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Mangin D, Lamarche L, Agarwal G, Ali A, Cassels A, Colwill K, Dolovich L, Brown ND, Farrell B, Freeman K, Frizzle K, Garrison SR, Gillett J, Holbrook A, Jurcic-Vrataric J, McCormack J, Parascandalo J, Richardson J, Risdon C, Sherifali D, Siu H, Borhan S, Templeton JA, Thabane L, Trimble J. Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy. Pilot Feasibility Stud 2023; 9:84. [PMID: 37202822 DOI: 10.1186/s40814-023-01315-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Polypharmacy is associated with poorer health outcomes in older adults. Other than the associated multimorbidity, factors contributing to this association could include medication adverse effects and interactions, difficulties in managing complicated medication regimes, and reduced medication adherence. It is unknown how reversible these negative associations may be if polypharmacy is reduced. The purpose of this study was to determine the feasibility of implementing an operationalized clinical pathway aimed to reduce polypharmacy in primary care and to pilot measurement tools suitable for assessing change in health outcomes in a larger randomized controlled trial (RCT). METHODS We randomized consenting patients ≥ 70 years old on ≥ 5 long-term medications into intervention or control groups. We collected baseline demographic information and research outcome measures at baseline and 6 months. We assessed four categories of feasibility outcomes: process, resource, management, and scientific. The intervention group received TAPER (team approach to polypharmacy evaluation and reduction), a clinical pathway for reducing polypharmacy using "pause and monitor" drug holiday approach. TAPER integrates patients' goals, priorities, and preferences with an evidence-based "machine screen" to identify potentially problematic medications and support a tapering and monitoring process, all supported by a web-based system, TaperMD. Patients met with a clinical pharmacist and then with their family physician to finalize a plan for optimization of medications using TaperMD. The control group received usual care and were offered TAPER after follow-up at 6 months. RESULTS All 9 criteria for feasibility were met across the 4 feasibility outcome domains. Of 85 patients screened for eligibility, 39 eligible patients were recruited and randomized; two were excluded post hoc for not meeting the age requirement. Withdrawals (2) and losses to follow-up (3) were small and evenly distributed between arms. Areas for intervention and research process improvement were identified. In general, outcome measures performed well and appeared suitable for assessing change in a larger RCT. CONCLUSIONS Results from this feasibility study indicate that TAPER as a clinical pathway is feasible to implement in a primary care team setting and in an RCT research framework. Outcome trends suggest effectiveness. A large-scale RCT will be conducted to investigate the effectiveness of TAPER on reducing polypharmacy and improving health outcomes. TRIAL REGISTRATION clinicaltrials.gov NCT02562352 , Registered September 29, 2015.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
- Dept. of General Practice, University of Otago, Christchurch, New Zealand.
| | - Larkin Lamarche
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Gina Agarwal
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Abbas Ali
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Alan Cassels
- University of Victoria, 3800 Finnerty Rd, Victoria, BC, Canada
| | - Kiska Colwill
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
- University of Toronto, 144 College Street, Toronto, ON, Canada
| | - Naomi Dore Brown
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Barbara Farrell
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, Canada
| | - Karla Freeman
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Kristina Frizzle
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Scott R Garrison
- University of Alberta, 6-60 University Terrace, Edmonton, AB, Canada
| | - James Gillett
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Anne Holbrook
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Jane Jurcic-Vrataric
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - James McCormack
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada
| | - Jenna Parascandalo
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Julie Richardson
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Cathy Risdon
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Diana Sherifali
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Henry Siu
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Sayem Borhan
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Jeffery A Templeton
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Lehana Thabane
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Johanna Trimble
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada
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Inappropriate Prescriptions in Older People-Translation and Adaptation to Portuguese of the STOPP/START Screening Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116896. [PMID: 35682479 PMCID: PMC9180165 DOI: 10.3390/ijerph19116896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
Inappropriate prescribing, which encompasses the prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), is a common problem for older people. The STOPP/START tool enables general practitioners, who are the main prescribers, to identify and reduce the incidence of PIMs and PPOs and appraise an older patient’s prescribed drugs during the diagnosis process to improve the clinical care quality. This study aimed to translate and validate the STOPP/START screening tool to enable its use by Portuguese physicians. A translation-back translation method including the validation of the obtained Portuguese version was used. Intra- and inter-rater reliability and agreement analyses were used in the validation process. A dataset containing the information of 334 patients was analyzed by one GP twice within a 2-week interval, while a dataset containing the information of 205 patients was independently analyzed by three GPs. Intra-rater reliability assessment led to a Kappa coefficient (κ) of 0.70 (0.65−0.74) for the STOPP criteria and 0.60 (0.52−0.68) for the START criteria, considered to be substantial and moderate values, respectively. The results of the inter-rater reliability rating were almost perfect for all combinations of raters (κ > 0.93). The version of the STOPP/START criteria translated into Portuguese represents an improvement in managing the medications prescribed to the elderly. It provides clinicians with a screening tool for detecting potentially inappropriate prescribing in patients older than 65 years old that is reliable and easy to use.
