1
|
Hendrix MRS, Yasar M, Mohammad AK, Hugtenburg JG, Vanhommerig JW, Gündoğan-Yilmaz R, van den Bemt PMLA, Denig P, Karapinar-Carkıt F. Prescription Sequence Symmetry Analysis (PSSA) to assess prescribing cascades: a step-by-step guide. BMC Med Res Methodol 2024; 24:8. [PMID: 38212730 PMCID: PMC10782776 DOI: 10.1186/s12874-023-02108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
Prescribing cascades occur when patients are prescribed medication to treat the adverse drug reaction of previously prescribed medication. Prescription sequence symmetry analysis (PSSA) can be used to assess the association between two medications in prescription or dispensing databases and thus the potential occurrence of prescribing cascades. In this article, a step-by-step guide is presented for conducting PSSA to assess prescribing cascades. We describe considerations for medication data collection and setting time periods for relevant parameters, including washout window, exposure window, continued exposure interval and blackout period. With two examples, we illustrate the impact of changes in these parameters on the strengths of associations observed. Given the impact seen, we recommend that researchers clearly specify and explain all considerations regarding medication included and time windows set when studying prescribing cascades with PSSA, and conduct subgroup and sensitivity analyses.
Collapse
Affiliation(s)
- Mandy R S Hendrix
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Mustafa Yasar
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Atiya K Mohammad
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Fatma Karapinar-Carkıt
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center +, Maastricht, the Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
2
|
Kojima T. [Polypharmacy in older people]. Nihon Ronen Igakkai Zasshi 2024; 61:13-21. [PMID: 38583964 DOI: 10.3143/geriatrics.61.13] [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] [Indexed: 04/09/2024]
Abstract
After the publication of the guidelines about the safe drug therapy for older people in 2015 by the Japan Geriatrics Society, the risk of polypharmacy has become popular. Older people are likely to have multimorbidity, resulting in the use of multiple drugs. This not only increases the frequency of side effects, but also increase confusion and difficulty in medication management and adherence. Polypharmacy is the problem related to these complicated drug therapies and will increase by age. It is necessary to review drugs and resolve polypharmacy without making comorbid conditions worth. To carry out effective medication reviews, the guidance established by the Ministry of Health, Labor and Welfare introduced that geriatric assessment is essential for those with polypharmacy, since not only all medical conditions, but also physical and cognitive functions, medications, living environment, and caregivers should be taken into consideration when discontinuing drugs. When tapering, potentially inappropriate medications (PIMs) should be always the targets, and PIMs drug lists such as the Beers criteria and STOPP/START became very popular in overseas. Even after the reductions, careful attention should be paid to changes in the patient's condition. For drugs that are continued, continuous checks are required to ensure compliance with patients' medication adherence. There are many possible reasons for poor medication adherence, and it will be difficult to improve unless we identify what the cause is in each patient, and making the prescriptions simple may be necessary.
Collapse
Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, The University of Tokyo
| |
Collapse
|
3
|
Doherty A, Moriarty F, Boland F, Clyne B, Fahey T, Kennelly S, Wallace E. Prescribing cascades in community-dwelling adults: protocol for a systematic review. HRB Open Res 2021; 4:72. [PMID: 34738069 PMCID: PMC8529400 DOI: 10.12688/hrbopenres.13345.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults. Methods: The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years); risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to 'treat' or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers. A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist. Discussion: This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades. Registration: PROSPERO [ CRD42021243163, 31/03/2021].
Collapse
Affiliation(s)
- Ann Doherty
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Fiona Boland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Seán Kennelly
- Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
- Department of Age-related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| |
Collapse
|
4
|
Doherty A, Moriarty F, Boland F, Clyne B, Fahey T, Kennelly S, Wallace E. Prescribing cascades in community-dwelling adults: protocol for a systematic review. HRB Open Res 2021; 4:72. [PMID: 34738069 PMCID: PMC8529400 DOI: 10.12688/hrbopenres.13345.1] [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: 07/01/2021] [Indexed: 04/04/2024] Open
Abstract
Introduction: Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults. Methods: The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years), including those in residential or nursing homes; risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to 'treat' or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers. A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist. Discussion: This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades. Registration: PROSPERO [ CRD42021243163, 31/03/2021].
