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Roncal-Belzunce V, Gutiérrez-Valencia M, Echeverría-Beistegui I, Martínez-Velilla N. Optipharm: Enhancing pharmacological management skills in healthcare students for geriatric care through gamified e-learning. Int J Med Inform 2024; 190:105535. [PMID: 39047675 DOI: 10.1016/j.ijmedinf.2024.105535] [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: 04/10/2024] [Revised: 06/01/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Complexities in older patient care and frequent polypharmacy requires tailored tools, specific skills and interdisciplinary collaborations. Traditional disease-centered education often overlooks these issues. Despite digital gamification's relevance in health education, limited exploration exists for gamified platforms addressing polypharmacy, especially within comprehensive geriatric assessment (CGA). OBJECTIVE This study outlines Optipharm's design, a gamified e-learning tool designed to enhance health students' education in managing polypharmacy among older adults. It also assesses its usability using a validated scale. METHODS Optipharm development utilized gamification techniques guided by pedagogical principles. Learning objectives addressed clinical and educational gaps in older adult care. Hosted on a Moodle system, the platform housed a structured clinical case as a SCORM file, a usability scale, a certificate of achievement, and a literature library. Optipharm was assessed by 304 medical students from the University of Navarre, Spain, using the SUS-G-Sp scale. RESULTS An immersive gamified e-learning tool simulating clinical practice settings was developed, requiring users to assume the role of healthcare professionals in multidisciplinary outpatient consultations. The interface, with a 2D cartoon-style aesthetic, aligns with learning objectives, integrating engaging storytelling and clear instructions for CGA in Phase 1 and pharmacological optimization in Phase 2. The evaluation of Optipharm's usability revealed very positive perceptions among users, with high agreement rates on usability items. CONCLUSION Optipharm represents a pioneering gamified tool designed to simulate clinical scenarios, allowing users to engage as healthcare professionals within multidisciplinary teams and address medication-related challenges in older patients with polypharmacy. It provides a secure, interactive learning environment with clear educational objectives and seamless integration of gamification elements, enhancing users' knowledge and skills in managing complex medication regimens. As a platform for experiential learning and knowledge exchange, Optipharm contributes to shaping the future of health education and fostering a culture of patient-centred care among future healthcare professionals.
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Affiliation(s)
- Victoria Roncal-Belzunce
- Public University of Navarre (UPNA), Pamplona, Navarre, Spain; Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain.
| | - Marta Gutiérrez-Valencia
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Innovation and Organization Unit, Navarre Health Service, Pamplona, Navarre, Spain
| | | | - Nicolás Martínez-Velilla
- Public University of Navarre (UPNA), Pamplona, Navarre, Spain; Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Hospital Universitario de Navarra (HUN)- Navarrabiomed, Pamplona, Navarre, Spain
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Puig T, Leache L, González-Senac NM, Carreras E, Gutiérrez-Valencia M, Losa L, Revuelta-Herrero JL, Marrero-Álvarez P, de Miguel M, Aguirrezabal Arredondo A, Aranguren A, Vilariño A, Ruiz VE, Fernández I, Bilbao J, González-Guerrero C, Del Pino B, Garin N. Prevalence of potentially inappropriate medications and prescription dynamics in elderly hospitalized patients in Spain. BMC Geriatr 2024; 24:798. [PMID: 39350081 PMCID: PMC11443693 DOI: 10.1186/s12877-024-05308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/16/2024] [Indexed: 10/04/2024] Open
Abstract
PURPOSE In recent years, the need for a more appropriate prescription of medications in the older population has emerged as a significant public health concern. In this study, we aimed to evaluate the prevalence of potentially inappropriate medications (PIM) in hospitalized adults aged ≥ 75. PATIENTS AND METHODS This was a retrospective descriptive observational study of patients at 16 hospitals in Spain. The study population included inpatients aged ≥ 75 admitted during a 7-day period (May 10 to 16, 2021). Data were obtained from the pharmacy databases of the participating hospitals. The list of PIMs was based on the Beers, STOPP-START, EU-PIM and PRISCUS criteria. RESULTS A total of 4,183 patients were included. PIMs were detected in 23.5% (N = 1,126) of the cohort. The prevalence rates at the participating hospitals ranged from 10% to 42.5%. The PIM/patient ratio was 1.2. The most common PIMs were midazolam, dexketoprofen, diazepam, and doxazosin, all of which (except for doxazosin) were more common in women. Benzodiazepines accounted for 70% of all PIMs. In 35% of cases, the PIMs were initiated before hospital admission. Of the 818 PIMs initiated during hospitalization, the two most common were benzodiazepines (49%) and anti-inflammatory drugs (25%). At discharge, only 4.9% of the PIMs initiated during the hospital stay were still prescribed. CONCLUSION In this population of older hospitalized patients, the overall prevalence of PIMs was moderate. However, the prevalence rate at the participating hospitals was highly variable. In most cases, PIMs prescribed prior to hospitalization for chronic conditions were not withdrawn during the hospital stay. No significant increase in PIMs was observed from pre-admission to post-discharge. These findings underscore the need for multidisciplinary interventions to optimize the pharmaceutical treatment in older adults in the hospital setting to reduce the consequences of PIMs in patients.
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Affiliation(s)
- T Puig
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - L Leache
- Innovation and Organization Unit, Navarre Health Service (SNS-O), Pamplona, Navarre, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - N M González-Senac
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain
| | - E Carreras
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Gutiérrez-Valencia
- Innovation and Organization Unit, Navarre Health Service (SNS-O), Pamplona, Navarre, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - L Losa
- Pharmacy Department, Complex Hospitalari Universitari Moisès Broggi, Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - J L Revuelta-Herrero
- Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Marrero-Álvarez
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Barcelona, 08035, Spain
| | - M de Miguel
- Department of Hospital Pharmacy, Osakidetza Basque Health Service, Cruces University Hospital, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | | | - A Aranguren
- Pharmacy Department, OSI Donostialdea- Hospital Universitario Donosti, Donostia, Spain
| | - A Vilariño
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, 08916, Spain
| | - V E Ruiz
- Quality Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - I Fernández
- Pharmacy Department, Osakidetza Basque Health Service, Zumárraga Hospital, Zumárraga, Spain
| | - J Bilbao
- Pharmacy Department, Hospital San Eloy, Integrated Health Care Organization Barakaldo-Sestao, Barakaldo, Spain
| | | | - B Del Pino
- Pharmacy Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - N Garin
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Barcelona, Spain
- Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, 08025, Spain
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González-Munguía S, Munguía-López O, Sánchez Sánchez E. Application of STOPP/START criteria in older patients in primary care using RStudio®. BMC Geriatr 2024; 24:782. [PMID: 39322952 PMCID: PMC11423496 DOI: 10.1186/s12877-024-05376-5] [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: 07/24/2023] [Accepted: 09/12/2024] [Indexed: 09/27/2024] Open
Abstract
OBJECTIVES To estimate the frequency of potentially inappropriate prescribing (PIP) in outpatients according to STOPP/START criteria, and to identify risk factors. For this purpose, an algorithm was developed and validated in RStudio® based on the information collected in the electronic prescription. METHODS The data corresponds to dispensations from two pharmacies in Spain made to patients over 18 years, over 4 years. For the analysis, only patients aged ≥ 65 years who are targeted by the STOPP/START criteria are included. The statistical programming language RStudio® was used to develop the algorithm. The STOPP criteria used as models for the implementation of the method were L2 and B12. A logistic regression analysis was performed. RESULTS A total of 15,601 treatment plans were obtained from 2312 patients ≥ 65 years (56% women), of whom 46.6% had polypharmacy (≥ 5 drugs) and 9.3% had excessive polypharmacy (≥ 10 drugs). In this group, PIPs were detected in 57% of patients and in 38% of their treatment plans; of these PIPs the most common were those related to the use of benzodiazepines for more than 28 days (D5 criterion) in 25.9% of patients, followed by the use of opioids prescribed without an associated laxative (L2 criterion) in 13.8% and finally, drugs duplication (A3 criterion) in 5.7%. The most numerous duplications related to criterion A3 were benzodiazepines (39%) and non-steroidal anti-inflammatory drugs (37.4%). CONCLUSIONS The method developed and validated in RStudio® with different STOPP criteria allows us to analyse the pharmacological treatment of many patients using different databases and to identify those at risk of suffering a PIP according to the STOPP criteria. Our results indicate a high prevalence of PIPs in patients ≥ 65 years, with polypharmacy being the most common risk factor affecting PIP.
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Affiliation(s)
- Silvia González-Munguía
- Hospital Universitario Nuestra Señora de La Candelaria. Servicio de Farmacia. Santa Cruz de Tenerife, 38010, Tenerife, Spain
- Programa de Doctorado en Ciencias de La Salud. Universidad de La Laguna, 38200, San Cristóbal de La Laguna. Tenerife, Spain
| | - Obdulia Munguía-López
- Departamento de Ingeniería Química y Tecnología Farmacéutica. Facultad de Farmacia, Universidad de La Laguna, 38200, San Cristóbal de La Laguna. Tenerife, Spain
| | - Esther Sánchez Sánchez
- Departamento de Ingeniería Química y Tecnología Farmacéutica. Facultad de Farmacia, Universidad de La Laguna, 38200, San Cristóbal de La Laguna. Tenerife, Spain.
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Suárez MDMS, Roldán AM, Cuenca MRC, Morales AJ. [Translated article] Pharmaceutical recommendations for therapeutic appropriateness in patients with multiple sclerosis. FARMACIA HOSPITALARIA 2024; 48:T230-T233. [PMID: 38825444 DOI: 10.1016/j.farma.2024.05.002] [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: 09/27/2023] [Revised: 01/28/2024] [Accepted: 02/25/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE To determine the prevalence of PIMDINAC criteria and to implement pharmacological interventions in a population with multiple sclerosis over 55 years of age. METHODS Retrospective, observational, open-label study, including patients with multiple sclerosis aged 55 years and older during December 2022 and February 2023. The main variable determined was the percentage of compliance with the PIMDINAC criteria. RESULTS Ninety-five patients were included, with the presence of PIMDINAC criteria detected in 67.4%. The most frequently detected criterion was non-adherence to concomitant treatment (84.4%), followed by drug-drug interactions (56.2%) and potentially inappropriate medication (25%). A total of 20 pharmaceutical interventions were performed in 17 patients (17.9%). Potentially inappropriate medication was responsible for 11 interventions, non-adherence for 7, and drug-drug interactions for 2. The 81.8% of interventions were accepted, resulting in the discontinuation of 15 inappropriately prescribed drugs. The prevalence of PIMDINAC criteria in this group of patients is high. The study revealed that PIMDINAC criteria were prevalent in 67.4% of the study population, with polypharmacy playing an important role, suggesting the potential for a multidisciplinary approach, through pharmaceutical interventions to address unnecessary or duplicate treatments.
