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Bakimli İ, Tuğrul E. Investigation of rational drug use behaviors and knowledge levels of older individuals: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230692. [PMID: 38294123 PMCID: PMC10830095 DOI: 10.1590/1806-9282.20230692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/27/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim of this study was to examine older individuals' rational drug use behavior, their knowledge of rational drug use, and the factors affecting it. METHODS This study was conducted cross-sectionally with 440 patients aged 65 years who received inpatient treatment in internal medicine and surgery clinics between October 2021 and November 2022 using a Rational Drug Use Scale and rational drug use behavior questions. RESULTS The findings showed that the mean age of older adults was 72.56±5.84 years, and 51.8% were men. It was determined that 79.1% of the older adults did not check their expiration date before using the medicines, and 85.9% of them retained the remaining medicines after treatment. Results indicated that 77.3% of older adults knew less about rational drug use. Additionally, a significant difference was observed between older adults' marital status, educational status, possession of outdated drugs at home, self-use of antibiotics without examination, and mean score on the Rational Drug Use Scale (p<0.05). CONCLUSION The results showed that the rational drug use knowledge level of older adults was low and that there were differences in the knowledge levels of rational drug use according to certain behaviors and factors.
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Affiliation(s)
- İpek Bakimli
- Manisa Merkezefendi State Hospital, Anesthesia Intensive Care Unit – Manisa, Turkey
| | - Emel Tuğrul
- Aydın Adnan Menderes University, Nursing Faculty, Department of Fundamentals of Nursing – Aydın, Turkey
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2
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Ambulatory Medication Safety in Primary Care: A Systematic Review. J Am Board Fam Med 2022; 35:610-628. [PMID: 35641040 PMCID: PMC9730343 DOI: 10.3122/jabfm.2022.03.210334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To review the literature on medication safety in primary care in the electronic health record era. METHODS Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias. RESULTS Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm. CONCLUSIONS This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.
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Kargar M, Atrianfar F, Rashidian A, Heidari K, Noroozian M, Gholami K, Javadi MR. Prescribing for geriatrics in Tehran; is it appropriate and rational? Med J Islam Repub Iran 2020; 33:143. [PMID: 32280649 PMCID: PMC7137821 DOI: 10.34171/mjiri.33.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The world’s population is growing older. Inappropriate and irrational use of drugs in the elderly is a considerable health concern due to consequences such as increased morbidity and adverse drug events. This study aimed to evaluate the rationality of prescribing and determining the extent of inappropriate prescribing in a sample of geriatric patients in Tehran.
Methods: This cross sectional study was performed on 1512 prescriptions of patients aged ≥ 65 years from 5 pharmacies affiliated to Tehran University of Medical Sciences in 2014. Prescription of potentially inappropriate medications (PIMs) was investigated using the Beers Criteria along with WHO prescribing indices. Date were analyzed using SPSS software, and significance level was set at less than 0.05.
Results: Mean (SD) age of patients was 73.9(6.7) years. A total of 472 (31.2%) patients received at least 1 PIM. Benzodiazepines were the most frequent drug class and general practitioners (GPs) were the most frequent prescriber of PIMs. The highest and the lowest percentage of prescriptions containing brand-names were prescribed by subspecialists (62.5%) and GPs (42.2%), respectively. Antibiotics and injectable medications were prescribed for 26.8% and 28.5% of patients by GPs. Mean (SD) number of drugs per prescription was 3.57 (1.92). Prescriptions containing systemic antibiotics and PIMs had significantly higher mean number of drugs compared to those without these items (both P < 0.001).
Conclusion: There is a need for interventions to improve the quality of prescribing for elderly patients, especially by GPs. Also, there are still some problems in rational use of drugs based on prescribing indices, especially, prescribing brand-names and injectable medications.
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Affiliation(s)
- Mona Kargar
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Atrianfar
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Heidari
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Noroozian
- Division of Memory and Behavioral Neurology, Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Javadi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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Stojanović M, Vuković M, Jovanović M, Dimitrijević S, Radenković M. GheOP 3 S tool and START/STOPP criteria version 2 for screening of potentially inappropriate medications and omissions in nursing home residents. J Eval Clin Pract 2020; 26:158-164. [PMID: 30722098 DOI: 10.1111/jep.13107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 01/25/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVE There is limited information about the comparative effectiveness of the START/STOPP (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment) criteria and the Ghent Older People's Prescriptions community Pharmacy Screening tool (GheOP3 S tool) for the screening of potentially inappropriate prescribing (PIP) in the geriatric population. Considering this, the aim of this study was to compare the ability of the START/STOPP criteria and GheOP3 S tool to identify the PIP and potential prescribing omissions (PPOs) among elderly patients visiting their primary care physician. METHODS This is a retrospective observational study where a total of 422 subjects were included. The Charlson Co-morbidity Index (CCI) and the Medicines Co-morbidity Index (MCI) for older people were used to determine the co-morbidity status. The user's diagnosis and medications prescribed were analysed with the START/STOPP criteria and GheOP3 S tool. The Wilcoxon signed rank test was used to compare these criteria. The statistical relationship between the occurrence of PIP and users' age, the number of medication prescribed, the number of diagnoses, CCI, and MCI was determined with one-tailed bivariate correlation. RESULTS The START/STOPP criteria detected 843 PIPs and 1067 PPOs, while the GheOP3 S tool detected 936 PIPs and 202 PPOs. The GheOP3 S tool detected significantly more PIPs than did the STOPP criteria (P = 0.003). A significantly higher number of PPOs were detected with the START criterion (P < 0.0001). The results obtained with the START/STOPP criteria positively correlated with mentioned variables. Oppositely, there is a negative correlation between the results obtained with the GheOP3 S tool and age. Still, the positive correlation could be found with the rest of the variables. CONCLUSION The results of this study indicate that both tested tools demonstrated efficiency to detect PIPs and PPOs. The GheOP3 S tool detected significantly more PIPs than did the STOPP criteria. On the other hand, the START criteria performed much better for the screening of PPOs.
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Affiliation(s)
- Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Vuković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Jovanović
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Gerontology Center Belgrade, Belgrade, Serbia
| | | | - Miroslav Radenković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Assiri GA, Shebl NA, Mahmoud MA, Aloudah N, Grant E, Aljadhey H, Sheikh A. What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open 2018; 8:e019101. [PMID: 29730617 PMCID: PMC5942474 DOI: 10.1136/bmjopen-2017-019101] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients' homes. DESIGN Systematic review. DATA SOURCE Six international databases were searched for publications between 1 January 2006 and 31 December 2015. DATA EXTRACTION AND ANALYSIS Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments. Synthesis of data was informed by an appreciation of the medicines' management process and the conceptual framework from the International Classification for Patient Safety. RESULTS 60 studies met the inclusion criteria, of which 53 studies focused on medication errors, 3 on error-related adverse events and 4 on risk factors only. The prevalence of prescribing errors was reported in 46 studies: prevalence estimates ranged widely from 2% to 94%. Inappropriate prescribing was the most common type of error reported. Only one study reported the prevalence of monitoring errors, finding that incomplete therapeutic/safety laboratory-test monitoring occurred in 73% of patients. The incidence of preventable adverse drug events (ADEs) was estimated as 15/1000 person-years, the prevalence of drug-drug interaction-related adverse drug reactions as 7% and the prevalence of preventable ADE as 0.4%. A number of patient, healthcare professional and medication-related risk factors were identified, including the number of medications used by the patient, increased patient age, the number of comorbidities, use of anticoagulants, cases where more than one physician was involved in patients' care and care being provided by family physicians/general practitioners. CONCLUSION A very wide variation in the medication error and error-related adverse events rates is reported in the studies, this reflecting heterogeneity in the populations studied, study designs employed and outcomes evaluated. This review has identified important limitations and discrepancies in the methodologies used and gaps in the literature on the epidemiology and outcomes of medication errors in community settings.
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Affiliation(s)
- Ghadah Asaad Assiri
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Department of Paediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nada Atef Shebl
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Mansour Adam Mahmoud
- College of Pharmacy, Clinical Pharmacy Department, Taibah University, Madinah, Al Madinah, Saudi Arabia
| | - Nouf Aloudah
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Elizabeth Grant
- The Global Health Academy, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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6
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Martins VDS, Mori ALPM, Dorea EL, Pinto GA, Hirata MH, Hirata FDC, Hirata RDC. Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Alkan A, Yaşar A, Karcı E, Köksoy EB, Ürün M, Şenler FÇ, Ürün Y, Tuncay G, Ergün H, Akbulut H. Severe drug interactions and potentially inappropriate medication usage in elderly cancer patients. Support Care Cancer 2016; 25:229-236. [DOI: 10.1007/s00520-016-3409-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
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Pohl-Dernick K, Meier F, Maas R, Schöffski O, Emmert M. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list. BMC Health Serv Res 2016; 16:109. [PMID: 27039188 PMCID: PMC4818863 DOI: 10.1186/s12913-016-1366-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. METHODS Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. RESULTS In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. CONCLUSIONS The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.
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Affiliation(s)
- Katharina Pohl-Dernick
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany.
| | - Florian Meier
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, 91054, Erlangen, Germany
| | - Oliver Schöffski
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
| | - Martin Emmert
- Junior Professor for Health Services Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
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9
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Terrery CL, Nicoteri JAL. The 2015 American Geriatric Society Beers Criteria: Implications for Nurse Practitioners. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2015.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Rongen S, Kramers C, O'Mahony D, Feuth TB, Olde Rikkert MGM, Ahmed AIA. Potentially inappropriate prescribing in older patients admitted to psychiatric hospital. Int J Geriatr Psychiatry 2016; 31:137-45. [PMID: 26032252 DOI: 10.1002/gps.4302] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objectives of this study are to determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) and to assess related risk factors in older people with major psychiatric illness. METHODS This was a cross-sectional study of older patients hospitalized in a psychiatric hospital (n = 164; mean age 74.9 ± 7.3 years; 62% female). The primary endpoint was the prevalence of participants receiving PIMs and PPOs, which was assessed by using the Beers criteria 2012 and the screening tool of older person's potentially inappropriate prescriptions (STOPP) and screening tool of alert doctors to the right treatment (START) criteria. Univariate and multivariate logistic regression was used to assess significant risk factors for PIMs in this population. RESULTS A total of 1269 drugs were prescribed to included patients (range: 0-19 drugs/day). PIMs were identified in 47% and 79% of participants, based on the Beers 2012 and STOPP criteria, respectively. Most PIMs (70%) concerned psychotropic drugs. The STOPP criteria identified more PIMs (331) than the Beers criteria 2012 (199). According to the START criteria, 59% of participants had PPOs. The number of prescribed medications was significantly associated with the occurrence of PIMs according to the Beers 2012 [OR 1.2 (95% CI 1.1-1.3)] and STOPP [OR 1.5 (95% CI 1.3-1.8)] criteria. CONCLUSION Potentially inappropriate prescribing, as identified by the Beers and STOPP/START criteria, is highly prevalent among older patients hospitalized with major psychiatric illness. However, the focus on psychotropic drugs prescription without taking into account the benefit of these drugs to individual patients may limit the application of the Beers and STOPP criteria in psychiatric hospitals.
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Affiliation(s)
- Sara Rongen
- Department of Psychogeriatric Medicine, Vincent van Gogh Institute, Venray, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Ton B Feuth
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud Alzheimer Centre and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Amir I A Ahmed
- Department of Psychogeriatric Medicine, Vincent van Gogh Institute, Venray, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboud Alzheimer Centre and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Eiras A, Teixeira MA, González-Montalvo JI, Castell MV, Queipo R, Otero Á. [Consumption of drugs in over 65 in Porto (Portugal) and risk of potentially inappropriate medication prescribing]. Aten Primaria 2016; 48:110-20. [PMID: 26014888 PMCID: PMC6877889 DOI: 10.1016/j.aprim.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine medication consumption in the older people from a central area of Oporto; determine the prevalence of prescription of Potentially Inappropriate Medication and to analyse the polypharmacy and other important connected factors. DESIGN, SETTING AND PATIENTS Cross-sectional study with a sample of 747 patients older than 64 years, who were attended in a Primary care health centre: USF Rainha D. Amélia, Oporto, Portugal. MAIN OUTCOME MEASURES identification of all medication prescribed from electronic registers. Polypharmacy was considered more than 5 medication prescribed and Potential Inappropriate Medication was identified by Beers criteria 2012. The socio-demographic factors, diagnosis and health care services use were registered too. Logistic regression analysis was used to determine the association between co-variables. RESULTS There were 89.2% (95%CI: 87.6-92.0) of the studied population with at least one prescription. The polypharmacy was present at 59.2% (95%CI: 55.7-62.7) of people. The Potential Inappropriate Medication was present in 37.0% (95%CI: 33.5-40.5) of the cases. The Potential Inappropriate Medication was related with increasing age [OR=1.02 (95%CI: 1.00-1.05)], polypharmacy [OR=4.45 (95%CI: 3.12-6.36)], and be diagnosed with depression/anxiety [OR=2.18 (95%CI: 1.36-3.51)] and/or arthrosis [OR=1.64 (95%CI: 1.11-2.42)]. CONCLUSION The rate of medication prescription, polypharmacy and the prescription of Potentially Inappropriate Medication are very high in Portuguese population studied. The polypharmacy is the most important factor related with this potential inappropriate medication. The physician need to have carefully with prescription of the anxiolytic and anti-inflammatory pain drugs.
