the 3 groups within the trial period. CONCLUSIONS AND IMPLICATIONS Deprescribing for frail older people living in RACFs can be a cost-saving intervention without reducing the quality of life. Systemwide implementation of deprescribing across RACFs in Australia has the potential to improve health care delivery through the cost savings, which could be reapplied to further optimize care within RACFs.
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Affiliation(s)
- Charles E Okafor
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Amy T Page
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | | | - Sarah N Hilmer
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Kolling Institute, Northern Sydney Local Health District and The University of Sydney, St Leonards, New South Wales, Australia
| | - Richard I Lindley
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; The George Institute for Global Health, Barangaroo, Sydney, New South Wales, Australia
| | - Dee Mangin
- McMaster University, Hamilton, Ontario, Canada; University of Otago, Christchurch Central City, Christchurch, New Zealand
| | - Vasi Naganathan
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Department of Geriatric Medicine, Centre of Education and Research in Ageing, Concord Repatriation Hospital, New South Wales, Australia
| | - Christopher Etherton-Beer
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
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Mill D, Johnson JL, Percival M, Lee K, Salter SM, D'Lima D, Seubert L, Clifford R, Page AT. Pharmacists' use of guidelines for the supply of non-prescription medicines: a cross-sectional survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:478-488. [PMID: 37440321 DOI: 10.1093/ijpp/riad044] [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: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Guidelines support best practice for healthcare practice. In Australia, some non-prescription medicines are only accessible after consultation with a pharmacist and are known as Pharmacist Only medicines. Guidelines for providing some Pharmacist Only medicines are available, however, it is currently unknown if and how these guidelines are used in practice.The objective was to characterise pharmacists', intern pharmacists and pharmacy students' use of guidelines for Pharmacist Only medicines. METHODS A cross-sectional electronic survey of Australian registered pharmacists, intern pharmacists and pharmacy students was administered in July 2020. Questions explored the participants' use of Pharmacist Only medicine guidelines (available both in print and online; available online only) in the preceding 12 months. Data were analysed descriptively (i.e. frequencies, percentages). KEY FINDINGS In total, 574 eligible respondents completed the survey. Overall, 396 (69%) reported accessing the online and in-print guidelines in the previous 12 months with 185 (33%) accessing online-only guidelines. The guideline on emergency contraception was used the most out of all guidelines in the past 12 months (278, 48%). Overall, respondents reported accessing guidelines to update knowledge, check their practice reflected best practice and content familiarisation. Respondents' reasons for not accessing guidelines were due to respondents stating they did not need the information or that they had previously accessed the guidelines more than 12 months ago. These reasons varied between respondent groups. CONCLUSIONS Access and use of the Pharmacist Only medicines guidelines varied between pharmacists, interns and students. Further understanding of the influences of the use of these guidelines will help inform professional bodies on how best to develop guidelines to increase consistent use in practice and implement interventions to increase use.
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Affiliation(s)
- Deanna Mill
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta L Johnson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Mia Percival
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Kenneth Lee
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sandra M Salter
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - Liza Seubert
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Theresa Page
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
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Mill D, Johnson JL, Corre L, Lee K, D'Lima D, Clifford R, Seubert L, Salter SM, Page AT. Use of a reference text by pharmacists, intern pharmacists and pharmacy students: a national cross-sectional survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:548-557. [PMID: 37454279 DOI: 10.1093/ijpp/riad047] [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] [Received: 01/19/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Reference texts assist pharmacists by addressing knowledge gaps and enabling evidence-based decisions when providing patient care. It is unknown whether reference text utilisation patterns differ between pharmacists, intern pharmacists and pharmacy students. To describe and compare the self-reported use and perceptions of a reference text, namely the national formulary, by pharmacists, intern pharmacists and pharmacy students. METHODS Registered pharmacists, intern pharmacists and pharmacy students living in Australia were surveyed in July 2020. The survey was electronic and self-administered. Questions considered self-reported use of a specific reference text in the preceding 12 months. KEY FINDINGS There were 554 eligible responses out of 774 who commenced the survey: 430 (78%) pharmacists, 45 (8%) intern pharmacists and 79 (14%) pharmacy students. Most participants (529/554, 96%) reported historical use of the text, though pharmacists were significantly less likely than intern pharmacists and students to use it frequently (52/422, 12% versus 16/43, 37% versus 23/76, 30%, P < 0.001). Pharmacists (44%, 177/404) reported using the text as a tool to resolve a situation when providing a service or patient care (177/404, 44%) or as a teaching resource (150/404, 38%). In contrast, intern pharmacists and students most commonly use these to familiarise themselves with the contents (30/43, 70%; 46/76, 61%) or update their knowledge (34/43, 79%; 53/76, 70%). CONCLUSIONS Access and use patterns varied significantly across career stages. A broader understanding of the use of reference texts may help develop interventions to optimise the content and usability. Varying usage patterns across the groups may inform the tailoring of texts for future use.