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Affiliation(s)
| | - Alicia Martín Roldán
- Servicio de Farmacia, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
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Sánchez Suárez MDM, Martín Roldán A, Cantudo Cuenca MR, Jiménez Morales A. Pharmaceutical recommendations for therapeutic appropriateness in multiple sclerosis patients. FARMACIA HOSPITALARIA 2024; 48:230-233. [PMID: 38538448 DOI: 10.1016/j.farma.2024.02.015] [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: 09/27/2023] [Revised: 01/28/2024] [Accepted: 02/25/2024] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVE To determine the prevalence of PIMDINAC criteria and to implement pharmacological interventions in a population with multiple sclerosis over 55 years of age. METHODS Retrospective observational open-label study including patients with multiple sclerosis aged 55 years and older between December 2022 and February 2023. The main variable determined was the percentage of compliance with the PIMDINAC criteria. RESULTS Ninety-five patients were included, with the presence of PIMDINAC criteria detected in 67.4%. The most frequently detected criterion was non-adherence to concomitant treatment (84,4%), followed by drug-drug interactions (56.2%) and potentially inappropriate medication (25%). A total of 20 pharmaceutical interventions were performed in 17 patients (17.9%). Potentially inappropriate medication was responsible for 11 interventions, non-adherence for 7 and drug-drug interactions for 2. The 81.8% of interventions were accepted, resulting in the discontinuation of 15 inappropriately prescribed drugs. The prevalence of PIMDINAC criteria in this group of patients is high. The study revealed that PIMDINAC criteria were prevalent in 67.4% of the study population, with polypharmacy playing an important role, suggesting the potential for a multidisciplinary approach, through pharmaceutical interventions to address unnecessary or duplicate treatments.
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Affiliation(s)
| | - Alicia Martín Roldán
- Servicio de Farmacia, Hospital Universitario Virgen de las Nieves, Granada, España
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Ortonobes S, Herranz S, Lleal M, Sevilla-Sánchez D, Jordana R, Mascaró O, Ferrández O, de Jaime E, Estrada R, Nazco GJ, Baré M. Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study. BMC Geriatr 2024; 24:584. [PMID: 38978009 PMCID: PMC11232270 DOI: 10.1186/s12877-024-05185-w] [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: 02/08/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE Multimorbidity and polypharmacy in older adults converts the detection and adequacy of potentially inappropriate drug prescriptions (PIDP) in a healthcare priority. The objectives of this study are to describe the clinical decisions taken after the identification of PIDP by clinical pharmacists, using STOPP/START criteria, and to evaluate the degree of accomplishment of these decisions. METHODS Multicenter, prospective, non-comparative cohort study in patients aged 65 and older, hospitalized because of an exacerbation of their chronic conditions. Each possible PIDP was manually identified by the clinical pharmacist at admission and an initial decision was taken by a multidisciplinary clinical committee. At discharge, criteria were re-applied and final decisions recorded. RESULTS From all patients (n = 674), 493 (73.1%) presented at least one STOPP criteria at admission, significantly reduced up to 258 (38.3%) at discharge. A similar trend was observed for START criteria (36.7% vs. 15.7%). Regarding the top 10 most prevalent STOPP criteria, the clinical committee initially agreed to withdraw 257 (34.2%) prescriptions and to modify 93 (12.4%) prescriptions. However, the evaluation of final clinical decisions revealed that 503 (67.0%) of those STOPP criteria were ultimately amended. For the top 10 START criteria associated PIDP, the committee decided to initiate 149 (51.7%) prescriptions, while a total of 198 (68.8%) were finally introduced at discharge. CONCLUSIONS The clinical committee, through a pharmacotherapy review, succeeded in identifying and reducing the degree of prescription inadequacy, for both STOPP and START criteria, in older patients with high degree of multimorbidity and polypharmacy. TRIAL REGISTRATION NCT02830425.
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Affiliation(s)
- Sara Ortonobes
- Pharmacy Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Spain.
| | - Susana Herranz
- Acute Care Geriatric Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Catalonia, Spain
- Research Network On Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Marina Lleal
- Clinical Epidemiology and Cancer Screening Department, Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health, Autonomous University of Barcelona (UAB), 08193, Bellaterra, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | | | - Rosa Jordana
- Internal Medicine Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Spain
| | - Oscar Mascaró
- Internal Medicine Department, University Hospital of Vic, Multidisciplinary Inflamation Research Group (MIRG), Facultat de Medicina, Universitat de Vic, Universitat Central de Catalunya, 08500, Vic, Spain
| | - Olivia Ferrández
- Pharmacy Department, Consorci Parc de Salut Mar, 08003, Barcelona, Spain
| | - Elisabet de Jaime
- Geriatrics Department, Consorci Parc de Salut Mar, 08003, Barcelona, Spain
| | - Rafael Estrada
- Internal Medicine, Hospital Galdakao-Usansolo, 48960, Galdakao, Spain
| | - Gloria Julia Nazco
- Pharmacy Department, Hospital Universitario de Canarias, 38320, La Laguna, Spain
| | - Marisa Baré
- Research Network On Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Primary Care Center, CAP Can Rull, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), 08206, Sabadell, Spain.
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Bautista Gómez AJ, López Orozco M, Barajas Esparza L, de La Cruz Durán H, Chehue Romero A, Bermúdez Camps IB, Téllez López AM, López Vargas LC, Valverde Merino MI, Martínez Martínez F, Reyes Hernández I. Feasibility and reliability of a quality indicator system for an ambulatory dispensing service. Drugs Context 2024; 13:2024-1-3. [PMID: 38817803 PMCID: PMC11139164 DOI: 10.7573/dic.2024-1-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/29/2024] [Indexed: 06/01/2024] Open
Abstract
Background For a medication dispensing service to function with quality, continuous evaluation is required, which is why it is necessary to have reliable measurement tools that make it possible. Quality indicators can serve as tools for managing quality, as they are variables that directly or indirectly measure changes in a situation and help evaluate the progress made in addressing it. This article aims to determine the feasibility and reliability of a quality indicator system for a drug dispensing service for paediatric outpatients in two Mexican hospitals. Methods A study of the development type of health systems and services at a microlevel was conducted from October 2020 to October 2021 in the pharmaceutical service of two Mexican hospitals. To determine the feasibility of the quality indicators, a retrospective evaluation was performed, which considered the indicators that could be calculated with the available information to be feasible. To determine reliability, an inter-observer agreement study (Kappa (κ)) was performed. Results The feasibility analysis revealed that all five reference indicators related to the structure were feasible in both hospitals. In the Infantil of the Californias hospital, all six process indicators evaluated were feasible, whilst only one was found feasible in H+ Querétaro. As for outcome indicators, only one was feasible in the Infantil of the Californias hospital. The causes of non-feasibility in both hospitals were the non-documentation of the primary data related to the stages of the process and the lack of instruments to measure patient satisfaction. The reliability of the indicators showed little variability. Conclusion Although not all indicators were feasible, solutions were proposed so that the 15 reference indicators could be used if an organization decided to do so. The reliability of the indicators was demonstrated, evidencing the importance of the data sheet as a tool to generate valid reliable measures.This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/.
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Affiliation(s)
- Andrea Jetzú Bautista Gómez
- Department of Pharmaceutical Services, Hospital H+ Querétaro, Queretaro, Mexico
- Pharmacy Academic Area, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | | | | | | | - Alejandro Chehue Romero
- Pharmacy Academic Area, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | - Isis Beatriz Bermúdez Camps
- Pharmacy Academic Area, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | - Ana María Téllez López
- Pharmacy Academic Area, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | - Laura Cristina López Vargas
- Pharmacy Academic Area, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | | | | | - Ivette Reyes Hernández
- Pharmacy Academic Area, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
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Gutiérrez-Igual S, Lucas-Domínguez R, Martí Rodrigo A, Romero Crespo I, Montesinos Mezquita MC. [New tools for medication review: DRP in patients treatment with proton pump inhibitors]. Aten Primaria 2024; 56:102836. [PMID: 38150850 PMCID: PMC11058877 DOI: 10.1016/j.aprim.2023.102836] [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: 10/16/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To analyze, using the medication review program, Revisem®, the prevalence of drug-related problems (DRP) in patients in the province of Valencia who were on active treatment with proton pump inhibitors (PPI) in 2022. DESIGN Descriptive and retrospective observational study. MATERIAL AND METHODS The pharmacotherapeutic history of 295 patients was analyzed following the criteria proposed by the Pharmaceutical Care Network Europe, using the Revisem® digital platform of the Muy Ilustre Colegio Oficial de Farmacéuticos (MICOF). RESULTS The mean age of the patients was 81.8 ± 11.1 years and 66.4% were women. At least one DRP was detected in 97.3% of patients. 46.9% of the DRP analyzed were interactions, of which 29.7% involved a PPI, with omeprazole being the most frequent. DRPs with PPI are significantly related to certain patient conditions and pharmacological groups, such as female sex, age over 54 years and polypharmacy. CONCLUSIONS The application of the Revisem® digital platform allows the detection of a high prevalence of DRP at the provincial level. The application of new technological tools to detect the prevalence of DRP is essential to optimize patient treatments.
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Affiliation(s)
- Salvador Gutiérrez-Igual
- Servicios Asistenciales Farmacéuticos y Formación, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF), Valencia, España; Departamento de Farmacología, Universidad de Valencia (UV), Burjassot, España.
| | - Rut Lucas-Domínguez
- UISYS, Departamento de Historia de la Ciencia y Documentación, Facultad de Medicina y Odontología, Universidad de Valencia (UV), Valencia, España; Unidad asociada al Instituto Interuniversitario de Investigación Avanzada sobre Evaluación de la Ciencia y la Universidad (INAECU), UC3M-UAM3, Madrid, España; CIBERONC, Valencia, España.
| | - Alberto Martí Rodrigo
- Servicios Asistenciales Farmacéuticos y Formación, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF), Valencia, España
| | - Isabel Romero Crespo
- Servicios Asistenciales Farmacéuticos y Formación, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF), Valencia, España
| | - M Carmen Montesinos Mezquita
- Departamento de Farmacología, Universidad de Valencia (UV), Burjassot, España; Equipo Estudios de Bioactividad, Instituto Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico (IDM). Universidad Politécnica de Valencia (UPV). Universidad de Valencia (UV), Valencia, España
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Corral-Tuesta C, Rodríguez Díaz-Pavón A, Montero-Errasquín B, Álvarez-Pinheiro CG, Lavilla-Gracia V, Cruz-Jentoft AJ. Chronic benzodiazepine usage among older people: prevalence, indications, and treatment modifications in patients admitted to an acute geriatric unit. Eur Geriatr Med 2024; 15:539-543. [PMID: 38214865 DOI: 10.1007/s41999-023-00918-3] [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: 10/06/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024]
Abstract
AIM To investigate the prevalence and indications of benzodiazepines (BZD) usage among patients admitted to an acute geriatric unit and assess changes in prescriptions. METHODS BZD indications were documented reviewing clinical records, with appropriateness assessed based on the STOPP-START criteria. Changes in BZD prescriptions were recorded at discharge and 3 months later. RESULTS Among the 366 patients included (mean age: 92.8 years, 68% females), 91 (24.9%) were on BZD upon admission, being inappropriate in 93.4%. At discharge, BZD discontinuation was observed in 40.7% and dose reduction initiated in 57.4%. Among patients discharged without prescriptions, 10.8% resumed their use at 3 months. Of those discharged with BZD tapering, 74.1% were still on them 3 months later. CONCLUSIONS The majority of patients employing BZD lacked a medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction for most patients but was not maintained in the outpatient setting.
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Affiliation(s)
- C Corral-Tuesta
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | | | - B Montero-Errasquín
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - C G Álvarez-Pinheiro
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - V Lavilla-Gracia
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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10
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Zambrano L, Bustos RH, Beltran E, Gomez D, Arias S, Briceño W. STOPP-START Criteria Used to Identify the Elderly Population Prone to Potentially Inadequate Prescribing in a Colombian Cohort. Curr Aging Sci 2024; 17:135-143. [PMID: 38317476 DOI: 10.2174/0118746098274486231227101704] [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: 08/06/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Elderly people have multiple comorbidities that often require treatment with multiple medications. Having strategies to lessen the risks associated with pharmacological interactions and potentially inadequate prescribing (PIP) is of major importance. The STOPP- START criteria are useful in identifying PIP along with other tools, such as LASA (look alike/sound alike) drugs and high-risk medications (HRM). OBJECTIVE We aimed to clinically and sociodemographically characterize the population with PIP according to the STOPP-START criteria in hospitalized elderly patients over 6 months in a third-level hospital in Colombia, South America. We also aimed to calculate the prevalence of PIP, LASA drugs and HRM and to identify other problems related with medication. Finally, we proposed an algorithm for the identification of PIP in this population. METHODS AND MATERIALS This was a descriptive, cross-sectional study in hospitalized patients older than 60 years during the first semester of 2021 to identify PIP according to STOPP- START criteria. An analysis of clinical and sociodemographic variables was conducted, as well as the construction of an algorithm to identify PIP in the elderly in a semiautomated way. Data were collected and analyzed using the software SPSS 2021, using descriptive statistics and measures of central tendency. RESULTS The prevalence of PIP in the study population was 25%. Furthermore, 60% of patients had one problem related to medication, and 27% used at least one LASA drug or HRM. CONCLUSION This study allows one to characterize, for the first time, the Colombian population prone to PIP, as well as the construction of an algorithm that identifies PIP in a semiautomated way.
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Affiliation(s)
- Loren Zambrano
- PGY-2 at the Clinical Pharmacology Department, Universidad de La Sabana Faculty of Medicine, Chía, Colombia, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá. Chía, Cundinamarca, 250001, Colombia
| | - Rosa-Helena Bustos
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá. Chía, Cundinamarca, 250001, Colombia
| | - Edgar Beltran
- BS Pharm Universidad El Bosque, Bogotá, 11001, Colombia
| | - Daniel Gomez
- BS Pharm Universidad El Bosque, Bogotá, 11001, Colombia
| | - Sara Arias
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá. Chía, Cundinamarca, 250001, Colombia
| | - Wilson Briceño
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá. Chía, Cundinamarca, 250001, Colombia
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Ruíz-González C, González-López MDC, García-Ramón MJ, Ruiz-Fernández MD, Rebollo-Lavado B, Andújar-Rodríguez E, Ventura-Miranda MI. A description of risk associated with use of antipsychotics among community dwelling older adults: A descriptive cross-sectional study. Geriatr Nurs 2024; 55:362-367. [PMID: 38171187 DOI: 10.1016/j.gerinurse.2023.12.009] [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: 10/07/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
The objective of this research was to analyze the risk of adverse effects in patients older than 65 years with dementia and in concomitant treatment with antidementia and antipsychotic drugs and who are cared for by community nurses. A retrospective cross-sectional descriptive study was carried out. A total of 332 patients who were cared for by primary care teams participated. Most of the patients were women, totally dependent for the basic activities of daily living and residing in the family home. They were polymedicated and there was poor therapeutic adherence. The risk of adverse effects was higher in polymedicated patients who had been taking antipsychotics for longer periods and in those who had a main caregiver. However, those patients who had been assessed by the community nurse were protected from suffering adverse effects. This study demonstrates how integrated and continuous nursing care can reduce adverse effects in this type of patient.
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Affiliation(s)
- Carlos Ruíz-González
- Primary Health Care District of Almeria, Andalusian Health Service, 04006 Almería, Spain
| | | | | | - María Dolores Ruiz-Fernández
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile.
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12
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Anlay DZ, Paque K, Van Leeuwen E, Cohen J, Dilles T. Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review. Br J Clin Pharmacol 2024; 90:12-106. [PMID: 37697479 DOI: 10.1111/bcp.15906] [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: 04/01/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIMs), evaluate development and validation methods, and describe evidence levels for medication inclusion. METHODS Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines. RESULTS From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence. CONCLUSIONS Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.
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Affiliation(s)
- Degefaye Zelalem Anlay
- End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kristel Paque
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- HAST, Hasselt, Belgium
| | - Ellen Van Leeuwen
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences & Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Tinne Dilles
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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13
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Hormigo-Sanchez AI, Lopez-Garcia A, Mahillo-Fernandez I, Askari E, Morillo D, Perez-Saez MA, Riesco M, Urrutia C, Martinez-Peromingo FJ, Cordoba R, Gonzalez-Montalvo JI. Frailty assessment to individualize treatment in older patients with lymphoma. Eur Geriatr Med 2023; 14:1393-1402. [PMID: 37823983 PMCID: PMC10754742 DOI: 10.1007/s41999-023-00870-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment. METHODS Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan-Meier survival curves. RESULTS Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival (p = 0.002), response to treatment (p < 0.001) and likelihood of increased frailty (p = 0.024) were observed, with type III-IV patients showing significantly worse outcomes. CONCLUSION Performance of standardized, systematic CGA by geriatricians permits older lymphoma patients to be classified according to frailty, with significant differences in terms of clinical outcomes across groups. We propose incorporating CGA performed by geriatricians as part of the multidisciplinary care team to optimize therapeutic strategy for these patients.
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Affiliation(s)
- Ana I Hormigo-Sanchez
- Department of Geriatric Medicine, Fundación Jiménez Díaz University Hospital, Avenida Reyes Católicos, 2. CP 28040, Madrid, Spain.
- Health Research Institute IIS-FJD, Madrid, Spain.
- Faculty of Medicine, Department of Medicine, Autonoma University of Madrid, Madrid, Spain.
| | - Alberto Lopez-Garcia
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
- Health Research Institute IIS-FJD, Madrid, Spain
| | | | - Elham Askari
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
| | - Daniel Morillo
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
| | - María A Perez-Saez
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
| | - Miriam Riesco
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | - Celia Urrutia
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | | | - Raúl Cordoba
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
- Health Research Institute IIS-FJD, Madrid, Spain
| | - Juan I Gonzalez-Montalvo
- Department of Geriatric Medicine, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Department of Medicine, Autonoma University of Madrid, Madrid, Spain
- Biomedical Research Institute of La Paz University Hospital. IdiPAZ, Madrid, Spain
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McGettigan S, Curtin D, O'Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: uptake and clinical impact. Expert Rev Clin Pharmacol 2023; 16:1175-1185. [PMID: 37947757 DOI: 10.1080/17512433.2023.2280219] [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: 07/24/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION STOPP/START criteria for potentially inappropriate medications (PIMs, STOPP) and potential prescribing omissions (PPOs, START) have gained considerable interest and traction since they were first published in 2008. This review focuses on their uptake and impact in various clinical settings. AREAS COVERED STOPP/START criteria, now in their third iteration, are explicit criteria designed to facilitate detection of common and clinically important PIMs and PPOs during routine medication review in any clinical setting. We examine the influence of the criteria, particularly in clinical trials that focused on their impact on clinically relevant endpoints. EXPERT OPINION STOPP/START criteria are widely used in several countries within Europe and beyond for medication review and audit. As a discreet intervention, the criteria have been tested in several single-center and two large-scale multi-center clinical trials. The single-center trials indicate that STOPP/START criteria reduce polypharmacy, inappropriate prescribing, ADRs (adverse drug reactions), medication cost and falls. In contrast, the SENATOR and OPERAM multicentre trials did not demonstrate significant reduction in ADRs, all-cause mortality, drug-related hospital readmissions, nor any improvement in quality-of-life. Further clinical trials are required to examine whether STOPP/START criteria as an intervention can deliver significant clinical benefit in a reproducible manner in various clinical settings.
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Affiliation(s)
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
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15
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Martín-Díaz M, Pino-Merlo G, Bueno-Cabanillas A, Khan KS. [Longitudinality in Primary Care and Polypharmacy. A Systematic Review]. Semergen 2023; 49:101994. [PMID: 37276757 DOI: 10.1016/j.semerg.2023.101994] [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: 01/16/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
The aim of this work was to collect, evaluate and interpret the available evidence on the relationship between continuity in primary care (i.e., longitudinality), and the prevalence of polypharmacy and its associated problems. Following the PRISMA reporting statement, we carried out a systematic review of the literature searching PubMed and Scopus databases. The screening of titles and summaries and the review of references carried out independently by two authors detected 16 works of potential interest, of which 4 were discarded after the independent review of all the originals because they did not meet inclusion criteria. The 12 papers selected studied the relationship between Longitudinality, measured with various quantitative indices, and the rate of polypharmacy or various associated problems, such as duplicate drugs, inadequate prescriptions or drug interactions. They all showed a significant relationship, often strong (RR>2 or<0.5), between longitudinality indicators and the various dependent variables. Although our knowledge could be improved by prospective studies that more directly evaluate longitudinality and its impact on problems due to excess medication, with the existing evidence, we can affirm that the protection and promotion of continuity in primary care can be a key element for the control of polypharmacy and associated problems.
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Affiliation(s)
- M Martín-Díaz
- Cirugía General y del Aparato Digestivo, Hospital General Básico Santa Ana de Motril, Área de Gestión Sanitaria Sur de Granada, Motril, Granada, España.
| | - G Pino-Merlo
- Unidad de Calidad y Seguridad del Paciente, Área de Gestión Sanitaria Sur de Granada, Granada, España
| | - A Bueno-Cabanillas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación BioSanitaria de Granada (IBS-Granada), Granada, España
| | - K S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Fujita K, Masnoon N, Mach J, O’Donnell LK, Hilmer SN. Polypharmacy and precision medicine. CAMBRIDGE PRISMS. PRECISION MEDICINE 2023; 1:e22. [PMID: 38550925 PMCID: PMC10953761 DOI: 10.1017/pcm.2023.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 07/05/2024]
Abstract
Precision medicine is an approach to maximise the effectiveness of disease treatment and prevention and minimise harm from medications by considering relevant demographic, clinical, genomic and environmental factors in making treatment decisions. Precision medicine is complex, even for decisions about single drugs for single diseases, as it requires expert consideration of multiple measurable factors that affect pharmacokinetics and pharmacodynamics, and many patient-specific variables. Given the increasing number of patients with multiple conditions and medications, there is a need to apply lessons learned from precision medicine in monotherapy and single disease management to optimise polypharmacy. However, precision medicine for optimisation of polypharmacy is particularly challenging because of the vast number of interacting factors that influence drug use and response. In this narrative review, we aim to provide and apply the latest research findings to achieve precision medicine in the context of polypharmacy. Specifically, this review aims to (1) summarise challenges in achieving precision medicine specific to polypharmacy; (2) synthesise the current approaches to precision medicine in polypharmacy; (3) provide a summary of the literature in the field of prediction of unknown drug-drug interactions (DDI) and (4) propose a novel approach to provide precision medicine for patients with polypharmacy. For our proposed model to be implemented in routine clinical practice, a comprehensive intervention bundle needs to be integrated into the electronic medical record using bioinformatic approaches on a wide range of data to predict the effects of polypharmacy regimens on an individual. In addition, clinicians need to be trained to interpret the results of data from sources including pharmacogenomic testing, DDI prediction and physiological-pharmacokinetic-pharmacodynamic modelling to inform their medication reviews. Future studies are needed to evaluate the efficacy of this model and to test generalisability so that it can be implemented at scale, aiming to improve outcomes in people with polypharmacy.
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Affiliation(s)
- Kenji Fujita
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Nashwa Masnoon
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - John Mach
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa Kouladjian O’Donnell
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah N. Hilmer
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
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Prevalence of Potentially Inappropriate Prescriptions According to the New STOPP/START Criteria in Nursing Homes: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11030422. [PMID: 36766997 PMCID: PMC9914658 DOI: 10.3390/healthcare11030422] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population.
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Guo X, Li M, Du X, Jiang C, Li S, Tang R, Sang C, Yu R, Long D, Dong J, Ma C. Multimorbidity, polypharmacy and inappropriate prescribing in elderly patients with atrial fibrillation: A report from the China Atrial Fibrillation Registry Study. Front Cardiovasc Med 2022; 9:988799. [PMID: 36148073 PMCID: PMC9485537 DOI: 10.3389/fcvm.2022.988799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMultimorbidity, polypharmacy and inappropriate prescribing is common in elderly patients worldwide. We aimed to explore the current status of multimorbidity, polypharmacy and the appropriateness of pharmacological therapy among elderly patients with atrial fibrillation (AF) in China.Materials and methodsWe randomly selected 500 patients aged 65 years or older from the China AF Registry study. Multimorbidity was defined as ≥2 comorbidities and polypharmacy was defined as ≥5 long-term prescribed drugs. Appropriateness of prescribing was evaluated using the Screening Tool of Older People’s Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria version 2. Patients’ attitudes toward polypharmacy were evaluated by the Patients’ Attitudes Towards Deprescribing (PATD) questionnaire.ResultsAmong the 500 patients included (mean age 75.2 ± 6.7 years, 49.0% male), 98.0% had multimorbidity and 49.4% had polypharmacy. The prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) was 43.6% (n = 218) and 71.6% (n = 358), respectively. Traditional Chinese medicine attributed largely to PIMs. Anticoagulants were the most common PPOs. Many clinical factors increased the risk of PIMs and PPOs. However, polypharmacy increased the risk of PIMs (OR 2.70, 95%CI 1.78–4.11; p < 0.0001), but not PPOs. In addition, 73.7% patients with polypharmacy were willing to have one or more of their medications prescribed if advised by their doctor.ConclusionMultimorbidity and polypharmacy were highly prevalent in elderly patients with AF in China. A high prevalence of inappropriate prescribing was also observed. Therefore, much more attention should be paid to the serious health problem in the elderly population.
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Affiliation(s)
- Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ronghui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- *Correspondence: Changsheng Ma,
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Delgado-Parada E, Alonso-Sánchez M, Ayuso-Mateos JL, Robles-Camacho M, Izquierdo A. Liaison psychiatry before and after the COVID-19 pandemic. Psychiatry Res 2022; 314:114651. [PMID: 35640325 PMCID: PMC9124364 DOI: 10.1016/j.psychres.2022.114651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.
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Affiliation(s)
- E Delgado-Parada
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain
| | - M Alonso-Sánchez
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain.
| | - J L Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
| | - M Robles-Camacho
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain
| | - A Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
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20
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Inappropriate Prescriptions in Older People-Translation and Adaptation to Portuguese of the STOPP/START Screening Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116896. [PMID: 35682479 PMCID: PMC9180165 DOI: 10.3390/ijerph19116896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
Inappropriate prescribing, which encompasses the prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), is a common problem for older people. The STOPP/START tool enables general practitioners, who are the main prescribers, to identify and reduce the incidence of PIMs and PPOs and appraise an older patient’s prescribed drugs during the diagnosis process to improve the clinical care quality. This study aimed to translate and validate the STOPP/START screening tool to enable its use by Portuguese physicians. A translation-back translation method including the validation of the obtained Portuguese version was used. Intra- and inter-rater reliability and agreement analyses were used in the validation process. A dataset containing the information of 334 patients was analyzed by one GP twice within a 2-week interval, while a dataset containing the information of 205 patients was independently analyzed by three GPs. Intra-rater reliability assessment led to a Kappa coefficient (κ) of 0.70 (0.65−0.74) for the STOPP criteria and 0.60 (0.52−0.68) for the START criteria, considered to be substantial and moderate values, respectively. The results of the inter-rater reliability rating were almost perfect for all combinations of raters (κ > 0.93). The version of the STOPP/START criteria translated into Portuguese represents an improvement in managing the medications prescribed to the elderly. It provides clinicians with a screening tool for detecting potentially inappropriate prescribing in patients older than 65 years old that is reliable and easy to use.
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21
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Mouazer A, Tsopra R, Sedki K, Letord C, Lamy JB. Decision-support systems for managing polypharmacy in the elderly: A scoping review. J Biomed Inform 2022; 130:104074. [PMID: 35470079 DOI: 10.1016/j.jbi.2022.104074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
Polypharmacy, the consuming of more than five drugs, is a public health problem. It can lead to many interactions and adverse drug reactions and is very expensive. Therapeutic guidelines for managing polypharmacy in the elderly have been issued, but are highly complex, limiting their use. Decision-support systems have therefore been developed to automate the execution of these guidelines, or to provide information about drugs adapted to the context of polypharmacy. These systems differ widely in terms of their technical design, knowledge sources and evaluation methods. We present here a scoping review of electronic systems for supporting the management, by healthcare providers, of polypharmacy in elderly patients. Most existing reviews have focused mainly on evaluation results, whereas the present review also describes the technical design of these systems and the methodologies for developing and evaluating them. A systematic bibliographic search identified 19 systems differing considerably in terms of their technical design (rule-based systems, documentary approach, mixed); outputs (textual report, alerts and/or visual approaches); and evaluations (impact on clinical practices, impact on patient outcomes, efficiency and/or user satisfaction). The evaluations performed are minimal (among all the systems identified, only one system has been evaluated according to all the criteria mentioned above) and no machine learning systems and/or conflict management systems were retrieved. This review highlights the need to develop new methodologies, combining various approaches for decision support system in polypharmacy.
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Affiliation(s)
- Abdelmalek Mouazer
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, F-93000 Bobigny, France.
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, F-75006 Paris, France; INRIA, HeKA, INRIA Paris, France; Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Karima Sedki
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, F-93000 Bobigny, France
| | - Catherine Letord
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, F-93000 Bobigny, France; Department of Biomedical Informatics, Rouen University Hospital, Normandy, France
| | - Jean-Baptiste Lamy
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, F-93000 Bobigny, France
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22
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Peris-Campillo P, Trillo-Mata JL, Roca-Navarro MP, Usó-Talamantes R, Navarro-Pérez J. Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019). Rev Esp Geriatr Gerontol 2022; 57:90-94. [PMID: 35292158 DOI: 10.1016/j.regg.2022.01.006] [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: 06/15/2021] [Revised: 12/03/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). OBJECTIVE Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019. METHOD Descriptive population-based study. SETTING 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain. PERIOD 2015-2019. SUBJECTS Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. ANALYSES frequencies and time trends, both overall and by specific type. RESULTS Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). CONCLUSIONS IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.
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Affiliation(s)
- Paula Peris-Campillo
- Emergency Department, University Clinical Hospital, Health Department 'València - Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain.
| | - José Luis Trillo-Mata
- Direction of Pharmacy, Health Department 'València-Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain
| | - María Pilar Roca-Navarro
- Primary Care Physician, República Argentina Health Centre, Health Department 'València-Clinic-Malvarrosa', Valencia, C/ República Argentina n° 8, Valencia, Spain
| | - Ruth Usó-Talamantes
- Medical Direction, Valencia Quiron Hospital, Av. Blasco Ibáñez n° 14, 46010 Valencia, Spain
| | - Jorge Navarro-Pérez
- Medical Direction, Health Department 'València-Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain; INCLIVA Health Research Institute, University Clinical Hospital, Health Department 'València - Clinic-Malvarrosa', Valencia, Spain; CIBERESP Consortium for Biomedical Research in Epidemiology & Public Health, Spain
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23
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Rovira C, Modamio P, Pascual J, Armengol J, Ayala C, Gallego J, Mariño EL, Ramirez A. Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomised controlled trial protocol. BMJ Open 2022; 12:e051238. [PMID: 35140146 PMCID: PMC8830237 DOI: 10.1136/bmjopen-2021-051238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on person-centred care model. This article outlines a study protocol, which aims to explore the effects of the intervention to improve therapeutic adequacy in polymedicated elderly patients. METHODS AND ANALYSIS An open, randomised, multicentre, controlled clinical trial. The study population includes polymedicated (≥8 prescription medications) patients ≥75 years old. In the intervention group, the multidisciplinary team (primary care pharmacist, family doctor and nurse) will meet to carry out multidimensional reviews (frailty, clinical complexity, morbidity and therapeutic adequacy) of the study subjects. If changes are proposed to the treatment plan, a clinical interview will be conducted with the patient to agree on changes in accordance with their preferences. Follow-up visits will be scheduled at 6 and 12 months. In the control group, where the usual clinical practice will be followed, the necessary data will be collected to compare the results.The key variables are the variation in the mean number of incidents (potentially inappropriate prescription) per patient, the number of medications, the number of changes implemented to the treatment plan and the variation in the number of hospital admissions. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the IDIAPJGol and by the University of Barcelona's Bioethics Commission. The results are expected to be published in peer reviewed open-access journals, and as part of a doctoral thesis. TRIAL REGISTRATION NUMBER NCT04188470. Pre-results.
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Affiliation(s)
- Carol Rovira
- Clinical Pharmacy and Pharmaceutical Care Unit. Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry. Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
- Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit. Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry. Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Joaquim Pascual
- Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain
| | - Joan Armengol
- Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain
| | - Cristian Ayala
- Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain
| | - Joan Gallego
- Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit. Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry. Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Anna Ramirez
- Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain
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Saturno-Hernández PJ, Poblano-Verástegui O, Acosta-Ruiz O, Bautista-Morales AC, Gómez-Cortez PM, Alcántara-Zamora JL, Gutiérrez-Robledo LM. Potentially inappropriate prescribing in older adults in Mexico. Rev Saude Publica 2021; 55:80. [PMID: 34816982 PMCID: PMC8601402 DOI: 10.11606/s1518-8787.20210550033110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico. METHODS Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014–2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing. RESULTS Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas. CONCLUSIONS The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.
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Affiliation(s)
| | - Ofelia Poblano-Verástegui
- Centro de Investigación en Evaluación y Encuestas. Instituto Nacional de Salud Pública. Morelos, México
| | - Omar Acosta-Ruiz
- Centro de Investigación en Evaluación y Encuestas. Instituto Nacional de Salud Pública. Morelos, México
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Ibarra Mira ML, Caro-Teller JM, Rodríguez Quesada PP, Garcia-Muñoz C, Añino Alba A, Ferrari Piquero JM. Impact of a Pharmaceutical Care Program at Discharge on Patients at High Risk of Readmission According to the Hospital Score. J Pharm Technol 2021; 37:310-315. [PMID: 34790969 DOI: 10.1177/87551225211047607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A significant percentage of hospital readmissions within 30 days of discharge are a result of avoidable drug-related problems. Stratifying patients according to readmission risk is key to pharmaceutical intervention (PI) design strategies to improve treatment outcomes. Objective: To assess whether a pharmaceutical care (PC) program at discharge in polymedicated patients at high potentially avoidable readmission (PAR) risk, according to the HOSPITAL score, improves 30-day readmission rate (30-dRR). Methods: This prospective controlled, quasi-experimental, 11-month study included 163 chronic polymedicated patients (>5 medications) at high PAR risk according to the HOSPITAL score. We calculated the 30-dRR and number of medication variations and Medication Regimen Complexity Index-E (MRCI-E) after PI. Results were compared with a retrospective cohort of chronic patients at high PAR risk. Results: The 30-dRR was 18.4% in the intervention group and 25.6% in the control group (odds ratio [OR] = 0.66; 95% CI = 0.38 to 1.14). Total medication reduction (-1.28; 95% CI = -1.88 to -0.68), number of high-risk medications in chronic patients (-0.58; 95% CI = -0.9 to -0.26), and MRCI-E (-6.42; 95% CI = -8.07 to -4.76) were statistically significant (P < .001). The number of medications at discharge was associated with an increased readmission risk (OR = 1.07; 95% CI = 1.01 to 1.14). Conclusions: The degree of polypharmacy and patients' treatment complexity after hospital discharge significantly reduced as a result of the PC program compared with the control group. This highlights the need for patient selection and prioritization strategies for implementing PIs focused on reducing polypharmacy and preventing drug-related problems that may cause PAR.
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26
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Candeias C, Gama J, Rodrigues M, Falcão A, Alves G. Potentially Inappropriate Medications and Potential Prescribing Omissions in Elderly Patients Receiving Post-Acute and Long-Term Care: Application of Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment Criteria. Front Pharmacol 2021; 12:747523. [PMID: 34737705 PMCID: PMC8560892 DOI: 10.3389/fphar.2021.747523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Screening Tool of Older People's Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria have been used to detect potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). These criteria were applied to geriatric Portuguese patients receiving post-acute and long-term care to assess the prevalence and predictors of PIMs and PPOs. Methods: An observational, retrospective, cross-sectional and multicenter study was performed in 161 patients (aged ≥65 years) from eight Units for Integrated Continuous Care. Results: In these studied patients (mean age: 81.6, 64% female, median number of medications: 9) PIMs were detected in 85.1% and PPOs in 81.4% of patients. While PIMs mainly involved the central nervous system and psychotropic drugs (66.5%), PPOs were mostly related to musculoskeletal system (55.3%) and cardiovascular (39.8%) system. A subsequent analysis with logistic regression found the female gender, the hospital provenience, and the number of medications as predictors of PIMs. Predictors of PPOs were the Charlson Comorbidity Index and history of recent fractures. Conclusion: PIMs and PPOs were highly prevalent in the studied patients receiving post-acute and long-term care in Units for Integrated Continuous Care. Therefore, STOPP/START criteria might be an effective tool for improving prescribing quality and clinical outcomes in these frail elderly patients.
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Affiliation(s)
- Catarina Candeias
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,UMP-Union of Portuguese Mercies, Lisboa, Portugal
| | - Jorge Gama
- CMA-UBI-Centre of Mathematics and Applications, University of Beira Interior, Covilhã, Portugal
| | - Márcio Rodrigues
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,ESALD-IPCB-Dr. Lopes Dias School of Health, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,UDI-IPG-Research Unit for Inland Development, Polytechnic Institute of Guarda, Guarda, Portugal
| | - Amílcar Falcão
- CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.,Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,ESALD-IPCB-Dr. Lopes Dias School of Health, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,UFBI-Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal
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González-López MDC, García-Ramón MJ, Nievas-Soriano BJ, Parrón-Carreño T. Assessment of the Risk of Antipsychotics in Patients with Dementia in Actual Clinical Practice in Primary Health Care. Pharmaceuticals (Basel) 2021; 14:997. [PMID: 34681225 PMCID: PMC8540725 DOI: 10.3390/ph14100997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
Behavioral and psychological symptoms are almost universal in elderly patients with dementia. Antipsychotic drugs can be used but only in specific contexts as they can generate severe adverse effects. The main aim of this research was to evaluate the use of antipsychotic drugs in patients with accompanying treatment for dementia in actual clinical practice in primary health care. We further sought to analyze risk variables and factors associated and to acknowledge how sociodemographic and clinical factors weighed on adverse effects' occurrence. A multicentric cross-sectional descriptive study was performed in three provinces of Spain. Stratified random sampling was performed to select 332 patients. Clinical data from their digital medical records were collected by their family doctors. The Global risk defined if the patients were subjected to risk. Univariate, bivariate, and multivariate analyses were performed. The most used antipsychotics were quetiapine (65.5%), haloperidol (21.75%), and risperidone (15.8%); 93.8% of patients showed risk, and 81.1% of doses and 75.5% of treatment durations were inappropriate. These two last factors increased the global risk 23 and 20 times, respectively. Conclusions: In actual clinical practice conditions, a high use of antipsychotic drugs was found in patients with dementia. Most patients had inappropriate doses and treatment duration, factors that increased the risk of adverse effects considerably.
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Affiliation(s)
| | - María José García-Ramón
- Primary Health Care District of Almeria, Andalusian Health Service, 04006 Almería, Spain; (M.d.C.G.-L.); (M.J.G.-R.)
| | - Bruno José Nievas-Soriano
- Department of Nursing Science, Physiotherapy and Medicine, University of Almería, 04006 Almería, Spain;
| | - Tesifón Parrón-Carreño
- Department of Nursing Science, Physiotherapy and Medicine, University of Almería, 04006 Almería, Spain;
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28
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Pardo-Cabello AJ, Manzano-Gamero V, Luna JDD. The impact of PIPs on mortality and readmissions in older adults: a retrospective cohort study. Eur J Clin Pharmacol 2021; 78:139-145. [PMID: 34529111 DOI: 10.1007/s00228-021-03217-7] [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: 03/20/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Our aim was to determine the impact of potentially inappropriate prescriptions (PIP), according to "Screening Tool of Older Persons' Prescriptions" criteria version 2 (STOPP-2), on mortality and hospital admissions. METHODS Monocentric retrospective cohort study. Patients over 65 years of age and who were consecutively discharged from internal medicine at a Spanish university hospital in 2016 were included. The mortality and hospital admissions of the cohort of patients were analysed using their electronic health records within two years from the time of discharge. Analysis was done based on the type and number of STOPP-2 criteria as well as taking into account the total number of medications. The subdistribution hazard ratios (SHR) were estimated through a competing proportional hazards model. RESULTS A total of 270 patients with a median age of 82 years (interquartile range/IQR 76-86 years), and 152 (56.3%) women were studied. It was found out that 28.3% of patients with PIP died compared to 17.2% of patients without it. Digoxin (B1 STOPP-2 criterion) with a subdistribution hazard ratio (SHR) 2.40 (95% CI 0.63-9.18), selective serotonin re-uptake inhibitors/SSRIs (D4) with a SHR 1.76 (95% CI 0.52-5.96) and neuroleptic drugs (K2) with a SHR 2.01 (95% CI 0.82-4.95) non-significantly increased the risk of death. Dementia (SHR 5.45; 95% CI 2.76-10.78) was then the only statistically significant risk factor for death. Sixty percent of patients with a PIP had shown at least one hospital admission compared to 51% of patients without it. The number of drugs at discharge (SHR 1.03; 95% CI 1.01-1.05) and having 1-2 STOPP-2 criteria (SHR 1.17; 95% CI 1.02-1.35) significantly increased the risk of hospital admission. CONCLUSION The number of drugs at discharge and having any STOPP criteria significantly increased the risk of hospital admission in this cohort. PIP, only according to some specific STOPP-2 criteria involving digoxin, neuroleptics and SSRIs, might associate with a statistically non-significantly higher risk on mortality.
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Affiliation(s)
| | - Victoria Manzano-Gamero
- Department of Internal Medicine, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Juan de Dios Luna
- Department of Biostatistics, School of Medicine, University of Granada, Granada, Spain
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29
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Martínez-Sotelo J, Pinteño-Blanco M, García-Ramos R, Cadavid-Torres MI. [Prescription appropriateness in elderly patients with polypharmacy in primary care: Cluster-randomized controlled trial PHARM-PC]. Aten Primaria 2021; 53:102124. [PMID: 34488034 PMCID: PMC8424444 DOI: 10.1016/j.aprim.2021.102124] [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: 10/05/2020] [Revised: 03/29/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Objetivos Evaluar la efectividad de la revisión sistemática de medicación realizada por farmacéutico sobre medicaciones potencialmente inapropiadas (MPI), resultados en salud y costes. Diseño Ensayo clínico prospectivo, abierto, controlado y aleatorizado por clústeres. Emplazamiento Seis centros de atención primaria de las Islas Baleares. Participantes Se incluyeron 42 clústeres (21 por grupo), y 549 pacientes de ≥ 65 años y ≥ 5 medicamentos crónicos, de los cuales 277 se asignaron al Grupo Intervención (GI) y 272 al Grupo Control (GC). Se excluyeron pacientes: institucionalizados, desplazados, atendidos habitualmente por la sanidad privada, o en atención domiciliaria. Intervención Detección de MPI por parte del farmacéutico mediante combinación de métodos explícitos e implícitos y comunicación de las alternativas terapéuticas más apropiadas al médico prescriptor. Mediciones Se evaluaron la proporción de pacientes con MPI y número medio de MPI/paciente (variables principales); así como morbilidad, mortalidad, y costes (variables secundarias). Análisis estadístico Siguiendo el principio de intención de tratar, se compararon las variables cuantitativas y cualitativas mediante las pruebas t Student y X2, respectivamente. Los resultados se expresaron como diferencia de proporciones para variables cualitativas y diferencia de medias para cuantitativas, con los correspondientes intervalos de confianza 95% (IC 95%). Resultados Después de la intervención, la proporción de pacientes con MPI disminuyó un 13,7% (IC 95%: 9,3; 18,2) más en GI que GC. El número medio de MPI/paciente y coste medio de MPI/paciente disminuyeron en 0,43 (IC 95%: 0,32; 0,54) y 72,11€ (IC 95%: 26,15; 118,06) más en GI que GC, respectivamente. Sin embargo, no se observaron diferencias estadísticamente significativas en morbilidad, mortalidad ni en costes de episodios asistenciales. Conclusiones La detección de MPI y emisión de recomendaciones por el farmacéutico pudo contribuir a reducir significativamente MPI y gasto en medicamentos, pero sin alcanzar diferencias estadísticamente significativas en morbimortalidad ni costes de episodios asistenciales.
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Affiliation(s)
| | | | - Rosario García-Ramos
- Servicio de Farmacia. Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - María Isabel Cadavid-Torres
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica. Universidade de Santiago de Compostela, Santiago de Compostela, España
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30
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Díaz Planelles I, Saurí Ferrer I, Trillo-Mata JL, Navarro-Pérez J. [Analysis of potentially inappropriate prescriptions according to the START criteria in nursing homes]. Rev Esp Geriatr Gerontol 2021; 56:195-202. [PMID: 34116800 DOI: 10.1016/j.regg.2021.03.004] [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: 10/16/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The potentially inappropriate prescription by omission of a drug is defined as the failure to prescribe drugs that are clinically indicated. The objective of this article is to describe and analyse the evolution of inappropriate prescriptions by omission in nursing homes of a health department. MATERIAL AND METHODS Retrospective observational descriptive study carried out in nursing homes of the Valencia-Clínico-Malvarrosa health department during the period 2016-2018. All institutionalized patients during this period were included. The prevalence of potentially inappropriate prescriptions by omission was assessed based on version 2 of the START criteria. The variables came from the electronic medical records of ambulatory care of the Conselleria de Sanitat (Abucasis). RESULTS 2251 different patients were selected, mean age of 79,53years, 69% women, and an average of 4,60 chronic drugs/resident. A total of 2647 inappropriate prescriptions by omission were identified during the study period, and the results were similar during these 3years. The most prevalent START criteria were those related to the musculoskeletal system and the cardiovascular system, and those related to analgesic consumption. The mean value of inappropriate prescriptions by omission prevalence for the period studied were 39.54%. CONCLUSION The results of our study confirm a high prevalence of potentially inappropriate prescriptions by omission in residents of nursing homes, and the maintenance of this prevalence during the 3years of the study.