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Affiliation(s)
- Andreia Eiras
- Unidade de Saúde Familiar Rainha D. Amélia, Oporto, Portugal.
| | | | - Juan I González-Montalvo
- IDIPAZ Instituto de Investigación Sanitaria, Hospital La Paz, Madrid, España; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Maria-Victoria Castell
- IDIPAZ Instituto de Investigación Sanitaria, Hospital La Paz, Madrid, España; Centro de Salud Dr. Castroviejo, Atención Primaria, Subdirección Asistencial Norte, Madrid, España
| | - Rocio Queipo
- IDIPAZ Instituto de Investigación Sanitaria, Hospital La Paz, Madrid, España
| | - Ángel Otero
- IDIPAZ Instituto de Investigación Sanitaria, Hospital La Paz, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
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Bjerre LM, Ramsay T, Cahir C, Ryan C, Halil R, Farrell B, Thavorn K, Catley C, Hawken S, Gillespie U, Manuel DG. Assessing potentially inappropriate prescribing (PIP) and predicting patient outcomes in Ontario's older population: a population-based cohort study applying subsets of the STOPP/START and Beers' criteria in large health administrative databases. BMJ Open 2015; 5:e010146. [PMID: 26608642 PMCID: PMC4663446 DOI: 10.1136/bmjopen-2015-010146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale. METHODS AND ANALYSIS The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65 years and older), and to assess the health outcomes and health system costs associated with PIP-more specifically, the association between PIP and the occurrence of ED visits, hospitalisations and death, and their related costs. This will be done within the framework of a population-based retrospective cohort study using Ontario's large health administrative and population databases. Eligible patients aged 66 years and older who were issued at least 1 prescription between 1 April 2003 and 31 March 2014 (approximately 2 million patients) will be included. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ottawa Health Services Network Ethical Review Board and from the Bruyère Research Institute Ethics Review Board. Dissemination will occur via publication, presentation at national and international conferences, and ongoing exchanges with regional, provincial and national stakeholders, including the Ontario Drug Policy Research Network and the Ontario Ministry of Health and Long-Term Care. TRIAL REGISTRATION NUMBER Registered with clinicaltrials.gov (registration number: NCT02555891).
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Affiliation(s)
- Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES@ uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy Ramsay
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catriona Cahir
- Economic and Social Research Institute, Trinity College Dublin, Dublin, Ireland
| | - Cristín Ryan
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roland Halil
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Barbara Farrell
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Kednapa Thavorn
- ICES@ uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Steven Hawken
- ICES@ uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Douglas G Manuel
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES@ uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 2015; 71:1415-27. [PMID: 26407687 DOI: 10.1007/s00228-015-1954-4] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people. PURPOSE This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP. METHODS The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000-December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics. RESULTS Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2-26.7 %; range 0.0-98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A). CONCLUSION PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.
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Affiliation(s)
- Eline Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Annemie Somers
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
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Santos APAL, Silva DT, Alves-Conceição V, Antoniolli AR, Lyra DP. Conceptualizing and measuring potentially inappropriate drug therapy. J Clin Pharm Ther 2015; 40:167-76. [PMID: 25682702 DOI: 10.1111/jcpt.12246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Elderly people are the principal consumers of prescription drugs. The more the medication used by the patient, the greater the likelihood there is of the patient being subjected to potentially inappropriate drug therapy (PIDT). PIDT has been measured in the literature with both implicit and explicit tools. The purpose of this review was to assess the use of tools to detect PIDT in various studies and to determine which terms are used to refer to PIDT in practice. METHODS A systematic review was conducted according to the following steps: the first was identification. In this step, studies were selected from different combinations of the descriptors 'aged', 'elderly', 'inappropriate prescribing' and 'drug utilization' in three different languages, using the Embase, Medline, Scielo, Scopus and Web of Science databases. Second, the papers that satisfied the inclusion criteria for data extraction were carefully examined by three evaluators to determine the tools used and terms that referred to PIDT. RESULTS AND DISCUSSION From the combinations of keywords, 8610 articles were found. At the end of the selection process, 119 of the articles complied with the specified criteria. The degree of agreement among evaluators was moderate for the study titles (κ1 = 0·479) and substantial for abstracts (κ2 = 0·647). With respect to the PIDT evaluation criteria used by the studies, 27·7% used two criteria. Of the 27 evaluation criteria identified, the Beers criteria were used by 82·3% of the studies. More than 50 different terms to identify PIDT were found in the literature. WHAT IS NEW AND CONCLUSION This review is the first study to conceptualize and discuss terms that refer to PIDT. At present, there is no consensus regarding terms used to refer to PIDT, with over 50 different terms currently in use. This review shows an increase in the number of articles aimed at evaluating PIDT using implicit and explicit tools.
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Affiliation(s)
- A P A L Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Pharmacy College, Federal University of Sergipe, São Cristóvão, Brazil
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Shade MY, Berger AM, Chaperon C. Potentially inappropriate medications in community-dwelling older adults. Res Gerontol Nurs 2014; 7:178-92. [PMID: 24530281 DOI: 10.3928/19404921-20140210-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022]
Abstract
Potentially inappropriate medication (PIM) use is a significant worldwide public health problem. Community-dwelling older adults are susceptible to the negative outcomes associated with the use of PIMs. A database search (January 1991-June 2013) produced 19 prospective correlational and 10 intervention studies. The current state of the science reveals that conceptual clarity is lacking regarding the use of PIMs. The prevalence of PIM use is well documented in an abundance of descriptive studies. However, researchers have not examined an intervention's effects on health outcomes in community-dwelling older adults. Although independent older adults can acquire PIMs outside of a provider, current interventions aim to change the behavior of the prescribing physician and pharmacist. Nurses need to collaborate with other disciplines in PIM use research. Priority needs are to design interventions that reduce the use of PIMs and negative health outcomes.
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Chiatti C, Bustacchini S, Furneri G, Mantovani L, Cristiani M, Misuraca C, Lattanzio F. The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review. Drug Saf 2013; 35 Suppl 1:73-87. [PMID: 23446788 DOI: 10.1007/bf03319105] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions.A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high.Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be beneficial to improve the reliability of results. Preliminary evidence suggests that programmes aimed at comprehensively assessing geriatric conditions, detecting 'high-risk' prescriptions and training patients to comply with prescribed therapies could be costeffective measures to reduce the burden of ADEs.
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Affiliation(s)
- Carlos Chiatti
- Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy
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O’Sullivan DP, O’Mahony D, Parsons C, Hughes C, Murphy K, Patterson S, Byrne S. A Prevalence Study of Potentially Inappropriate Prescribing in Irish Long-Term Care Residents. Drugs Aging 2012; 30:39-49. [DOI: 10.1007/s40266-012-0039-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Luo R, Scullin C, Mullan AMP, Scott MG, McElnay JC. Comparison of tools for the assessment of inappropriate prescribing in hospitalized older people. J Eval Clin Pract 2012; 18:1196-202. [PMID: 21883716 DOI: 10.1111/j.1365-2753.2011.01758.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED RATIONAL, AIMS AND OBJECTIVE: The aim of the present study was to compare the ease of use and the capability of four approaches [Medication Appropriateness Index (MAI), the Beers' criteria 2003, the Improved Prescribing in the Elderly Tool (IPET) and Health Plan Employer Data and Information Set (HEDIS)] in assessing changes in medication appropriateness in elderly patients over a period of hospitalization. METHODS A retrospective observational study in two hospitals in Northern Ireland using the four measures was undertaken, involving a cohort of 192 patients (aged > 65 years). Medication appropriateness assessments were made at three stages during the patients' hospital 'journey', that is, at admission, during their inpatient stay and at discharge. The identifying rates of inappropriate prescribing in elderly patients in hospital used validated screening tools: MAI, the Beers' criteria 2003, the IPET and HEDIS. RESULTS The MAI was the most comprehensive approach but was also the most time consuming to apply. Data derived using the MAI indicated clearly that there was improved medication appropriateness over the three hospital stay stages (P < 0.001). Although this trend was also significant for the Beers' criteria 2003 (P < 0.05) and the IPET (P < 0.05) approaches, the HEDIS was unable to differentiate changes in appropriateness over time. There was a good correlation between data derived using the MAI and the Beers' criteria 2003 and the IPET approaches; this correlation was not evident for the HEDIS. CONCLUSIONS The MAI is the most convincing tool in evaluating medication appropriateness, but is very time consuming to apply. Beers' criteria 2003 and the IPET perform to an acceptable standard within the clinical setting and are more practical in their application. The HEDIS, although simplest to apply, does not have the sensitivity to measure change in appropriateness over time.
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Affiliation(s)
- Ruoyin Luo
- Clinical and Practice Research Group, School of Pharmacy, Queen's University, Belfast, Belfast, Northern Ireland, UK
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19
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Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Basger BJ, Chen TF, Moles RJ. Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method. BMJ Open 2012; 2:e001431. [PMID: 22983875 PMCID: PMC3467596 DOI: 10.1136/bmjopen-2012-001431] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/20/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians. DESIGN RAND/UCLA appropriateness method. PARTICIPANTS A panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members. MAIN OUTCOME MEASURE Agreement on all criteria. RESULTS Forty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. CONCLUSIONS A set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals.
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Bell JS, Ahonen J, Lavikainen P, Hartikainen S. Potentially inappropriate drug use among older persons in Finland: application of a new national categorization. Eur J Clin Pharmacol 2012; 69:657-64. [PMID: 22890588 DOI: 10.1007/s00228-012-1372-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The Finnish Medicines Agency published a new consensus categorization for potentially inappropriate drug (PID) use among persons aged 75 years and older (A = suitable, B = limited evidence, C = suitable for use under certain conditions only, D = inappropriate) in 2010. We investigated factors associated with use of one or more Category D drugs. METHOD Cross-sectional analyses were conducted using baseline data from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) Study collected in Kuopio, Finland, in 2004. From a random sample of 1000 persons aged 75 years and older, 781 persons provided consent to participate. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CIs) for factors associated with PID use. RESULTS PIDs were used by 30 % (n = 234) of all participants on a regular or as-needed basis. Among the 764 persons (98 %) who used prescription or non-prescription drugs, PID use was associated with the number of drugs in use (adjusted OR 1.20; 95 % CI 1.13-1.28) and moderate self-rated health compared to good self-rated health (adjusted OR 1.74; 95 % CI 1.19-2.55). PID use was associated with poor maximum walking speed (adjusted OR 1.64; 95 % CI 1.10-2.45), poor Timed Up and Go (TUG) test scores (adjusted OR 1.66; 95 % CI 1.11-2.47), impaired instrumental activities of daily living (adjusted OR 1.50; 95 % CI 1.06-2.12) and Mini Mental State Examination scores <18 (adjusted OR 2.27; 95 % CI 1.41-3.65). CONCLUSION PID use was highly prevalent and associated with impaired functional outcomes. This highlights the importance of clinicians conducting regular reviews of drug therapy.
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Affiliation(s)
- J Simon Bell
- Kuopio Research Centre of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
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Prithviraj GK, Koroukian S, Margevicius S, Berger NA, Bagai R, Owusu C. Patient Characteristics Associated with Polypharmacy and Inappropriate Prescribing of Medications among Older Adults with Cancer. J Geriatr Oncol 2012; 3:228-237. [PMID: 22712030 DOI: 10.1016/j.jgo.2012.02.005] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES: To identify patient characteristics associated with polypharmacy and inappropriate medication (PIM) use among older patients with newly diagnosed cancer. DESIGN: Cross-Sectional Study. SETTING: Ambulatory oncology clinics at an academic medical center. PARTICIPANTS: 117 patients aged ≥ 65 years with newly diagnosed histologically confirmed stage I-IV cancer were enrolled between April 2008 and September 2009. MEASUREMENTS: Medication review, included patient self-report and medical records. Polypharmacy was defined as the concurrent use of ≥ five medications, (Yes/No). PIM use was defined as use of ≥ one medication included in the 2003 update of Beers Criteria, (Yes/No). RESULTS: The prevalence of polypharmacy and PIM use were 80% and 41%, respectively. Three independent correlates of medication use were identified. An increase in comorbidity count by one, ECOG-PS score by one, and PIM use by one, was associated with an increase in medication use by 0.48 (P=0.0002), 0.79 (P=0.01) and 1.22 (P=0.006), respectively. Two independent correlates of PIM use were identified. The odds of using PIMs decreased by 10% for one unit increase in Body Mass Index [Odds Ratio (OR) 0.90, 95% CI = (0.84, 0.97)], and increased by 18% for each increase in medication count by one [OR 1.18, 95% CI = (1.04, 1.34)]. CONCLUSION: There was a high prevalence of polypharmacy and PIM use in older patients with newly diagnosed cancer. Given the co-occurrence of polypharmacy with poor performance status and multi-morbidity, multi-dimensional interventions are needed in the geriatric-oncology population to improve health and cancer outcomes.
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Affiliation(s)
- Gopi K Prithviraj
- Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
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Lam MPS, Cheung BMY. The use of STOPP/START criteria as a screening tool for assessing the appropriateness of medications in the elderly population. Expert Rev Clin Pharmacol 2012; 5:187-97. [PMID: 22390561 DOI: 10.1586/ecp.12.6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although numerous initiatives and interventions have been developed to promote medication safety, medication incidents still remain an important cause of hospitalization. To avoid this, it is important for physicians to prescribe safely. To date, the Beers criteria have been the most widely used explicit criteria for assessing the appropriateness of medications in the elderly, but they do have limitations. The more recent STOPP/START criteria were developed in the hope of addressing the deficiencies observed in the Beers criteria. This article gives an overview of STOPP/START criteria and its applications, and reviews the studies that assessed medication appropriateness using STOPP/START and/or the Beers criteria.
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Affiliation(s)
- May P S Lam
- Department of Medicine, The University of Hong Kong, Hong Kong.
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Parsons C, Johnston S, Mathie E, Baron N, Machen I, Amador S, Goodman C. Potentially Inappropriate Prescribing in Older People with Dementia in Care Homes. Drugs Aging 2012; 29:143-55. [DOI: 10.2165/11598560-000000000-00000] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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García-Gollarte F, Baleriola-Júlvez J, Ferrero-López I, Cruz-Jentoft AJ. Inappropriate Drug Prescription at Nursing Home Admission. J Am Med Dir Assoc 2012; 13:83.e9-15. [DOI: 10.1016/j.jamda.2011.02.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 02/06/2011] [Accepted: 02/16/2011] [Indexed: 01/13/2023]
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Chang CB, Chan DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging 2011; 27:947-57. [PMID: 21087065 DOI: 10.2165/11584850-000000000-00000] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Several sets of explicit criteria for potentially inappropriate medications (PIMs) have been developed by expert consensus. The purpose of this review is to summarize and compare existing criteria to enable more informed choices about their use. After a systematic literature search was conducted, seven examples of criteria published between 1991 and 2009 were included in the review and their individual characteristics are presented. Common medications listed in the majority of these criteria are also summarized. PIMs listed regardless of co-morbidities in all seven criteria sets were long-acting benzodiazepines and tricyclic antidepressants. PIMs regardless of co-morbidities were most similar among the Beers, Rancourt and Winit-Watjana criteria. Several drug-disease interactions such as benzodiazepines and falls were cited in most criteria. With respect to drug-drug interactions, most criteria agreed that concomitant use of warfarin and NSAIDs should be avoided. The prevalence of PIMs varied with patient population, availability of medications in local markets, the specialties of the prescribing physicians and the assessment instruments used. The associations between PIMs use and health outcomes were largely inconclusive because of limited data. Further research is necessary to validate these published criteria in terms of reducing the incidence of adverse drug reactions and improving health outcomes among older adults. Incorporation of these criteria into computer-assisted order entry systems would increase their utilization in daily practice.
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Affiliation(s)
- Chirn-Bin Chang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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Petek Šter M, Cedilnik Gorup E. Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study. Croat Med J 2011; 52:16-24. [PMID: 21328716 PMCID: PMC3046495 DOI: 10.3325/cmj.2011.52.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents', physicians', and nursing home characteristics associated with prescribing. METHODS In a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients' medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents', physicians', and nursing home characteristics associated with prescribing. RESULTS Residents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents' characteristics associated with psychotropic medication use were female sex (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians' characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76). CONCLUSION Frequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate.
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Affiliation(s)
- Marija Petek Šter
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia.
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Richter T, Mann E, Meyer G, Haastert B, Köpke S. Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts. J Am Med Dir Assoc 2011; 13:187.e7-187.e13. [PMID: 21549645 DOI: 10.1016/j.jamda.2011.03.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/21/2011] [Accepted: 03/22/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents. METHODS We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents' characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation. RESULTS Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6% (95% CI 72.0-77.2%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8% (95% CI 48.3-55.2%) and 52.4% (95% CI 48.7-56.1%). Of all antipsychotics, 66% (Austria) and 47% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender. CONCLUSION Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.
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Affiliation(s)
- Tanja Richter
- University of Hamburg, Unit of Health Sciences and Education, Hamburg, Germany.
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Fiss T, Dreier A, Meinke C, van den Berg N, Ritter CA, Hoffmann W. Frequency of inappropriate drugs in primary care: analysis of a sample of immobile patients who received periodic home visits. Age Ageing 2011; 40:66-73. [PMID: 20823125 DOI: 10.1093/ageing/afq106] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND drug intake is associated with the risk of drug-related problems (DRPs), e.g. the intake of PIM. OBJECTIVE the proportion of potentially inappropriate medication (PIM) taken by elderly people was analysed. DESIGN community-based, prospective cohort study. SETTING ambulatory health-care sector in a German rural area. SUBJECTS seven hundred and forty-four patients with age >65 years and regular intake of drugs. METHODS comprehensive home medication review (HMR) provided by specially qualified assistants of GP practices using electronic case reporting forms (eCRFs), and GP's diagnoses were extracted from patients' health records. Updated Beers' list of Fick et al. was used to detect PIM for patients >65 years and drug-condition interaction. RESULTS a total of 18% (n= 134) of the patients received 163 inappropriate drugs. Out of these drugs, most prevalent PIM were benzodiazepine derivates (n= 45). Out of all drugs, 25 drug-condition interactions were identified. The intake of PIM was slightly associated with self-reported falls (: 0.1074; P= 0.0244). Multivariate logistic regression showed significant results for the number of taken substances (OR = 1.176; 95% CI 1.121-1.234, P< 0.001). CONCLUSIONS a high proportion of patients taking PIM in a community-based setting were investigated. Statistical associations with self-reported falls were found. Confounding may influence data. Further research to investigate findings is needed.
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Affiliation(s)
- Thomas Fiss
- Department of Epidemiology of Health Care and Community Health, Ernst Moritz Arndt University of Greifswald, Ellernholzstr, Germany.
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Ruggiero C, Dell'Aquila G, Gasperini B, Onder G, Lattanzio F, Volpato S, Corsonello A, Maraldi C, Bernabei R, Cherubini A. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging 2010; 27:747-58. [PMID: 20809664 DOI: 10.2165/11538240-000000000-00000] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Potentially inappropriate medications in older patients increase the risk of adverse drug events, which are an important cause of hospital admission and death among hospitalized patients. Little information is available about the prevalence of potentially inappropriate drug prescriptions (PIDPs) and the related health adverse outcomes among nursing home (NH) residents. OBJECTIVE To estimate the prevalence of PIDPs and the association with adverse outcomes in NH residents. METHODS A total of 1716 long-term residents aged >or=65 years participating in the ULISSE (Un Link Informatico sui Servizi Sanitari Esistenti per l'anziano [A Computerized Network on Health Care Services for Older People]) project were evaluated using a standardized comprehensive geriatric assessment instrument, i.e. the interResident Assessment Instrument Minimum Data Set. A thorough evaluation of residents' drug use, medical diagnoses and healthcare resource utilization was performed. A PIDP was defined according to the most recent update of the Beers criteria. RESULTS Almost one out of two persons (48%) had at least one PIDP and almost one out of five had two or more PIDPs (18%). Residents with a higher number of PIDPs had a higher likelihood of being hospitalized. Compared with residents without PIDPs, those with two or more PIDPs at baseline had a higher probability of being hospitalized (hazard ratio 1.73; 95% CI 1.14, 2.60) during the following 12 months. Risk of PIDP was positively associated with the total number of drugs and diseases, but negatively with age. PIDPs defined according to specific conditions (n = 780; 55%) were slightly more frequent than PIDPs based on single medications irrespective of specific indication (n = 639; 45%). CONCLUSIONS PIDP is a significant problem among Italian NH residents. There is an urgent need for intervention trials to test strategies to reduce inappropriate drug use and its associated adverse health outcomes.
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Affiliation(s)
- Carmelinda Ruggiero
- Department of Clinical and Experimental Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy.
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Anthierens S, Tansens A, Petrovic M, Christiaens T. Qualitative insights into general practitioners views on polypharmacy. BMC FAMILY PRACTICE 2010; 11:65. [PMID: 20840795 PMCID: PMC2945967 DOI: 10.1186/1471-2296-11-65] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 09/15/2010] [Indexed: 01/10/2023]
Abstract
Background Polypharmacy is common among older people. The purpose of this study is to describe GPs' views and beliefs on polypharmacy in order to identify the role of the GP in relation to improving prescribing behaviour. The awareness of these often established beliefs is key for understanding behaviour and promoting change which can guide action towards more rational prescribing. Methods A qualitative descriptive methodology was used with semi-structured interviews. Interviews were conducted with 65 GPs from the region of Aalst, a district of a mixed urban and rural population in Belgium. The aim of the study was to describe the GPs' perspectives on polypharmacy in primary care. Results GPs acknowledge that polypharmacy is a problem in their older patient population, especially because of the risk of adverse drug reactions, interactions and lowered adherence. GPs mention that difficulties in keeping an overview of the exact medication intake is an important problem caused by polypharmacy. The patients' strong belief in their medication and self-medication are seen as important barriers in reducing the number of drugs taken. Next to these patient related factors, there are some factors related to the prescriber, such as the lack of regular evaluation of the medication schedule by GPs and the involvement of several prescribers, especially in a hospital setting. According to the respondents, prevention and evidence based medicine guidelines often induce polypharmacy. Conclusions GPs point out that polypharmacy is an important problem in their older patient population. They see an important role for themselves in optimizing drug regimens for their patients. However, they do not have a readymade solution for polypharmacy. The limited set of options for addressing polypharmacy leave GPs feeling powerless to tackle the problem. There is a need for simple GP friendly tools and access to pharmacotherapeutic advice. Future research in this area and interventions seeking to improve prescribing for the elderly will have to focus on practical tools and take into account the GPs' sense of helplessness.
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Affiliation(s)
- Sibyl Anthierens
- Vaccine & Infectious Disease Institute & Centre for Primary Care, University of Antwerp, Belgium.
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STOPP & START criteria: A new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med 2010. [DOI: 10.1016/j.eurger.2010.01.007] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Conejos Miquel M, Sánchez Cuervo M, Delgado Silveira E, Sevilla Machuca I, González-Blazquez S, Montero Errasquin B, Cruz-Jentoft A. Potentially inappropriate drug prescription in older subjects across health care settings. Eur Geriatr Med 2010. [DOI: 10.1016/j.eurger.2009.12.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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