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Kalfsvel L, Versmissen J, van Doorn A, van den Broek W, van der Kuy H, van Rosse F. Better performance of medical students on pharmacotherapy knowledge and skills tests is associated with practising with e-learning program P-scribe. Br J Clin Pharmacol 2021; 88:1334-1346. [PMID: 34505717 PMCID: PMC9293177 DOI: 10.1111/bcp.15077] [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: 04/20/2021] [Revised: 08/19/2021] [Accepted: 08/28/2021] [Indexed: 12/03/2022] Open
Abstract
Aims Junior doctors write most hospital prescriptions, yet are more than twice as likely to make an error in their prescriptions compared to senior doctors. A possibility to enhance pharmacotherapy education is through the use of e‐learning modules. The aim of this study was to determine whether P‐scribe, as the chosen e‐learning resource, helps students in passing their pharmacotherapy assessments. Methods This retrospective study was undertaken in the Erasmus Medical Center, the Netherlands. All 270 medical students who started their master's curriculum in the academic session of 2017–2018 were included. Data were analysed to identify the frequency of student's use per e‐learning module, total time students spent on e‐learning modules and timing of the use of e‐learning modules in relation to their assessments. The results of the assessments were analysed to identify possible correlations between the time students spent using P‐scribe, their timing of use and their assessment results. Results Students who passed their knowledge‐based assessment first time had a mean practice time of five more hours than students who did not pass first time (P < .05, 95% CI: 3.4–6.6). These students practised on average six e‐learning modules more (P < .05, 95% CI: 4.1–7.0) than students who failed their first attempt. Students who passed their skill‐based prescription test first time, practised on average five more e‐learning modules (P = .006, 95% CI: 1.4–8.3) than students who failed their first attempt. Conclusion Students who passed their pharmacotherapy assessments first time spent more time, and practised more frequently, with e‐learning modules.
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Affiliation(s)
- Laura Kalfsvel
- Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Adriaan van Doorn
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Walter van den Broek
- Erasmus MC, University Medical Center Rotterdam, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands
| | - Hugo van der Kuy
- Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Floor van Rosse
- Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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4
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Roux B, Berthou-Contreras J, Beuscart JB, Charenton-Blavignac M, Doucet J, Fournier JP, de la Gastine B, Gautier S, Gonthier R, Gras V, Grau M, Noize P, Polard E, Rudelle K, Valnet-Rabier MB, Tannou T, Laroche ML. REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors (REMEDI[e]S): French implicit and explicit criteria. Eur J Clin Pharmacol 2021; 77:1713-1724. [PMID: 34115158 DOI: 10.1007/s00228-021-03145-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To establish a consensus on both explicit and implicit criteria in order to identify potentially inappropriate prescribing (PIP) in French older people aged 75 years and over or 65 years and over with multimorbidity. METHODS Fifteen experts in geriatrics, general practice, pharmacy, and clinical pharmacology were involved in a two-round Delphi survey to assess preliminary explicit and implicit criteria based on an extensive literature review and up-to-date evidence data. Experts were asked to rate their level of agreement using a 5-level Likert scale for inclusion of criteria and also for rationale and therapeutic alternatives. A consensus was considered as reached if at least 75% of the experts rated criteria as "strongly agreed" or "agreed." RESULTS The new tool included a seven-step algorithm (implicit criteria) encompassing the three main domains that define PIP (i.e. overprescribing, underprescribing, and misprescribing) and 104 explicit criteria. Explicit criteria were divided into 6 tables related to inappropriate drug duplications (n = 7 criteria), omissions of medications and/or medication associations (n = 16), medications with an unfavourable benefit/risk ratio and/or a questionable efficacy (n = 39), medications with an unsuitable dose (n = 4) or duration (n = 6), drug-disease (n = 13), and drug-drug interactions (n = 19). CONCLUSION The REMEDI[e]S tool (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors) is an original mixed tool, adapted to French medical practices, aimed at preventing PIP both at the individual level in clinical practice and the population level in large-scale studies. Therefore, its use could contribute to an improvement in healthcare professionals' prescribing practices and safer care in older adults.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. .,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.
| | - Julie Berthou-Contreras
- Department of Pharmacy, Clinical Pharmacy Unit, University Hospital of Besançon, Besançon, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | | | - Jean Doucet
- Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, 76031, Rouen Cedex, France
| | - Jean-Pascal Fournier
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Blandine de la Gastine
- Geriatric Department, Institut du Vieillissement, Hospices Civils de Lyon, Hôpital Pierre Garraud, Lyon, France
| | - Sophie Gautier
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Lille, Lille, France
| | - Régis Gonthier
- Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de La Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France
| | - Valérie Gras
- Centre of Pharmacovigilance, Department of Clinical Pharmacology, University Hospital of Amiens, Amiens, France
| | - Muriel Grau
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Pernelle Noize
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
| | - Elisabeth Polard
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Rennes, Rennes, France
| | - Karen Rudelle
- University Department of General Medicine, Faculty of Medicine, Limoges, France
| | - Marie-Blanche Valnet-Rabier
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Besançon, Besançon, France
| | - Thomas Tannou
- Geriatric Departement, University Hospital of Besançon, Besançon, France
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.,Laboratoire Vie-Santé (Vieillissement Fragilité Prévention, E-Santé), IFR GEIST, Université de Limoges, Limoges, France
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5
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Salema NE, Clement N, Hysenagolli R, Hibberd R, Bell BG, Gookey G, Avery A, Knox R. The evaluation of an e-learning prescribing course for general practice. EDUCATION FOR PRIMARY CARE 2021; 32:219-225. [PMID: 33794750 DOI: 10.1080/14739879.2021.1874250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prescribed medication may lead to significant morbidity or mortality as a result of these medications causing adverse events, or because of a prescribing error. E-learning is a common tool used in supporting training in prescribing. This paper describes the development of an e-learning course and the subsequent evaluation undertaken by the users with the aim of obtaining an effective e-learning course for prescribing. The e-learning course was developed by general practitioners and pharmacists and focussed on the principles of good prescribing, examined the common reasons for prescribing errors, and was evaluated using self-reported quantitative and qualitative measures. Scores significantly increased on an assessment given before and after the course. The majority of respondents reported that the e-learning course had a positive impact on prescribing knowledge, skills and attitudes, with medication reviews the top area where a change in prescribing practice was reported. Over 90% of the respondents agreed that the e-learning course was easy to use and a useful part of their continuing professional education. This study shows that clinicians recognise the on-going need for training in prescribing, but the lack of training is one of the factors contributing to errors, which suggests that more education is needed, not just for GPs in training, but for qualified GPs as well.
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Affiliation(s)
- Nde-Eshimuni Salema
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Naomi Clement
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rexhep Hysenagolli
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachel Hibberd
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Brian G Bell
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gill Gookey
- NHS Rushcliffe CCG, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Anthony Avery
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Richard Knox
- School of Medicine, Division of Primary Care, University Of Nottingham, Nottingham, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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6
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Ng B, Duong M, Lo S, Le Couteur D, Hilmer S. Deprescribing perceptions and practice: Reported by multidisciplinary hospital clinicians after, and by medical students before and after, viewing an e-learning module. Res Social Adm Pharm 2021; 17:1997-2005. [PMID: 33773940 DOI: 10.1016/j.sapharm.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are many barriers to deprescribing in the routine care of older inpatients with polypharmacy. Implementation is limited by factors related to clinicians, patients, and the acute care setting. A short (11 min) e-learning module for multidisciplinary hospital clinicians was developed to address two commonly reported barriers: awareness of polypharmacy and self-efficacy in deprescribing. OBJECTIVES 1) Describe the level of awareness of polypharmacy and self-efficacy of deprescribing in multi-disciplinary hospital clinicians following completion of an online e-learning module; and 2) describe the immediate impact of an online educational module in awareness and self-efficacy of polypharmacy and deprescribing in senior medical students. METHODS A questionnaire was developed and administered to hospital clinicians following completion of the e-learning module. Senior medical students undertook the questionnaire pre- and post-module. RESULTS Overall, 99 hospital clinicians with diverse clinical roles, experience, and ages, and 30 medical students completed the questionnaire. Although most (≥80%) hospital clinicians reported a general awareness of polypharmacy and deprescribing, there was moderate to low current activity in medication review and deprescribing, a perceived lack of role in medication review by junior doctors, and minimal knowledge of deprescribing tools. Use of a previously validated self-efficacy questionnaire showed lowest self-efficacy in domains related to developing deprescribing plans and implementing them. Pre-post analysis of medical student responses found a small statistically significant improvement following viewing the module in awareness of polypharmacy, deprescribing and deprescribing tools, perception of their role in deprescribing, and self-efficacy in planning and implementation of deprescribing decisions. CONCLUSIONS Hospital clinicians and senior medical students had limited self-efficacy in deprescribing and hospital clinicians reported they did not deprescribe frequently. Targets for educational and behavioral interventions were identified. A short e-learning module on polypharmacy and deprescribing may be a useful component of a multi-strategic intervention to implement deprescribing into routine inpatient care.
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Affiliation(s)
- Brendan Ng
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia; Capital and Coast District Health Board, Wellington, New Zealand.
| | - Mai Duong
- Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Sarita Lo
- Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - David Le Couteur
- University of Sydney and Concord Hospital, Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - Sarah Hilmer
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
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Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Patient-reported outcome measures. Res Social Adm Pharm 2020; 16:1760-1767. [DOI: 10.1016/j.sapharm.2020.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/23/2019] [Accepted: 01/26/2020] [Indexed: 11/20/2022]
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Drenth‐van Maanen AC, Wilting I, Jansen PAF. Prescribing medicines to older people-How to consider the impact of ageing on human organ and body functions. Br J Clin Pharmacol 2020; 86:1921-1930. [PMID: 31425638 PMCID: PMC7495267 DOI: 10.1111/bcp.14094] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022] Open
Abstract
Ageing is associated with several changes in human organs, which result in altered medication pharmacokinetics and pharmacodynamics. Ageing is also associated with changes in human body functions, such as impaired vision, hearing, swallowing, motor and cognitive functions, which can affect the adequate intake and administration of drugs. As a consequence, older people, and especially patients older than 75 years, are the main users of many drugs and they frequently use 5 drugs or more long-term (i.e. polypharmacy). All this increases the complexity of adequate drug intake, administration and adherence. However, there is a lack of evidence on the considerations that should be taken into account to ensure appropriate drug prescribing to older people. This review article summarizes the most clinically relevant changes in human organ and body functions and the consequential changes in pharmacokinetics and pharmacodynamics in older people, along with possible dosing consequences or alternatives for drugs frequently prescribed to this patient population. Recommendations are given on how ageing could be considered in clinical drug development, drug authorization and appropriate prescribing.
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Affiliation(s)
- A. Clara Drenth‐van Maanen
- Geriatric DepartmentUniversity Medical Center UtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor), The Netherlands
| | - Ingeborg Wilting
- Department of Clinical PharmacyUniversity Medical Center Utrecht, The Netherlands
| | - Paul A. F. Jansen
- Geriatric DepartmentUniversity Medical Center UtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor), The Netherlands
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Sikkens JJ, Caris MG, Schutte T, Kramer MHH, Tichelaar J, van Agtmael MA. Improving antibiotic prescribing skills in medical students: the effect of e-learning after 6 months. J Antimicrob Chemother 2019; 73:2243-2246. [PMID: 29746682 DOI: 10.1093/jac/dky163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/11/2018] [Indexed: 02/01/2023] Open
Abstract
Background Antimicrobial prescribing behaviour is first established during medical study, but teachers often cite lack of time as an important problem in the implementation of antimicrobial stewardship in the medical curriculum. The use of electronic learning (e-learning) is a potentially time-efficient solution, but its effectiveness in changing long-term prescribing behaviour in medical students is as yet unknown. Methods We performed a prospective controlled intervention study of the long-term effects of a short interactive e-learning course among fourth year medical students in a Dutch university. The e-learning was temporarily implemented as a non-compulsory course during a 6 week period. Six months later, all students underwent an infectious disease-based objective structured clinical examination (OSCE) aimed at simulating postgraduate prescribing. If they passed, each student did the OSCE only once. We created a control group of students from a period when the e-learning was not implemented. Main outcomes were the OSCE pass percentage and knowledge, drug choice and overall scores. We used propensity scores to create equal comparisons. Results We included 71 students in the intervention group and 285 students in the control group. E-learning participation in the intervention group was 81%. The OSCE pass percentage was 86% in the control group versus 97% in the intervention group (+11%, OR 5.9, 95% CI 1.7-20.0). OSCE overall, knowledge and drug choice grades (1-10) were also significantly higher in the intervention group (differences +0.31, +0.31 and +0.51, respectively). Conclusions E-learning during a limited period can significantly improve medical students' performance of an antimicrobial therapeutic consultation in a situation simulating clinical practice 6 months later.
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Affiliation(s)
- Jonne J Sikkens
- Department of Internal Medicine, VU University Medical Centre Amsterdam, Postbus 7057, MB, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Martine G Caris
- Department of Internal Medicine, VU University Medical Centre Amsterdam, Postbus 7057, MB, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Tim Schutte
- Department of Internal Medicine, VU University Medical Centre Amsterdam, Postbus 7057, MB, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Mark H H Kramer
- Department of Internal Medicine, VU University Medical Centre Amsterdam, Postbus 7057, MB, Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, VU University Medical Centre Amsterdam, Postbus 7057, MB, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, VU University Medical Centre Amsterdam, Postbus 7057, MB, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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10
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Bakkum MJ, Tichelaar J, Wellink A, Richir MC, van Agtmael MA. Digital Learning to Improve Safe and Effective Prescribing: A Systematic Review. Clin Pharmacol Ther 2019; 106:1236-1245. [PMID: 31206612 PMCID: PMC6896235 DOI: 10.1002/cpt.1549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
With the aim to modernize and harmonize prescribing education, the European Association for Clinical Pharmacology and Therapeutics (EACPT) Working Group on education recommended the extensive use and distribution of digital learning resources (DLRs). However, it is unclear whether the complex task of prescribing medicine can be taught digitally. Therefore, the aim of this review was to investigate the effect of diverse DLRs in clinical pharmacology and therapeutics education. Databases PubMed, EMBASE, CINAHL, ERIC, and CENTRAL were systematically searched. Sixty-five articles were included in the analyses. Direct effects on patients were studied, but not detected, in six articles. Skills and behavior were studied in 11 articles, 8 of which reported positive effects. Knowledge acquisition was investigated in 19 articles, all with positive effects. Qualitative analyses yielded 10 recommendations for the future development of DLRs. Digital learning is effective in teaching knowledge, attitudes, and skills associated with safe and effective prescribing.
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Affiliation(s)
- Michiel J Bakkum
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics (EACPT) Education Working Group, Frankfurt, Germany
| | - Anne Wellink
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics (EACPT) Education Working Group, Frankfurt, Germany
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11
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Boersma MN, Huibers CJA, Drenth-van Maanen AC, Emmelot-Vonk MH, Wilting I, Knol W. The effect of providing prescribing recommendations on appropriate prescribing: A cluster-randomized controlled trial in older adults in a preoperative setting. Br J Clin Pharmacol 2019; 85:1974-1983. [PMID: 31108564 PMCID: PMC6710520 DOI: 10.1111/bcp.13987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/28/2019] [Accepted: 05/09/2019] [Indexed: 11/27/2022] Open
Abstract
AIMS The Systematic Tool to Reduce Inappropriate Prescribing is a method to assess patient's medication and has been incorporated into a clinical decision support system: STRIP Assistant. Our aim was to evaluate the effect of recommendations generated using STRIP Assistant on appropriate prescribing and mortality in a preoperative setting. METHODS This cluster-randomized controlled trial was carried out at the preoperative geriatric outpatient clinic. Residents who performed a comprehensive geriatric assessment were randomized to the control group and intervention group in a 1:1 ratio. Visiting patients aged 70 years or older on 5 or more medications were included. INTERVENTION prescribing recommendations were generated by a physician using STRIP Assistant and given to the resident. Control group residents performed a medication review according to usual care. PRIMARY OUTCOME number of medication changes made because of potential prescribing omissions (PPOs), potentially inappropriate medications (PIMs), and suboptimal dosages according to the prescribing recommendations. Secondary outcome: 3-month postoperative mortality. RESULTS 65 intervention and 59 control patients were included, attended by 34 residents. Significantly more medication changes because of PPOs and PIMs were made in the intervention group than in the control group (PPOs 26.2% vs 3.4%, odds ratio 0.04 [95% confidence interval 0.003-0.46] P < .05; PIMS 46.2% vs 15.3% odds ratio 0.14 [95% confidence interval 0.07-0.57] P < .005). There were no differences in dose adjustments or in postoperative mortality. CONCLUSION Prescribing recommendations generated with the help of STRIP Assistant improved appropriate prescribing in a preoperative geriatric outpatient clinic but did not affect postoperative mortality.
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Affiliation(s)
- Marijke Nynke Boersma
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), UMC Utrecht, The Netherlands
| | | | - Anna Clara Drenth-van Maanen
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), UMC Utrecht, The Netherlands
| | | | | | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), UMC Utrecht, The Netherlands
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12
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Kympers C, Tommelein E, Van Leeuwen E, Boussery K, Petrovic M, Somers A. Detection of potentially inappropriate prescribing in older patients with the GheOP³S-tool: completeness and clinical relevance. Acta Clin Belg 2019; 74:126-136. [PMID: 30698077 DOI: 10.1080/17843286.2019.1568353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S-) tool was recently developed as an explicit screening method to detect Potentially Inappropriate Prescribing (PIP) in the community pharmacy. We aimed to validate the GheOP3S-tool as an effective screening method for PIP. METHODS All patients admitted to the acute geriatric ward of the Sint-Vincentius hospital (Belgium) were consecutively screened for inclusion (≥70 years,≥5 drugs chronically). PIP prevalence was evaluated by applying the GheOP3S-tool on the complete medication history. For each PIP-item, clinical relevance of the detected item, relevance of proposed alternative and subsequent acceptance by the treating geriatrician and a general practitioner were evaluated. Additionally, contribution to the current admission and preventability was assessed by the geriatrician. The completeness of a PIP-screening with the GheOP3S-tool was evaluated through comparison with the adapted Medication Appropriateness Index (aMAI). RESULTS We detected 250 GheOP3S-items in 57 of 60 included patients (95%) (median: four PIP-items per patient; IQR: 3-5). Both the geriatrician and the general practitioners scored the clinical relevance of the detected items 'serious' or 'significant' in over 70% of cases. Proposed alternative treatment plans were accepted for 79% of the PIP-items (n = 198). The aMAI detected 536 items, of which 145 were also detected by the GheOP3S-tool. A total of 119 PIP-items were additionally detected by the GheOP3S-tool. CONCLUSION The clinical relevance of the PIP-items detected with the GheOP3S-tool is high, likewise the acceptance rate of proposed alternatives.
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Affiliation(s)
- C. Kympers
- Department of Internal medicine, section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - E. Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium
| | - Ellen Van Leeuwen
- Department of Family Medicine and Primary Health Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K. Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium
| | - M. Petrovic
- Department of Internal medicine, section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - A. Somers
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium
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13
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Wuyts J, Maesschalck J, De Wulf I, Foubert K, Boussery K, De Lepeleire J, Foulon V. Studying the impact of a medication use evaluation for polymedicated older patients by the community pharmacist (SIMENON): study protocol. BMC Health Serv Res 2018; 18:623. [PMID: 30089523 PMCID: PMC6083518 DOI: 10.1186/s12913-018-3440-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Aged polymedicated patients are particularly vulnerable for drug-related problems. A medication review aims to optimize the medication use of patients and improve health outcomes. In this study, the effect of a pharmacist-led medication use review is investigated for polymedicated ambulatory older patients with the aim of implementing this pharmaceutical care intervention across Belgium. Methods This article describes the study protocol of the SIMENON study and reports the results of the feasibility study, which aimed to test and optimize this study protocol. In the SIMENON intervention study, 75 Belgian community pharmacies each recruit 12 patients for a medication use review. For each patient, the identified drug-related problems and subsequent interventions are registered using the PharmDISC classification. In a subset of Dutch speaking patients, a pretest-posttest single group design is used to measure the impact of this review on patient related outcomes using questionnaires. The main outcome of the study is the type and number of drug-related problems and related interventions. A second outcome is the impact of the medication use review on adherence, objectively measured with dispensing data. Evolution in medication related quality of life is another outcome, measured with the Living with Medicines Questionnaire version 3. Other patient reported outcomes include adherence, self-management, patient satisfaction, fall incidents and use of emergency healthcare services. Discussion The findings of this study can provide data on the effectiveness of a medication use review in the Belgian primary care setting. Furthermore, it will provide insights in which patients benefit most of this intervention and therefore facilitate the implementation of medication review in Belgium. Trial registration ClinicalTrials.gov NCT03179722. Retrospectively registered 7 June 2017.
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Affiliation(s)
- J Wuyts
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 O&N2, Box 521, 3000, Leuven, Belgium.
| | - J Maesschalck
- Association of Belgian Pharmacies (APB), Archimedesstraat 11, 1000, Brussels, Belgium
| | - I De Wulf
- Association of Belgian Pharmacies (APB), Archimedesstraat 11, 1000, Brussels, Belgium
| | - K Foubert
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - K Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - J De Lepeleire
- Department Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - V Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 O&N2, Box 521, 3000, Leuven, Belgium
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14
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Van der Linden L, Hias J, Dreessen L, Milisen K, Flamaing J, Spriet I, Tournoy J. Medication review versus usual care to improve drug therapies in older inpatients not admitted to geriatric wards: a quasi-experimental study (RASP-IGCT). BMC Geriatr 2018; 18:155. [PMID: 29970005 PMCID: PMC6029069 DOI: 10.1186/s12877-018-0843-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 06/25/2018] [Indexed: 11/12/2022] Open
Abstract
Background Interdisciplinary geriatric consultation teams (IGCT) are regularly requested to provide comprehensive geriatric assessments in older inpatients. Our primary aim was to evaluate whether medication reviews increased the number of IGCT-provided drug-related recommendations. Secondary aims were to reduce the number of potentially inappropriate medications (PIMs), and to identify the acceptance rate of and determinants for the number of recommendations. Methods A before-after study was performed in older inpatients not admitted to acute geriatric wards. The before cohort received usual care (UC); the after cohort was subjected to the intervention (I), consisting of a systematic medication review, based on but not limited to the RASP (Rationalization of Home Medication by an Adjusted STOPP in Older Patients) list. The primary outcome measure was the number of IGCT-provided drug-related recommendations. Age, sex, Charlson Comorbidity Index, creatinine clearance and serum creatinine were ascertained upon enrolment. Following variables were determined on admission and at discharge: number of drugs and number as well as type of RASP-identified PIMs. Acceptance by ward-based physicians was also determined. Poisson regression was performed to identify determinants for the primary outcome measure. Results Fifty-nine participants were enrolled (nUC = 29; nI = 30). The intervention increased the number of drug-related recommendations from a median of 0 (IQR: 0–1) to 8 (IQR: 6.75–10) (p < 0.001). The median number of accepted recommendations differed significantly as well (UC vs. I: 0.0 (0.0–0.5) vs. 3.0 (0.0–5.3); p < 0.001). In the intervention cohort, patients were discharged with fewer drugs compared to admission (UC vs. I: 108.5%, IQR: 100.0–135.8% vs. 92%, IQR: 80.5–103.5%; p = 0.002). More RASP PIMs were discontinued in the intervention cohort, with a mean difference of 1.49 RASP PIMs (95% confidence interval (CI): 0.70, 2.23; p < 0.001). Regression analysis identified two determinants: allocation to the intervention cohort with an incidence rate ratio (IRR) of 14.1 (95% CI: 8.30, 23.8) and the number of preadmission drugs with an IRR of 1.06 (95% CI: 1.03, 1.09). Conclusions A structured medication review as part of usual IGCT care may contribute to an increased detection of drug-related problems and help to further reduce polypharmacy in older inpatients, not admitted to acute geriatric care wards. Trial registration NCT02165618, retrospectively registered June 17, 2014.
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Affiliation(s)
- Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. .,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium.
| | - Julie Hias
- Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Lisa Dreessen
- Department of Geriatric Medicine, University Hospital of Brussels, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Louvain, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Louvain, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Louvain, Belgium
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15
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Drenth-van Maanen AC, Leendertse AJ, Jansen PAF, Knol W, Keijsers CJPW, Meulendijk MC, van Marum RJ. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): Combining implicit and explicit prescribing tools to improve appropriate prescribing. J Eval Clin Pract 2018; 24:317-322. [PMID: 28776873 DOI: 10.1111/jep.12787] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022]
Abstract
Inappropriate prescribing is a major health care issue, especially regarding older patients on polypharmacy. Multiple implicit and explicit prescribing tools have been developed to improve prescribing, but these have hardly ever been used in combination. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) combines implicit prescribing tools with the explicit Screening Tool to Alert physicians to the Right Treatment and Screening Tool of Older People's potentially inappropriate Prescriptions criteria and has shared decision-making with the patient as a critical step. This article describes the STRIP and its ability to identify potentially inappropriate prescribing. The STRIP improved general practitioners' and final-year medical students' medication review skills. The Web-application STRIP Assistant was developed to enable health care providers to use the STRIP in daily practice and will be incorporated in clinical decision support systems. It is currently being used in the European Optimizing thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly (OPERAM) project, a multicentre randomized controlled trial involving patients aged 75 years and older using multiple medications for multiple medical conditions. In conclusion, the STRIP helps health care providers to systematically identify potentially inappropriate prescriptions and medication-related problems and to change the patient's medication regimen in accordance with the patient's needs and wishes. This article describes the STRIP and the available evidence so far. The OPERAM study is investigating the effect of STRIP use on clinical and economic outcomes.
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Affiliation(s)
- A Clara Drenth-van Maanen
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands.,Expertise Centre Pharmacotherapy for Old Persons (Ephor), Utrecht, The Netherlands
| | - Anne J Leendertse
- Department of General Practice, Julius for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paul A F Jansen
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands.,Expertise Centre Pharmacotherapy for Old Persons (Ephor), Utrecht, The Netherlands
| | - Wilma Knol
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands.,Expertise Centre Pharmacotherapy for Old Persons (Ephor), Utrecht, The Netherlands
| | - Carolina J P W Keijsers
- Expertise Centre Pharmacotherapy for Old Persons (Ephor), Utrecht, The Netherlands.,Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Michiel C Meulendijk
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rob J van Marum
- Expertise Centre Pharmacotherapy for Old Persons (Ephor), Utrecht, The Netherlands.,Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,VUmc, Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
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16
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Desnoyer A, Blanc AL, Pourcher V, Besson M, Fonzo-Christe C, Desmeules J, Perrier A, Bonnabry P, Samer C, Guignard B. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. BMJ Open 2017; 7:e016070. [PMID: 28760793 PMCID: PMC5642656 DOI: 10.1136/bmjopen-2017-016070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection. DESIGN Five-step study involving selection of medical domains, literature review and 17 semistructured interviews, a two-round Delphi survey, a forward/back-translation process and an electronic tool development. SETTING 22 University and general hospitals from Canada, Belgium, France and Switzerland. PARTICIPANTS 40 physicians and 25 clinical pharmacists were involved in the study.Agreement with the checklist statements and their usefulness for healthcare professional training were evaluated using two 6-point Likert scales (ranging from 0 to 5). PRIMARY AND SECONDARY OUTCOME MEASURES Agreement and usefulness ratings were defined as: >65% of the experts giving the statement a rating of 4 or 5, during the first Delphi-round and >75% during the second. RESULTS 166 statements were generated during the first two steps. Mean agreement and usefulness ratings were 4.32/5 (95% CI 4.28 to 4.36) and 4.11/5 (4.07 to 4.15), respectively, during the first Delphi-round and 4.53/5 (4.51 to 4.56) and 4.36/5 (4.33 to 4.39) during the second (p<0.001). The final checklist includes 160 statements in 17 medical domains and 56 pathologies. An algorithm of approximately 31 000 lines was developed including comorbidities and medications variables to create the electronic tool. CONCLUSION PIM-Check is the first electronic prescription-screening checklist designed to detect PIM in internal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety.
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Affiliation(s)
- Aude Desnoyer
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anne-Laure Blanc
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Hôpitaux de l’Est Lémanique, Vevey, Switzerland
| | - Valérie Pourcher
- Department of Infectious and Tropical Diseases, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- UMR996—Inflammation, Chemokines and Immunopathology, Inserm, Clamart, France
| | - Marie Besson
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Jules Desmeules
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Arnaud Perrier
- Department of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pascal Bonnabry
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Caroline Samer
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Bertrand Guignard
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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17
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Shamliyan TA, Khalil DH, Middleton M. Interventions for Community-dwelling Patients with Multiple Chronic Illnesses. Am J Med 2017; 130:148-152. [PMID: 27838377 DOI: 10.1016/j.amjmed.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Tatyana A Shamliyan
- Senior Director, Evidence-Based Medicine Quality Assurance, Elsevier, 1600 JFK Blvd 20(th) floor, Philadelphia, PA 19103.
| | - Dr Hanan Khalil
- Senior Lecturer/Pharmacist Academic, Faculty of Medicine, Nursing and Health Sciences, Monash Rural Heath, Monash University; Editor-in-Chief- International Journal of Evidence-Based Healthcare
| | - Maria Middleton
- Project Coordinator, Evidence-Based Medicine Center, Elsevier, 1600 JFK Blvd 20(th) floor, Philadelphia, PA 19103
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18
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Soiza RL, Subbarayan S, Antonio C, Cruz-Jentoft AJ, Petrovic M, Gudmundsson A, O'Mahony D. The SENATOR project: developing and trialling a novel software engine to optimize medications and nonpharmacological therapy in older people with multimorbidity and polypharmacy. Ther Adv Drug Saf 2016; 8:81-85. [PMID: 28382196 DOI: 10.1177/2042098616675851] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roy L Soiza
- Department of Medicine for the Elderly, NHS Grampian, Wards 303/4, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, UK
| | | | - Cherubini Antonio
- Italian National Research Centre on Aging, (IRCCS-INRCA), Ancona, Italy
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19
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Lavan AH, Gallagher PF, O’Mahony D. