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Jurado-Palomo J, Sanz-García A, Martín-Conty JL, Polonio-López B, López-Izquierdo R, Sáez-Belloso S, Del Pozo Vegas C, Martín-Rodríguez F. Prehospital point-of-care medication burden as a predictor of poor related outcomes in unselected acute diseases. Intern Emerg Med 2024:10.1007/s11739-024-03729-x. [PMID: 39090370 DOI: 10.1007/s11739-024-03729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
How prehospital medication predicts patient outcomes is unclear. The aim of this work was to unveil the association between medication burden administration in prehospital care and short, mid, and long-term mortality (2, 30, and 365 day) in unselected acute diseases and to assess the potential of the number of medications administered for short, mid, and long-term mortality prediction. A prospective, multicenter, ambulance-based, cohort study was carried out in adults with unselected acute diseases managed by emergency medical services (EMS). The study was carried out in Spain with 44 ambulances and four hospitals. The principal outcome was cumulative mortality at 2, 30, and 365 days. Epidemiological variables, vital signs, and prehospital medications were collected. Patients were classified into four categories: no medication dispensed in prehospital care, one to two medications, three to four medications, and five or more medications. A total of 6401 patients were selected. The 2-day mortality associated with each group was 0.5%, 1.8%, 6.5%, and 18.8%. The 30-day mortality associated with each group was 3.8%, 6.2%, 13.5%, and 31.9%. The 365-day mortality associated with each group was 11%, 15.3%, 25.2%, and 45.7%. The predictive validity of the number of drugs administered, measured by the area under the curve, was 0.808, 0.720, and 0.660 for 2-, 30-, and 365-day mortality, respectively. Our results showed that prehospital drugs could provide relevant information regarding the mortality prediction of patients. The incorporation of this score could improve the management of high-risk patients by the EMS.
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Affiliation(s)
- Jesús Jurado-Palomo
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain
- Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain.
| | - José Luis Martín-Conty
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Grupo de Investigación ITAS, Faculty of Health Sciences, Universidad de Castilla la Mancha, Avda. Real Fábrica de Seda, s/n, 45600, Talavera de la Reina, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - Silvia Sáez-Belloso
- Prehospital Emergency Medical Services (SACYL), Valladolid, Spain
- Faculty of Nursing, Universidad de Valladolid, Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Prehospital Emergency Medical Services (SACYL), Valladolid, Spain
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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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Cole JA, Gonçalves-Bradley DC, Alqahtani M, Barry HE, Cadogan C, Rankin A, Patterson SM, Kerse N, Cardwell CR, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2023; 10:CD008165. [PMID: 37818791 PMCID: PMC10565901 DOI: 10.1002/14651858.cd008165.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, so that many medicines may be used to achieve better clinical outcomes for patients. This is the third update of this Cochrane Review. OBJECTIVES To assess the effects of interventions, alone or in combination, in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers up until 13 January 2021, together with handsearching of reference lists to identify additional studies. We ran updated searches in February 2023 and have added potentially eligible studies to 'Characteristics of studies awaiting classification'. SELECTION CRITERIA For this update, we included randomised trials only. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy (four or more medicines) in people aged 65 years and older, which used a validated tool to assess prescribing appropriateness. These tools can be classified as either implicit tools (judgement-based/based on expert professional judgement) or explicit tools (criterion-based, comprising lists of drugs to be avoided in older people). DATA COLLECTION AND ANALYSIS Four review authors independently reviewed abstracts of eligible studies, and two authors extracted data and assessed the risk of bias of the included studies. We pooled study-specific estimates, and used a random-effects model to yield summary estimates of effect and 95% confidence intervals (CIs). We assessed the overall certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS We identified 38 studies, which includes an additional 10 in this update. The included studies consisted of 24 randomised trials and 14 cluster-randomised trials. Thirty-six studies examined complex, multi-faceted interventions of pharmaceutical care (i.e. the responsible provision of medicines to improve patients' outcomes), in a variety of settings. Interventions were delivered by healthcare professionals such as general physicians, pharmacists, nurses and geriatricians, and most were conducted in high-income countries. Assessments using the Cochrane risk of bias tool found that there was a high and/or unclear risk of bias across a number of domains. Based on the GRADE approach, the overall certainty of evidence for each pooled outcome ranged from low to very low. It is uncertain whether pharmaceutical care improves medication appropriateness (as measured by an implicit tool) (mean difference (MD) -5.66, 95% confidence interval (CI) -9.26 to -2.06; I2 = 97%; 8 studies, 947 participants; very low-certainty evidence). It is uncertain whether pharmaceutical care reduces the number of potentially inappropriate medications (PIMs) (standardised mean difference (SMD) -0.19, 95% CI -0.34 to -0.05; I2 = 67%; 9 studies, 2404 participants; very low-certainty evidence). It is uncertain whether pharmaceutical care reduces the proportion of patients with one or more PIM (risk ratio (RR) 0.81, 95% CI 0.68 to 0.98; I2 = 84%; 13 studies, 4534 participants; very low-certainty evidence). Pharmaceutical care may slightly reduce the number of potential prescribing omissions (PPOs) (SMD -0.48, 95% CI -1.05 to 0.09; I2 = 92%; 3 studies, 691 participants; low-certainty evidence), however it must be noted that this effect estimate is based on only three studies, which had serious limitations in terms of risk of bias. Likewise, it is uncertain whether pharmaceutical care reduces the proportion of patients with one or more PPO (RR 0.50, 95% CI 0.27 to 0.91; I2 = 95%; 7 studies, 2765 participants; very low-certainty evidence). Pharmaceutical care may make little or no difference to hospital admissions (data not pooled; 14 studies, 4797 participants; low-certainty evidence). Pharmaceutical care may make little or no difference to quality of life (data not pooled; 16 studies, 7458 participants; low-certainty evidence). Medication-related problems were reported in 10 studies (6740 participants) using different terms (e.g. adverse drug reactions, drug-drug interactions). No consistent intervention effect on medication-related problems was noted across studies. This also applied to studies examining adherence to medication (nine studies, 3848 participants). AUTHORS' CONCLUSIONS It is unclear whether interventions to improve appropriate polypharmacy resulted in clinically significant improvement. Since the last update of this review in 2018, there appears to have been an increase in the number of studies seeking to address potential prescribing omissions and more interventions being delivered by multidisciplinary teams.
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Affiliation(s)
- Judith A Cole
- Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | | | | | | | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Audrey Rankin
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Cristin Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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Roitto HM, Aalto UL, Öhman H, Saarela RKT, Kautiainen H, Salminen K, Pitkälä KH. Association of medication use with falls and mortality among long-term care residents: a longitudinal cohort study. BMC Geriatr 2023; 23:375. [PMID: 37331981 DOI: 10.1186/s12877-023-04096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Falls in long-term care are common. The aim of our study was to explore how medication use is associated with incidence of falls, related consequences, and all-cause mortality among long-term care residents. METHODS Five hundred thirty two long-term care residents aged 65 years or older participated in this longitudinal cohort study in 2018-2021. Data on medication use were retrieved from medical records. Polypharmacy was defined as use of 5-10 medications and excessive polypharmacy as use of > 10 medications. The numbers of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Participants were followed for three years for mortality. All analysis were adjusted for age, sex, Charlson Comorbidity Index, Clinical dementia rating, and mobility. RESULTS A total of 606 falls occurred during the follow-up. Falls increased significantly with the number of medications used. Fall rate was 0.84/person-years (pyrs) (95% CI 0.56 to 1.13) for the non-polypharmacy group, 1.13/pyrs (95% CI 1.01 to 1.26) for the polypharmacy group, and 1.84/pyrs (95% CI 1.60 to 2.09) for the excessive polypharmacy group. Incidence rate ratio for falls was 1.73 (95% CI 1.44 to 2.10) for opioids, 1.48 (95% CI 1.23 to 1.78) for anticholinergic medication, 0.93 (95% CI 0.70 to 1.25) for psychotropics, and 0.91 (95% CI 0.77 to 1.08) for Alzheimer medication. The three-year follow-up showed significant differences in mortality between the groups, the lowest survival rate (25%) being in the excessive polypharmacy group. CONCLUSION Polypharmacy, opioid and anticholinergic medication use predicted incidence of falls in long-term care. The use of more than 10 medications predicted all-cause mortality. Special attention should be paid to both number and type of medications when prescribing in long-term care.
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Affiliation(s)
- Hanna-Maria Roitto
- Department of Geriatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Finnish Institute for Health and Welfare, Population Health Unit, Helsinki, Finland.
- Department of Social Services and Health Care, Helsinki, Finland.
| | - Ulla L Aalto
- Department of Geriatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Öhman
- Department of Geriatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Karoliina Salminen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Famuyiro T, Montas A, Tanoos T, Obinyan TE, Raji M. Deprescribing in Real Time: Hospitalized Septuagenarian With Polypharmacy. Cureus 2023; 15:e40699. [PMID: 37485211 PMCID: PMC10359101 DOI: 10.7759/cureus.40699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Polypharmacy is a common and potentially preventable contributor to recurring emergency room visits, hospitalization, morbidity, and mortality. Its consequences are magnified in older adults due to the age-related decrease in functional and physiologic reserves, increased blood-brain barrier permeability, and altered drug metabolism, among others. In this article, we describe a case of polypharmacy in a septuagenarian to highlight the deprescribing approach implemented by the inpatient care team and to offer patient-centered insights to clinicians (primary care providers and hospitalists) when making deprescribing decisions. The overarching aim of this article is to build on existing literature regarding polypharmacy, prescribing cascades, and deprescribing in the context of what matters most and aligns with patient health priorities. This article highlights the importance of good geriatric medication reconciliation stewardship to avoid harm.