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Affiliation(s)
| | - Inma Saurí Ferrer
- INCLIVA Instituto de Investigación Sanitaria. Hospital Clínico Universitario de Valencia, Valencia, España
| | - José Luis Trillo-Mata
- Servicio de Farmacia de Área de Salud, Departamento de Salud Clínico-Malvarrosa. Hospital Clínico Universitario de Valencia, Valencia, España
| | - Jorge Navarro-Pérez
- Universidad de Valencia, Valencia, España; INCLIVA Instituto de Investigación Sanitaria. Hospital Clínico Universitario de Valencia, Valencia, España; Dirección Médica Hospital Clínico Universitario de Valencia, Valencia, España; Centro de Investigación Biomédica en red Epidemiología y Salud Pública (CIBERESP), España
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Troncoso-Mariño A, Roso-Llorach A, López-Jiménez T, Villen N, Amado-Guirado E, Fernández-Bertolin S, Carrasco-Ribelles LA, Borras JM, Violán C. Medication-Related Problems in Older People with Multimorbidity in Catalonia: A Real-World Data Study with 5 Years' Follow-Up. J Clin Med 2021; 10:709. [PMID: 33670201 PMCID: PMC7916946 DOI: 10.3390/jcm10040709] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Aging, multimorbidity, and polypharmacy are associated with medication-related problems (MRPs). This study aimed to assess the association that multimorbidity and mortality have with MRPs in older people over time. We followed multimorbid, older (65-99 years) people in Catalonia from 2012 to 2016, using longitudinal data and Cox models to estimate adjusted hazard ratios (HR). We reviewed electronic health records to collect explanatory variables and MRPs (duplicate therapy, drug-drug interactions, potentially inappropriate medications (PIM), and contraindicated drugs in chronic kidney disease (CKD) or liver disease). There were 723,016 people (median age: 74 years; 58.9% women) who completed follow-up. We observed a significant (p < 0.001) increase in the proportion with at least one MRP (2012: 66.9% to 2016: 75.5%); contraindicated drugs in CKD (11.1 to 18.5%) and liver disease (3.9 to 5.3%); and PIMs (62.5 to 71.1%), especially drugs increasing fall risk (67.5%). People with ≥10 diseases had more MRPs (in 2016: PIMs, 89.6%; contraindicated drugs in CKD, 34.4%; and in liver disease, 9.3%). All MRPs were independently associated with mortality, from duplicate therapy (HR 1.06; 95% confidence interval (CI) 1.04-1.08) to interactions (HR 1.60; 95% CI 1.54-1.66). Ensuring safe pharmacological treatment in elderly, multimorbid patient remains a challenge for healthcare systems.
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Affiliation(s)
- Amelia Troncoso-Mariño
- Medicines Area and Pharmacy Service, Barcelona Territorial Management, Institut Català de la Salut, 08015 Barcelona, Spain; (A.T.-M.); (N.V.); (E.A.-G.)
- Department of Clinical Sciences, University of Barcelona and IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (T.L.-J.); (S.F.-B.); (L.A.C.-R.)
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Tomás López-Jiménez
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (T.L.-J.); (S.F.-B.); (L.A.C.-R.)
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Noemí Villen
- Medicines Area and Pharmacy Service, Barcelona Territorial Management, Institut Català de la Salut, 08015 Barcelona, Spain; (A.T.-M.); (N.V.); (E.A.-G.)
| | - Ester Amado-Guirado
- Medicines Area and Pharmacy Service, Barcelona Territorial Management, Institut Català de la Salut, 08015 Barcelona, Spain; (A.T.-M.); (N.V.); (E.A.-G.)
| | - Sergio Fernández-Bertolin
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (T.L.-J.); (S.F.-B.); (L.A.C.-R.)
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Lucía A. Carrasco-Ribelles
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain; (A.R.-L.); (T.L.-J.); (S.F.-B.); (L.A.C.-R.)
- Departament de Teoria del Senyal i Comunicacions, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain
| | - Josep Ma Borras
- Department of Clinical Sciences, University of Barcelona and IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Concepción Violán
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
- Research Support Unit Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, 08303 Barcelona, Spain
- Concepción Violán, Research Support Unit Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol). Mare de Déu de Guadalupe 2, planta 1ª, Mataro, 08303 Barcelona, Spain
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Agüera-Ortiz L, García-Ramos R, Grandas Pérez FJ, López-Álvarez J, Montes Rodríguez JM, Olazarán Rodríguez FJ, Olivera Pueyo J, Pelegrín Valero C, Porta-Etessam J. Focus on Depression in Parkinson's Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics. PARKINSON'S DISEASE 2021; 2021:6621991. [PMID: 33628415 PMCID: PMC7884180 DOI: 10.1155/2021/6621991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/07/2021] [Accepted: 01/22/2021] [Indexed: 12/26/2022]
Abstract
Major and minor forms of depression are significant contributors to Parkinson's disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson's disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson's disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson's comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rocío García-Ramos
- Movement Disorders Unit, Servicio de Neurología, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Jesús Porta-Etessam
- Service of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, Spain
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Vinuesa-Hernando JM, Gimeno-Gracia M, Malo S, Sanjoaquin-Conde I, Crusells-Canales MJ, Letona-Carbajo S, Gracia-Piquer R. Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities. Int J Clin Pharm 2021; 43:1245-1250. [PMID: 33543418 DOI: 10.1007/s11096-021-01242-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. OBJECTIVES To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65 years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. METHODS Observational study including HIV people (> 65 years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. MAIN OUTCOME MEASURE PIP in elderly people living with HIV. RESULTS Thirty patients were included, 73% of whom were men, with a median age of 71 years (IQR 67 - 76) and a median duration of infection of 17 years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. CONCLUSION The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.
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Affiliation(s)
| | - Mercedes Gimeno-Gracia
- Pharmacy Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sara Malo
- Aragon Institute for Health Research, Zaragoza, Spain.,Microbiology, Preventive Medicine and Public Health Department, Universidad de Zaragoza, Zaragoza, Spain
| | - Isabel Sanjoaquin-Conde
- Aragon Institute for Health Research, Zaragoza, Spain.,Infectious Diseases Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco, Zaragoza, Spain
| | - María José Crusells-Canales
- Aragon Institute for Health Research, Zaragoza, Spain.,Infectious Diseases Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco, Zaragoza, Spain
| | - Santiago Letona-Carbajo
- Aragon Institute for Health Research, Zaragoza, Spain.,Infectious Diseases Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco, Zaragoza, Spain
| | - Raquel Gracia-Piquer
- Pharmacy Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco, Zaragoza, Spain
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Troncoso‐Mariño A, López‐Jiménez T, Roso‐Llorach A, Villén N, Amado‐Guirado E, Guisado‐Clavero M, Fernández‐Bertolin S, Pons Vigues M, Foguet‐Boreu Q, Violán C. Medication-related problems in older people in Catalonia: A real-world data study. Pharmacoepidemiol Drug Saf 2021; 30:220-228. [PMID: 33026123 PMCID: PMC7839740 DOI: 10.1002/pds.5149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to determine medication-related problems (MRPs) in primary care patients over 65 years of age. METHODS Cross-sectional study based on the electronic health records of patients (65-99 years of age) visited in 284 primary health care centers during 2012 in Catalonia. VARIABLES age, sex, sociodemographic variables, number of drugs, kidney and liver function and MRPs (duplicate therapy, drug-drug interactions, potentially inappropriate medications [PIMs] and drugs contraindicated in chronic kidney disease and in liver diseases). Unconditional logistic regression models were used to identify the factors associated with MRPs in patients with multimorbidity. RESULTS 916 619 older people were included and 853 085 of them met the criteria for multimorbidity. Median age was 75 years and 57.7% of them were women. High percentages of MRPs were observed: PIMs (62.8%), contraindicated drugs in chronic kidney disease (12.1%), duplicate therapy (11.1%), contraindicated drugs in liver diseases (4.2%), and drug-drug interactions (1.0%). These numbers were higher in the subgroup of patients with ≥10 diseases. The most common PIMs were connected to drugs that increase the risk of fall (66.8%), antiulcer agents without criteria for gastroprotection (40.6%), and the combination of drugs with anticholinergic effects (39.7%). In the multivariate analysis, the variables associated with all MRPs among the patients with multimorbidity were the number of drugs and the number of visits. CONCLUSIONS The coexistence of multimorbidity and polypharmacy is associated with an elevated risk of MRPs in older people. Medication safety for older patients constitutes a pressing concern for health services.
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Affiliation(s)
- Amelia Troncoso‐Mariño
- Àrea del Medicament i Servei de Farmàcia, Gerència Territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
- Department of Clinical SciencesUniversity of Barcelona and IDIBELL. L'Hospitalet de LlobregatBarcelonaSpain
| | - Tomás López‐Jiménez
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Albert Roso‐Llorach
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Noemí Villén
- Àrea del Medicament i Servei de Farmàcia, Gerència Territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
| | - Ester Amado‐Guirado
- Àrea del Medicament i Servei de Farmàcia, Gerència Territorial de BarcelonaInstitut Català de la SalutBarcelonaSpain
| | - Marina Guisado‐Clavero
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Sergio Fernández‐Bertolin
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
| | - Mariona Pons Vigues
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
- Àrea de Serveis AssistencialsServei Català de la SalutBarcelonaSpain
| | - Quintí Foguet‐Boreu
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
- Department of PsychiatryVic University HospitalBarcelonaSpain
- Department of Basic and Methodological Sciences, Faculty of Health Sciences and WelfareUniversity of Vic‐Central University of Catalonia (UVic‐UCC)VicSpain
| | - Concepción Violán
- Central Research UnitFundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina PreventivaUniversitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
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Agüera-Ortiz L, García-Ramos R, Grandas Pérez FJ, López-Álvarez J, Montes Rodríguez JM, Olazarán Rodríguez FJ, Olivera Pueyo J, Pelegrin Valero C, Porta-Etessam J. Depression in Alzheimer's Disease: A Delphi Consensus on Etiology, Risk Factors, and Clinical Management. Front Psychiatry 2021; 12:638651. [PMID: 33716830 PMCID: PMC7953133 DOI: 10.3389/fpsyt.2021.638651] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Alzheimer's disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. Dementia is often accompanied by depression, but specific diagnostic criteria and treatment approaches are still lacking. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice. Methods: Prospective, multicenter, 2-round Modified Delphi survey with 53 questions regarding risk factors (11), signs and symptoms (7), diagnosis (8), and treatment (27) of depression in dementia, with a particular focus on AD. The questionnaire was completed by a panel of 37 expert physicians in neurodegenerative diseases (19 neurologists, 17 psychiatrists, and 1 geriatrician). Results: Consensus was achieved in 40 (75.5%) of the items: agreement in 33 (62.3%) and disagreement in 7 (13.2%) of them. Among the most relevant findings, depression in the elderly was considered an early sign (prodromal) and/or a dementia risk factor, so routine cognitive check-ups in depressed patients should be adopted, aided by clinical scales and information from relatives. Careful interpretation of neuropsychological assessment must be carried out in patients with depression as it can undermine cognitive outcomes. As agreed, depression in early AD is characterized by somatic symptoms and can be differentiated from apathy by the presence of sadness, depressive thoughts and early-morning awakening. In later-phases, symptoms of depression would include sleep-wake cycle reversal, aggressive behavior, and agitation. Regardless of the stage of dementia, depression would accelerate its course, whereas antidepressants would have the opposite effect. Those that improve cognitive function and/or have a dual or multimodal mode of action were preferred: Duloxetine, venlafaxine/desvenlafaxine, vortioxetine, tianeptine, and mirtazapine. Although antidepressants may be less effective than in cognitively healthy patients, neither dosage nor treatment duration should differ. Anti-dementia cholinesterase inhibitors may have a synergistic effect with antidepressants. Exercise and psychological interventions should not be applied alone before any pharmacological treatment, yet they do play a part in improving depressive symptoms in demented patients. Conclusions: This study sheds light on several unresolved clinical challenges regarding depression in dementia patients. Further studies and specific recommendations for this comorbid patient population are still needed.
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Affiliation(s)
- Luis Agüera-Ortiz
- Service of Psychiatry, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rocío García-Ramos
- Movement Disorders Unit, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Francisco J Grandas Pérez
- Service of Neurology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain
| | - Jorge López-Álvarez
- Service of Psychiatry, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - F Javier Olazarán Rodríguez
- Service of Neurology, HGU Gregorio Marañón, Madrid, Spain.,Memory Disorders Unit, HM Hospitales, Madrid, Spain
| | | | - Carmelo Pelegrin Valero
- Service of Psychiatry, Hospital Universitario San Jorge, Huesca, Spain.,University of Zaragoza Associate Professor, Zaragoza, Spain
| | - Jesús Porta-Etessam
- Service of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, Spain
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Drug interactions for elderly people with mental and behavioral disorders: a systematic scoping review. Arch Gerontol Geriatr 2020; 93:104283. [PMID: 33227533 DOI: 10.1016/j.archger.2020.104283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools. METHODOLOGY A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications. RESULTS 36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines. CONCLUSION Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.
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Lopez-Rodriguez JA, Rogero-Blanco E, Aza-Pascual-Salcedo M, Lopez-Verde F, Pico-Soler V, Leiva-Fernandez F, Prados-Torres JD, Prados-Torres A, Cura-González I. Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross-sectional study. PLoS One 2020; 15:e0237186. [PMID: 32785232 PMCID: PMC7423095 DOI: 10.1371/journal.pone.0237186] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023] Open
Abstract
Background Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria. Objective To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person’s Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. Results A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. Conclusions The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.
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Affiliation(s)
- Juan A. Lopez-Rodriguez
- Primary Healthcare Center General Ricardos, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Eloísa Rogero-Blanco
- Primary Healthcare Center General Ricardos, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- * E-mail:
| | | | - Fernando Lopez-Verde
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Distrito Málaga/Guadalhorce, Málaga, Spain
- Primary Healthcare Center Las Delicias, Málaga, Spain
| | - Victoria Pico-Soler
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- EpiChron Research Group, IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Primary Healthcare Center Torrero-La Paz, Zaragoza, Spain
| | - Francisca Leiva-Fernandez
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Distrito Málaga/Guadalhorce, Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - J. Daniel Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Distrito Málaga/Guadalhorce, Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Alexandra Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- EpiChron Research Group, IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Miguel Servet University Hospital, Zaragoza, Spain
| | - Isabel Cura-González
- Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
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Bahat G, Ilhan B, Erdogan T, Halil M, Savas S, Ulger Z, Akyuz F, Bilge AK, Cakir S, Demirkan K, Erelel M, Guler K, Hanagasi H, Izgi B, Kadioglu A, Karan A, Kulaksizoglu IB, Mert A, Ozturk S, Satman I, Sever MS, Tukek T, Uresin Y, Yalcin O, Yesilot N, Oren MM, Karan MA. Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START. Eur Geriatr Med 2020; 11:491-498. [PMID: 32297261 PMCID: PMC7280176 DOI: 10.1007/s41999-020-00297-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/04/2020] [Indexed: 01/30/2023]
Abstract
Aim To meet the current need in different European countries for improving prescribing in older adults, we aimed to create an update screening tool getting origin from the two user friendly criterion sets: the STOPP/STARTv2 criteria and CRIME criteria. Findings Based on thorough literature review, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified. As a result, 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Message TIME criterion set is an update screening tool reported from Eastern Europe that included experts from geriatrics and other specialties frequently giving care to older adults and some additional practical explanations for clinical use. Electronic supplementary material The online version of this article (10.1007/s41999-020-00297-z) contains supplementary material, which is available to authorized users. Purpose To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need. Methods In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content. Results Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018–March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Conclusion TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults’ health. Electronic supplementary material The online version of this article (10.1007/s41999-020-00297-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Tugba Erdogan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Meltem Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sumru Savas
- Division of Geriatrics, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
| | - Zekeriya Ulger
- Department of Internal Medicine, Kirikkale University Medical School, Kirikkale, Turkey
| | - Filiz Akyuz
- Division of Gastroenterology, Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Sibel Cakir
- Department of Psychiatry, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Mustafa Erelel
- Department of Pulmonary Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Kerim Guler
- Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Belgin Izgi
- Department of Ophthalmology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Ayse Karan
- Department of Physical Therapy and Rehabilitation, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | | | - Ali Mert
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Savas Ozturk
- Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ilhan Satman
- Division of Endocrinology, Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Tufan Tukek
- Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Yagiz Uresin
- Department of Pharmacology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Onay Yalcin
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Nilufer Yesilot
- Department of Neurology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Meryem Merve Oren
- Department of Public Health, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
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Rogero-Blanco E, López-Rodríguez JA, Sanz-Cuesta T, Aza-Pascual-Salcedo M, Bujalance-Zafra MJ, Cura-González I. Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-sectional Study. JMIR Med Inform 2020; 8:e14130. [PMID: 32126005 PMCID: PMC7078622 DOI: 10.2196/14130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/22/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. OBJECTIVE This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person's Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). METHODS This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. RESULTS PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.001), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. CONCLUSIONS There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.
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Affiliation(s)
- Eloisa Rogero-Blanco
- General Ricardos Primary Health Care Centre, Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Juan A López-Rodríguez
- General Ricardos Primary Health Care Centre, Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
| | - Teresa Sanz-Cuesta
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
| | | | - M Jose Bujalance-Zafra
- Dirección Unidad Gestión Clínica Victoria en Málaga, Servicio Andaluz de Salud, Málaga, Spain
| | - Isabel Cura-González
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
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Gómez-Cortijo R, Flotats-Dam P, Iparraguirre-Azcona MK, Cubí-Montanyà D, Sabartés-Fortuny O, Castellarnau-Font A, Oller-Sales I, Arnau A. [Adequacy of the pharmacological prescription during the admission in a geriatric hospital. Clinical experiencie with STOPP/START criteria]. J Healthc Qual Res 2020; 35:95-101. [PMID: 32241728 DOI: 10.1016/j.jhqr.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES The elderly patient is particularly vulnerable to potentially inappropriate prescription (PIP) due to physiological reasons, comorbidity, polypharmacy or the different pharmacokinetics/pharmacodynamics of drugs. The aim of this study was to determine the prevalence of PIP according to the STOPP-START criteria in patients over 65 years admitted into a geriatric hospital, as well as to appraise its acceptance by geriatricians. MATERIAL AND METHODS Retrospective observational study. Patients older than 65 years consecutively admitted to medium/long-stay units were included. The study information was obtained by reviewing the clinical record of the patients. The PIP according to the STOPP-START criteria were assessed by the geriatrician, who decided whether or not to modify the medication and recorded the reasons. RESULTS 247 patients were included, mean age was 82.6 years (SD 7.3), 72.1% of patients were female and a median of 7 drugs (25-75 percentile: 4-9). 78.9% (95%CI: 73.3-83.9) of patients had at least one PIP STOPP-START at admission, 44.9% (95%CI: 38.6-51.4) PIP-STOPP and 59.5% (95%CI: 53.1-65.7) PIP-START. At hospital discharge, the prevalence of PIP-STOPP-START was 46.2% (95%CI: 39.8-52.6), 19.0% (95%CI: 14.3-24.5) of PIP-STOPP and 34.4% (95%CI: 28.5-40.7) PIP-START. CONCLUSIONS The comprehensive geriatric assessment and the use of the STOPP-START criteria can significantly reduce the prevalence of PIP among patients admitted to a geriatric hospital. Nevertheless, issues such as frailty, multimorbidity and functional goals would be taken into account in the appropriateness of the prescription.
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Affiliation(s)
- R Gómez-Cortijo
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Hospital Sant Andreu, Sant Andreu Salut, Manresa, España; Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, España.
| | - P Flotats-Dam
- Hospital Sant Andreu, Sant Andreu Salut, Manresa, España
| | | | - D Cubí-Montanyà
- Hospital Universitari de la Santa Creu-Hospital Universitari de Vic, Vic, España
| | | | | | - I Oller-Sales
- Servei de Farmàcia, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España
| | - A Arnau
- Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, España
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Rivas-Ruiz F, Machón M, Mateo-Abad M, Contreras-Fernández E, Güell C, Baro-Rodríguez L, Vrotsou K, Quirós-López R, Vergara I. Tackling frailty at primary care: evaluation of the effectiveness of a multicomponent intervention through a randomised controlled trial: study protocol. BMJ Open 2020; 10:e034591. [PMID: 32086358 PMCID: PMC7045273 DOI: 10.1136/bmjopen-2019-034591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This project focuses on how frailty is addressed in primary healthcare (PHC) and will evaluate the effectiveness of a multifactorial intervention (considering the appropriateness of the pharmaceutical prescription, the nutritional care provided and the exercise intervention) for persons with frailty, in terms of improving their functional capacity and reducing the incidence of adverse events related to frailty. The final evaluation will be made at 12 months' follow-up. METHODS AND ANALYSIS Pragmatic multicentre cluster randomised controlled clinical trial, single blind with two arms: multifactorial intervention in PHC versus usual follow-up. The randomisation unit is the patient list and the analysis unit is the patient. In addition, a cost-effectiveness study and a qualitative study will be carried out, the latter based on semistructured interviews and focus groups. Two hundred persons (100 per study branch) all aged ≥70 years, presenting frailty, but functionally independent and resident in the community, will be recruited. A baseline evaluation will be carried out prior to the intervention, with follow-up at 6 and 12 months. The main study variables considered will be functional capacity and incidence of adverse events; the secondary variables considered will be the patients' sociodemographic characteristics, nutritional status, level of physical activity and drug consumption, together with data on comorbidity, cognitive and affective status and health-related quality of life. Data will be analysed according to the intention-to-treat principle using a 5% significance level. ETHICS AND DISSEMINATION The study will at all times be conducted in strict accordance with the provisions of the Declaration of Helsinki and with the national legislation regulating patients' autonomy. All patients recruited will be asked to provide written informed consent before taking part in the clinical trial. On completion of the study, the principal investigator expects to publish the results of this research in a peer-reviewed open access scientific journal. TRIAL REGISTRATION NUMBER ISRCTN17143761.
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Affiliation(s)
- Francisco Rivas-Ruiz
- Unidad de Investigación, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Mónica Machón
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, San Sebastián, Spain
- Instituto de Investigación en Servicios de Salud Kronikgune, Baracaldo, Spain
| | - Maider Mateo-Abad
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Instituto de Investigación en Servicios de Salud Kronikgune, Baracaldo, Spain
| | - Eugenio Contreras-Fernández
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Unidad Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud, Distrito Sanitario de Atención Primaria Costa del Sol, Mijas, Málaga, Spain
| | - Carolina Güell
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, San Sebastián, Spain
- Osakidetza, Centro de salud de Altza, San Sebastián, Spain
| | - Luis Baro-Rodríguez
- Área del Medicamento, Distrito Sanitario de Atencion Primaria Costa del Sol, Mijas, Spain
| | - Kalliopi Vrotsou
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, San Sebastián, Spain
- Instituto de Investigación en Servicios de Salud Kronikgune, Baracaldo, Spain
| | - Raúl Quirós-López
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Medicina Interna, Agencia Sanitaria Costa del Sol, Marbella, Spain
| | - Itziar Vergara
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, San Sebastián, Spain
- Instituto de Investigación en Servicios de Salud Kronikgune, Baracaldo, Spain
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Baré M, Herranz S, Jordana R, Gorgas MQ, Ortonobes S, Sevilla D, De Jaime E, Ibarra O, Martín C. Multimorbidity patterns in chronic older patients, potentially inappropriate prescribing and adverse drug reactions: protocol of the multicentre prospective cohort study MoPIM. BMJ Open 2020; 10:e033322. [PMID: 31988230 PMCID: PMC7044922 DOI: 10.1136/bmjopen-2019-033322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Multimorbidity is a major challenge for current healthcare systems and professionals. From the different approaches that have been proposed to analyse this issue, the hypothesis of the existence of association patterns of different chronic conditions is gaining visibility. In addition, multimorbidity can be associated to polypharmacy, which can lead to a higher risk of potentially inappropriate prescribing (PIP) and consequently to adverse drug reactions (ADRs). The general objective of this novel study is to identify the association between PIP, multimorbidity patterns, polypharmacy and the presence of ADRs in older patients admitted for exacerbation of chronic diseases. METHODS AND ANALYSIS The MoPIM (morbidity, potentially inappropriate medication) study is a multicentre prospective cohort study of an estimated sample of 800 older (≥65 years) patients admitted to five general hospitals in Spain due to an exacerbation of a chronic disease. Patients referred to home hospitalisation, admitted due to an acute process or with a fatal outcome expected at the time of admission are excluded. Sociodemographic data, chronic morbidities and geriatric syndromes, number of chronic prescribed medications, PIP at admission to hospital and on discharge, according to the newest screening tool of older screening tool of older person's potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria, and ADRs during hospitalisation are being collected. Multimorbidity patterns will be identified using cluster analyses techniques, and the frequency of polypharmacy, PIP and ADRs will be calculated. Finally, the possible relationship between those indicators will be identified through bivariate and multivariate analyses. ETHICS AND DISSEMINATION The project has been approved by the clinical research ethics committees of each centre: Comité Ético de investigación Clínica del Parc Taulí, Comitè Ètic d'Investigació Clínica Osona per a la Recerca i Educació Sanitàries (FORES), Comité de Ètica de la Investigación con Medicamentos (CEIm)-Parc de Salut MAR, Comité Ético de Investigación Clínica de Euskadi, Comité de Ética de Investigación del Hospital Universitario de Canarias. The results will be actively and mainly disseminated through publication in peer-reviewed journals and communications in scientific conferences. TRIAL REGISTRATION NUMBER NCT02830425.
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Affiliation(s)
- Marisa Baré
- Department of Epidemiology and Cancer Screening, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Catalonia, Spain
| | - Susana Herranz
- Internal Medicine Department, Acute Care Geriatric Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Rosa Jordana
- Internal Medicine Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Maria Queralt Gorgas
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Sara Ortonobes
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Daniel Sevilla
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Catalonia, Spain
| | - Elisabet De Jaime
- Geriatrics Department, Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalonia, Spain
| | - Olatz Ibarra
- Pharmacy Department, Hospital Galdakao-Usansolo, Galdacano, País Vasco, Spain
| | - Candelaria Martín
- Internal Medicine Department, Hospital Universitario de Canarias, La Laguna, Canarias, Spain
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Palchik V, Bianchi M, Colautti M, Salamano M, Pires N, Catena JM, Dolza ML, Tassone V, Lillini G, Paciaroni J, Traverso ML. [Pharmaceutical care for older adults. Application of STOPP-START criteria]. J Healthc Qual Res 2019; 35:35-41. [PMID: 31870864 DOI: 10.1016/j.jhqr.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Drug-related problems can be caused by potentially inappropriate prescribing (PIP), one of the most used tools for its identification are the STOPP (Older Persons' potentially inappropriate Prescriptions) - START (Screening Tool to Alert doctors to Right Treatment) criteria. The objective of this study is to determine PIP in older adults who receive pharmaceutical care in the Pharmacotherapy Optimization Unit (POU)-Rosario. MATERIALS AND METHODS Pharmacoepidemiological observational study, which evaluates the quality of medication use. Workplace: POU-Rosario. Population under study: adults over 60 years of age, who received pharmacotherapy follow-up during the period March 2017 to February 2018. PIPs were identified using the STOPP-START criteria, 2014 version; selecting the most appropriate criteria to assess outpatient pharmacotherapy. Prevalence of PIP and amount of PIP per active principle were estimated. RESULTS 50 patients older than 60 years received pharmacotherapy follow-up in the POU; 47 patients (94.0%) had at least one PIP corresponding to a STOPP criterion; 17 STOPP criteria were found among the 41 initially selected, leading to 145 PIPs identified. And 7 START criteria among the 11 initially selected, leading to 50 PIPs identified. Medications with a higher amount of PIPs: benzodiazepines and proton pump inhibitors. CONCLUSIONS This study allowed the identification of a high prevalence of PIP. The data obtained show the usefulness of these criteria. The STOPP-START criteria have been included to support decision making during pharmacotherapy follow-up to propose pharmaceutical interventions, in order to enhance pharmacotherapy. These activities contribute to patient safety, a dimension of health quality.
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Affiliation(s)
- V Palchik
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - M Bianchi
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - M Colautti
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - M Salamano
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - N Pires
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - J M Catena
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - M L Dolza
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - V Tassone
- Colegio de Farmacéuticos de la Provincia de Santa Fe, 2.(a) Circunscripción, Rosario, Argentina
| | - G Lillini
- Colegio de Farmacéuticos de la Provincia de Santa Fe, 2.(a) Circunscripción, Rosario, Argentina
| | - J Paciaroni
- Colegio de Farmacéuticos de la Provincia de Santa Fe, 2.(a) Circunscripción, Rosario, Argentina
| | - M L Traverso
- Área de Farmacia Asistencial, Departamento de Farmacia, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.
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Gutiérrez-Valencia M, Aldaz Herce P, Lacalle-Fabo E, Contreras Escámez B, Cedeno-Veloz B, Martínez-Velilla N. Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017. Med Clin (Barc) 2019; 153:141-150. [DOI: 10.1016/j.medcli.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
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45
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Gonzalez-Colaço Harmand M, Aldea-Perona AM, Boada-Fernández del Campo C, Areosa-Sastre A, Rodríguez-Jiménez C, García Sánchez-Colomer M, Fernández Quintana E, Plasencia-Nuñez M, Masiero-Aparicio P, Grillo-Grillo C, Orellana-Mobilli A, García Sáiz M, Duarte Diéguez C, Hornillos Calvo M, Avellana Zaragoza JA, Martínez Velilla N, de Guzmán Pérez Hernández D, Ruiz González M, Blanco Reina E, Asensio Ostos C, Peiró A, Cabrera García L, Hortigüela Moro F, Pérez Alayón H, Espárrago García I, Santana Quilez J, Alonso Ramírez J, Fernández Oropesa C, López Varona MJ, Acín Gerico MT, Sanz Alvarez E, Martín de la Sierra MÁ, Peñalver MJ, Falomir Gómez T, Ruiz Salazar J, Rivas GE, Rey Rodríguez E. Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project). Eur J Clin Pharmacol 2019; 75:1161-1176. [DOI: 10.1007/s00228-019-02684-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/15/2019] [Indexed: 12/20/2022]
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46
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Delgado-Silveira E, Mateos-Nozal J, Muñoz García M, Rexach Cano L, Vélez-Díaz-Pallarés M, Albeniz López J, Cruz-Jentoft AJ. [Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)]. Rev Esp Geriatr Gerontol 2019; 54:151-155. [PMID: 30606497 DOI: 10.1016/j.regg.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty.
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Affiliation(s)
| | - Jesús Mateos-Nozal
- Servicio de Geriatría (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - Maria Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Lourdes Rexach Cano
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Jana Albeniz López
- Servicio de Geriatría (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
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47
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[Appropriate medications: Also at the end of life]. Rev Esp Geriatr Gerontol 2019; 54:127-128. [PMID: 30971344 DOI: 10.1016/j.regg.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
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48
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Gonzalez-Lopez A, Nava-Rebollo A, Chocarro-Martinez A, Andres-Martin B, Santana-Zapatero H, Herrera-Gomez F, Diego-Martin J, Escaja-Muga C, Grande-Villoria J. Prescripción potencialmente inapropiada en pacientes en diálisis utilizando los criterios STOPP-START. Nefrologia 2019; 39:92-94. [DOI: 10.1016/j.nefro.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/26/2018] [Accepted: 03/22/2018] [Indexed: 10/27/2022] Open
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49
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Rodríguez-Blanco R, Álvarez-García M, Villalibre-Calderón C, Piña-Ferreras LD, Junquera-Alonso S, Alonso-Lorenzo JC. [Updated report on STOPP-START criteria in Primary Care]. Semergen 2018; 45:180-186. [PMID: 30545673 DOI: 10.1016/j.semerg.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/06/2018] [Accepted: 06/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Avilés, Asturias, Spain. MATERIALS AND METHODS A descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. RESULTS The study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. CONCLUSIONS There were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP.
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Affiliation(s)
- R Rodríguez-Blanco
- Centro de Salud de Sabugo, Área Sanitaria III. SESPA, Avilés, Asturias, España.
| | - M Álvarez-García
- Centro de Salud Las Vegas, Corvera, Área Sanitaria III, SESPA, Avilés,Asturias, España
| | | | - L D Piña-Ferreras
- Centro de Salud de La Magdalena, Área Sanitaria III, SESPA, Avilés,Asturias, España
| | - S Junquera-Alonso
- Centro de Salud de La Magdalena, Área Sanitaria III, SESPA, Avilés,Asturias, España
| | - J C Alonso-Lorenzo
- Unidad de Salud Pública, Gerencia del Área Sanitaria IV, SESPA, Oviedo, Asturias, España
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50
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Garay-Bravo C, Peña A, Molina M, Sanfeliu J, Piles P, Blasco P, Salazar J. Application of the STOPP criteria in hospitalised elderly patients to detect and optimise inappropriate psychopharmaceutical prescriptions. Eur Geriatr Med 2018; 9:597-602. [PMID: 34654224 DOI: 10.1007/s41999-018-0091-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychotropic drugs are frequently used in the elderly population, but their inappropriate prescription can cause numerous adverse effects and interactions. OBJECTIVE To evaluate the impact of a multidisciplinary intervention to detect and optimise inappropriate prescriptions of psychotropic drugs in patients aged over 75 years in a hospital setting. DESIGN, SETTING, SUBJECTS AND METHODS A prospective study which included every patient aged over 75 years admitted to the Consorcio Hospital General in Valencia, Spain, and who had been prescribed psychotropic drugs inappropriately, carried out over 1 year. The intervention was to detect inappropriate prescriptions of psychotropic drugs using the STOPP criteria, treatment optimisation by a team of psychiatrists, readjustment of the electronic prescription register, and communication to the primary care physician. The impact of the intervention was assessed by measuring the persistence of the changes made 3 months after discharge and by quarterly assessment of inappropriate prescriptions. RESULTS Of 4571 admissions, 378 inappropriate prescriptions were detected in 346 patients. The drugs most frequently used were long half-life benzodiazepines (70%), which were substituted in 62% of the cases, withdrawn in 32%, and maintained in 6%. At 3 months follow-up, the changes had been maintained by the patients' primary care physician in 67%. Evaluation of the prescriptions during the subsequent quarters of the year showed a significant decrease in the inappropriate prescriptions, especially benzodiazepines. CONCLUSIONS Coordinated intervention by pharmacologists and psychiatrists in hospital settings, and communication between these professionals and primary care teams, can reduce psychotropic drugs inappropriately prescribed to the elderly.
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Affiliation(s)
- Claudio Garay-Bravo
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain.
| | - A Peña
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
| | - M Molina
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
| | - J Sanfeliu
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - P Piles
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
| | - P Blasco
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - J Salazar
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
- CIBERSAM, Valencia, Spain
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