Collapse
Affiliation(s)
- Ann Doherty
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Fiona Boland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Seán Kennelly
- Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
- Department of Age-related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| |
Collapse
|
5
|
Sternberg SA, Guy-Alfandary S, Rochon PA. Cascade médicamenteuse chez la personne âgée. CMAJ 2021; 193:E589. [PMID: 33875469 PMCID: PMC8084561 DOI: 10.1503/cmaj.201564-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Shelley A Sternberg
- Service de santé Maccabi (Sternberg), Modi'in, Israël; Service de santé Maccabi (Guy-Alfandary), Tel-Aviv, Israël; Hôpital Women's College (Rochon), Université de Toronto, Toronto, Ont.
| | - Shiri Guy-Alfandary
- Service de santé Maccabi (Sternberg), Modi'in, Israël; Service de santé Maccabi (Guy-Alfandary), Tel-Aviv, Israël; Hôpital Women's College (Rochon), Université de Toronto, Toronto, Ont
| | - Paula A Rochon
- Service de santé Maccabi (Sternberg), Modi'in, Israël; Service de santé Maccabi (Guy-Alfandary), Tel-Aviv, Israël; Hôpital Women's College (Rochon), Université de Toronto, Toronto, Ont
| |
Collapse
|
6
|
Affiliation(s)
- Shelley A Sternberg
- Maccabi Healthcare Services (Sternberg), Modiin, Israel; Maccabi Healthcare Services (Guy-Alfandary), Tel Aviv, Israel; Women's College Hospital (Rochon), University of Toronto, Toronto, Ont.
| | - Shiri Guy-Alfandary
- Maccabi Healthcare Services (Sternberg), Modiin, Israel; Maccabi Healthcare Services (Guy-Alfandary), Tel Aviv, Israel; Women's College Hospital (Rochon), University of Toronto, Toronto, Ont
| | - Paula A Rochon
- Maccabi Healthcare Services (Sternberg), Modiin, Israel; Maccabi Healthcare Services (Guy-Alfandary), Tel Aviv, Israel; Women's College Hospital (Rochon), University of Toronto, Toronto, Ont
| |
Collapse
|
7
|
Abstract
Introduction: Combined antiretroviral therapy has transformed HIV infection into a chronic disease thus people living with HIV (PLWH) live longer. As a result, the management of HIV infection is becoming more challenging as elderly experience age-related comorbidities leading to complex polypharmacy and a higher risk for drug-drug or drug-disease interactions. Furthermore, age-related physiological changes affect pharmacokinetics and pharmacodynamics thereby predisposing elderly PLWH to incorrect dosing or inappropriate prescribing and consequently to adverse drug reactions and the subsequent risk of starting a prescribing cascade. Areas covered: This review discusses the demographics of the aging HIV population, physiological changes and their impact on drug response as well as comorbidities. Particular emphasis is placed on common prescribing issues in elderly PLWH including drug-drug interactions with antiretroviral drugs. A PubMed search was used to compile relevant publications until February 2019. Expert opinion: Prescribing issues are highly prevalent in elderly PLWH thus highlighting the need for education on geriatric prescribing principles. Adverse health outcomes potentially associated with polypharmacy and inappropriate prescribing should promote interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits for a given patient. A multidisciplinary team approach is recommended for the care of elderly PLWH.
Collapse
Affiliation(s)
- Catia Marzolini
- a Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital of Basel and University of Basel , Basel , Switzerland.,b Department of Molecular and Clinical Pharmacology , University of Liverpool , Liverpool , UK
| | - Françoise Livio
- c Service of Clinical Pharmacology, Department of Laboratories , University Hospital of Lausanne , Lausanne , Switzerland
| |
Collapse
|
8
|
[Basic concepts and resolution for polypharmacy]. Nihon Ronen Igakkai Zasshi 2019; 56:442-448. [PMID: 31761849 DOI: 10.3143/geriatrics.56.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
9
|
Vouri SM, Chung JM, Binder EF. Successful intervention to mitigate an acetylcholinesterase inhibitor-induced rhinorrhea prescribing cascade: a case report. J Clin Pharm Ther 2017; 42:370-371. [PMID: 28251653 DOI: 10.1111/jcpt.12511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/02/2017] [Indexed: 01/22/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient. CASE SUMMARY A 77-year-old women experienced probable acetylcholinesterase inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine which lead to worsening cognitive function. We reduced the dose of the acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms of rhinorrhea were subsequently reduced without negatively impacting cognition. WHAT IS NEW AND CONCLUSION This was the first published prescribing cascade intervention that did not require discontinuation of both medications, which may be emulated in future prescribing cascade cases.
Collapse
Affiliation(s)
- S M Vouri
- Department of Pharmacy Practice, Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO, USA
| | - J M Chung
- Mercy Clinic Internal Medicine and Geriatrics - Old Tesson, St. Louis, MO, USA
| | - E F Binder
- Division of Geriatrics and Nutritional Science, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| |
Collapse
|