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Affiliation(s)
- Tolulope Famuyiro
- Department of Geriatrics, Baton Rouge General Medical Center, Baton Rouge, USA
| | - Alexia Montas
- Department of Family and Community Medicine, Baton Rouge General Medical Center, Baton Rouge, USA
| | - Taylor Tanoos
- Department of Nursing, Baton Rouge General Medical Center, Baton Rouge, USA
| | - Trisha E Obinyan
- Department of Pharmacy, Baton Rouge General Medical Center, Baton Rouge, USA
| | - Mukaila Raji
- Department of Internal Medicine-Division of Geriatrics & Palliative Medicine, University of Texas Medical Branch, Galveston, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, USA
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Danjuma MIM, Naseralallah L, Ansari S, Al Shebly R, Elhams M, AlShamari M, Kordi A, Fituri N, AlMohammed A. Prevalence and global trends of polypharmacy in patients with chronic liver disease: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32608. [PMID: 37171329 PMCID: PMC10174406 DOI: 10.1097/md.0000000000032608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Despite its central role in drug metabolism, the exact prevalence estimates and factors affecting global trends of polypharmacy in patients with chronic liver disease (CLD) have remained unexamined. The aim of this systematic review and meta-analysis is to estimate the prevalence of polypharmacy in patients with CLD and to comprehensively synthesize the socio-demographic factors that drive this. METHODS We conducted a comprehensive search of relevant databases (PubMed, EMBASE, Science citation index, Cochrane Database of Systematic Reviews, and database of abstracts of reviews of effectiveness) for studies published from inception to May 30, 2022 that reported on prevalence estimates of polypharmacy in patients with CLD. The risk of bias was conducted utilizing Loney criteria. The primary outcome was the pooled prevalence of polypharmacy in patients with CLD. We subsequently performed a systematic review and weighted meta-analysis to ascertain the exact pooled prevalence of polypharmacy among patients with CLD. RESULTS We identified approximately 50 studies from the initial literature search, of which 7 (enrolling N = 521,435 patients) with CLD met the inclusion criteria; of these, 58.7% were male, with a mean age of 53.9 (SD ± 12.2) years. The overall pooled prevalence of polypharmacy among patients with CLD was 31% (95% confidence interval [CI]: 4%-66%, I2 = 100%, τ2 ≤ 0.001, P ≤ .0001). We found higher pooled prevalence estimates among patients aged 50 years and older compared to their younger cohorts (42%, [CI 10-77]; I2 = 100%, P = <.001 vs 21%, [CI 0-70]; I2 = 100%, P = <.001). CONCLUSION In an examination of multiple community- and hospital-based databases of patients with CLD, we found a pooled prevalence estimate of polypharmacy of approximately 31%. This represents a case burden within the range reported in the general population and will likely respond to mitigation strategies employed thus far for patients in that population.
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Affiliation(s)
- Mohammed Ibn-Mas'ud Danjuma
- Weill Cornell College of Medicine, NY, Doha Qatar
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University (QU Health), Doha, Qatar
| | - Lina Naseralallah
- Department of Pharmacy, Hamad Medical Corporation, Doha Qatar
- School of Pharmacy, College of Medical and Dentil Science, University of Birmingham, Birmingham, UK
| | - Soubiya Ansari
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rafal Al Shebly
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Elhams
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Manwa AlShamari
- College of Medicine, Qatar University (QU Health), Doha, Qatar
| | - Ahmad Kordi
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nuha Fituri
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed AlMohammed
- Weill Cornell College of Medicine, NY, Doha Qatar
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Omuya H, Nickel C, Wilson P, Chewning B. A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023:7156969. [PMID: 37155330 DOI: 10.1093/ijpp/riad025] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Mixed findings about deprescribing impact have emerged from varied study designs, interventions, outcome measures and targeting sub-categories of medications or morbidities. This systematic review controls for study design by reviewing randomised-controlled trials (RCTs) of deprescribing interventions using comprehensive medication profiles. The goal is to provide a synthesis of interventions and patient outcomes to inform healthcare providers and policy makers about deprescribing effectiveness. OBJECTIVES This systematic review aims to (1) review RCT deprescribing studies focusing on complete medication reviews of older adults with polypharmacy across all health settings, (2) map patients' clinical and economic outcomes against intervention and implementation strategies and (3) inform research agendas based on observed benefits and best practices. METHODS The PRISMA framework for systematic reviews was followed. Databases used were EBSCO Medline, PubMed, Cochrane Library, Scopus and Web of Science. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials. RESULTS Fourteen articles were included. Interventions varied in setting, preparation, use of interdisciplinary teams, validated guidelines and tools, patient-centredness and implementation strategy. Thirteen studies (92.9%) found deprescribing interventions reduced the number of drugs and/or doses taken. No studies found threats to patient safety in terms of primary outcomes including morbidity, hospitalisations, emergency room use and falls. Four of five studies identifying health quality of life as a primary outcome found significant effects associated with deprescribing. Both studies with cost as their primary outcome found significant effects as did two with cost as a secondary outcome. Studies did not systematically study how intervention components influenced deprescribing impact. To explore this gap, this review mapped studies' primary outcomes to deprescribing intervention components using the Consolidated Framework for Implementation Research. Five studies had significant, positive primary outcomes related to health-related quality of life (HRQOL), cost and/or hospitalisation, with four reporting patient-centred elements in their intervention. CONCLUSIONS RCT primary outcomes found deprescribing is safe and reduces drug number or dose. Five RCTs found a significant deprescribing impact on HRQOL, cost or hospitalisation. Important future research agendas include analysing (1) understudied outcomes like cost, and (2) intervention and implementation components that enhance effectiveness, such as patient-centred elements.
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Affiliation(s)
- Helen Omuya
- Health Services Research in Pharmacy, School of Pharmacy, University of Wisconsin Madison, Madison WI
| | - Clara Nickel
- School of Pharmacy, University of Wisconsin Madison, Madison WI
| | - Paije Wilson
- Ebling Library for the Health Sciences, University of Wisconsin Madison, Madison, WI, USA
| | - Betty Chewning
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, WI, USA
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8
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Naseralallah L, Khatib M, Al-Khulaifi A, Danjuma M. Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis. Front Pharmacol 2023; 14:1122898. [PMID: 36843919 PMCID: PMC9950938 DOI: 10.3389/fphar.2023.1122898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Background and objectives: Polypharmacy and chronic kidney disease (CKD) are becoming increasingly common due to an ageing population and the rise of multimorbidity. In line with the therapeutic guidelines, managing CKD and its complications necessitates prescribing multiple medications, which predisposes patients to polypharmacy. The aim of this systematic review and meta-analysis is to describe the prevalence of polypharmacy in patients with CKD and to explore the global trends of factors driving any apparent variability in prevalence estimates. Methods: PubMed, Scopus, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar were searched from 1999 to November 2021. Study selection, data extraction, and critical appraisal were conducted by two independent reviewers. The pooled prevalence of polypharmacy was estimated utilizing the random effects model using the default double arcsine transformation. Results: This review involved 14 studies comprising of 17 201 participants, a significant proportion of which were males (56.12%). The mean age of the review population was 61.96 (SD ± 11.51) years. The overall pooled prevalence of polypharmacy amongst patients with CKD was 69% (95% CI: 49%-86%) (I2 = 100%, p < 0.0001), with a proportionately higher prevalence in North America and Europe as compared to Asia. Conclusion: The results from this meta-analysis showed a high pooled prevalence estimates of polypharmacy amongst patient cohorts with CKD. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022306572].
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Affiliation(s)
- Lina Naseralallah
- Clinical Pharmacy Department, Hamad Medical Corporation, Doha, Qatar,School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom,*Correspondence: Lina Naseralallah,
| | - Malkan Khatib
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Mohammed Danjuma
- College of Medicine, QU Health, Qatar University, Doha, Qatar,Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar,Weill Cornell College of Medicine, Doha, Qatar
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9
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Davies LE, Todd A, Robinson L, Kingston A. Does polypharmacy shape dependency transitions in the very old? Findings from the Newcastle 85+ Study. Age Ageing 2022; 51:6782915. [PMID: 36315431 PMCID: PMC9621148 DOI: 10.1093/ageing/afac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND helping older people to maintain their independence, and identifying risk factors that compromise this, is of high importance. Polypharmacy is common in the very old (aged ≥ 85) but whether it can shape transitions in dependency in this fastest growing subpopulation is unclear. METHODS using Newcastle 85+ Study data and multi-state modelling, we investigated the association between each additional medication prescribed and the progression of and recovery from dependency states, over 10 years (age 85-95). Participants were defined as either free from care (independent), requiring care less often than daily (low dependency), or requiring care at regular intervals each day or 24 hourly (medium/high dependency). RESULTS each additional medication prescribed was associated with a 10% decreased chance of recovery from low dependence to independence (hazard ratio (HR): 0.90, 95% confidence interval (CI): 0.82-0.99). DISCUSSION when a relatively able person visits the GP or clinical pharmacist, careful consideration should be given to whether the potential benefits from adding a new medication outweigh the risk to reduced recovery of independence.
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Affiliation(s)
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
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