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Affiliation(s)
- Deanna Mill
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta L Johnson
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lauren Corre
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Kenneth Lee
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Liza Seubert
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sandra M Salter
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Theresa Page
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
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6
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Page AT, Potter K, Naganathan V, Hilmer S, McLachlan AJ, Lindley RI, Coman T, Mangin D, Etherton-Beer C. Polypharmacy and medicine regimens in older adults in residential aged care. Arch Gerontol Geriatr 2023; 105:104849. [PMID: 36399891 DOI: 10.1016/j.archger.2022.104849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe medicines regimens used by older people living in residential aged care facilities (RACFs). MATERIALS AND METHODS This cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. RESULTS Medicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. CONCLUSION(S) Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.
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Affiliation(s)
- Amy Theresa Page
- Centre for Optimisation of Medicines, School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia; WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia.
| | | | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Hilmer
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrew J McLachlan
- ydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- University of Sydney, Sydney, Australia and the George Institute for Global Health, Sydney, Australia
| | - Tracy Coman
- Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland, Australia
| | | | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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7
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On the Ethics of Withholding and Withdrawing Unwarranted Diagnoses. Camb Q Healthc Ethics 2022:1-9. [PMID: 36524370 DOI: 10.1017/s0963180122000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
The number of diagnoses and the number of persons having diagnoses have increased substantially, and studies indicate that diagnoses are given or upheld even if they are unwarranted, that is, that they do not satisfy professionally accepted diagnostic criteria. In this article, the authors investigate the ethics of withholding and withdrawing unwarranted diagnoses. First, they investigate ethical aspects that make it difficult to withhold and to withdraw such diagnoses. Second, they scrutinize whether there are psychological factors, both in persons/patients and healthcare professionals, making it difficult to withdraw and withhold unwarranted diagnoses. Lastly, they use recent elements of the withholding-versus-withdrawing treatment debate in medical ethics to investigate whether there are any differences between withholding and withdrawing treatment and withdrawing and withholding unwarranted diagnoses. The authors conclude that it is crucial to acknowledge and address all these issues to reduce and avoid unwarranted diagnoses.
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8
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Hofmann B. Too Much, Too Mild, Too Early: Diagnosing the Excessive Expansion of Diagnoses. Int J Gen Med 2022; 15:6441-6450. [PMID: 35966506 PMCID: PMC9365059 DOI: 10.2147/ijgm.s368541] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Tremendous scientific and technological advances have vastly improved diagnostics. At the same time, false alarms, overdiagnosis, medicalization, and overdetection have emerged as pervasive challenges undermining the quality of healthcare and sustainable clinical practice. Despite much attention, there is no clarity on the classification and handling of excessive diagnoses. This article identifies three basic types of excessive diagnosing: too much, too mild, and too early. Correspondingly, it suggests three ways to reduce excess and advance high value care: we must stop diagnosing new phenomena, mild conditions, and early signs that do not give pain, dysfunction, and suffering.
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Affiliation(s)
- Bjørn Hofmann
- Institute for the Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway.,The Centre of Medical Ethics, Faculty of Medicine, the University of Oslo, Oslo, Norway
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9
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Lea M, Hofmann BM. Dediagnosing - a novel framework for making people less ill. Eur J Intern Med 2022; 95:17-23. [PMID: 34417089 DOI: 10.1016/j.ejim.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 01/06/2023]
Abstract
Diagnosing constitutes a substantial part of healthcare work and triggers a wide range of actions including the prescription of medicines. Dediagnosing is proposed as a novel framework for removing diagnoses that do not contribute to the reduction of persons' suffering and should be introduced to make people less ill. Dediagnosing comes together with other efforts to reduce overuse, such as deimplementation, deprescribing, decommissioning, and disinvestment. Because diagnoses may influence identity construction and social rights, dediagnosing must be conducted in close collaboration with the patient.
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Affiliation(s)
- Marianne Lea
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway; Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Norway.
| | - Bjørn Morten Hofmann
- Department for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway; Centre of Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
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10
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Wang KN, Page AT, Etherton-Beer CD. Mild cognitive impairment: To diagnose or not to diagnose. Australas J Ageing 2021; 40:111-115. [PMID: 33604998 DOI: 10.1111/ajag.12913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Older people living with mild cognitive impairment (MCI) have a slight but noticeable decline in their cognitive function, though do not meet the diagnostic criteria for dementia. MCI is controversial, with some saying it is a condition that does not require diagnosis, and others stating that it is a genuine clinical syndrome. Many people with MCI will improve, and most will not progress to dementia. Managing co-morbidities and exercising are likely to be the best treatment options. With limited evidence for effective interventions and uncertainty as to the prognostic value of the condition, the benefit of diagnosing MCI remains unclear.
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Affiliation(s)
- Kate N Wang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia.,Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amy T Page
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher D Etherton-Beer
- Western Australian Centre for Health and Ageing, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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11
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Prevalence and association of continuous polypharmacy and frailty among older women: A longitudinal analysis over 15 years. Maturitas 2021; 146:18-25. [PMID: 33722360 DOI: 10.1016/j.maturitas.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/01/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence of continuous polypharmacy and hyperpolypharmacy, determine medications that contribute to continuous polypharmacy, and examine the association between frailty and continuous polypharmacy. STUDY DESIGN A prospective study using data from the Australian Longitudinal Study on Women's Health. Women aged 77-82 years in 2003, and 91-96 years in 2017 were analysed, linking the Pharmaceutical Benefits Scheme data to participants' survey data. MAIN OUTCOME MEASURES The association between frailty and continuous polypharmacy was determined using generalised estimating equations for log binomial regressions, controlling for confounding variables. Descriptive statistics were used to determine the proportion of women with polypharmacy, and medications that contributed to polypharmacy. RESULTS The proportion of women with continuous polypharmacy increased over time as they aged. Among participants who were frail (n = 833) in 2017, 35.9 % had continuous polypharmacy and 1.32 % had hyperpolypharmacy. Among those who were non-frail (n = 1966), 28.2 % had continuous polypharmacy, and 1.42 % had hyperpolypharmacy. Analgesics (e.g. paracetamol) and cardiovascular medications (e.g. furosemide and statins) commonly contributed to continuous polypharmacy among frail and non-frail women. Accounting for time and other characteristics, frail women had an 8% increased risk of continuous polypharmacy (RR 1.08; 95 % CI 1.05, 1.11) compared to non-frail women. CONCLUSIONS Combined, polypharmacy and frailty are key clinical and public health challenges. Given that one-third of women had continuous polypharmacy, monitoring and review of medication use among older women are important, and particularly among women who are frail.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom.
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
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12
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Bennett F, Ferner R, Sofat R. Overprescribing and rational therapeutics: Barriers to change and opportunities to improve. Br J Clin Pharmacol 2020; 87:34-38. [PMID: 32216108 DOI: 10.1111/bcp.14291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/03/2023] Open
Abstract
There is increasing national and international interest in overprescribing and polypharmacy, and the burden that the inappropriate use of multiple medicines can place on individual patients and on society as a whole. This paper explores the challenges faced by prescribers and pharmacists wishing to reduce polypharmacy, including the uncertainties about the risks and benefits of continuing or stopping individual drugs. We discuss the factors influencing us to prescribe-which may lead to overprescribing-including the increasing number of guidelines, perceived patient pressure and advertising. We offer a critical appraisal of the tools currently available to clinicians and pharmacists aiming to rationalise medicines, and finally a systems-wide approach to improving overprescribing and problematic polypharmacy.
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Affiliation(s)
- Frances Bennett
- Department of Clinical Pharmacology, University College London Hospital Foundation Trust, UK
| | - Robin Ferner
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.,Institute of Cardiovascular Science, University College London, UK
| | - Reecha Sofat
- Department of Clinical Pharmacology, University College London Hospital Foundation Trust, UK.,Institute of Health Informatics, University College London, UK.,Centre of Clinical Pharmacology, Division of Medicine, University College London, UK
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13
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Hosking SM, Etherton-Beer C, Page AT. Undiagnosing: Correcting the medical record to prevent over-intervention. Case Rep Womens Health 2019; 23:e00133. [PMID: 31384565 PMCID: PMC6664263 DOI: 10.1016/j.crwh.2019.e00133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Indexed: 11/24/2022] Open
Abstract
Over-diagnosis can lead to over-intervention and over-prescribing, particularly among older adults. Undiagnosing is a strategy to review diagnostic labels and remove those that are unnecessary or no longer beneficial. Undiagnosing relies on accurate and comprehensive medical records to inform a thorough review of diagnoses Effective communication and collaborative decision making regarding undiagnosing are essential to ensure consumer centered care.
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Affiliation(s)
- Sarah M Hosking
- Deakin University, School of Medicine, Geelong, VIC, Australia
| | - Christopher Etherton-Beer
- University of Western Australia, Western Australian Centre for Health and Ageing, Perth, WA, Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Amy T Page
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia.,Monash University, Centre for Medicine Use and Safety, Melbourne, VIC, Australia.,University of Western Australia, School of Allied Health, Centre for Medicines Optimisation, Perth, WA, Australia
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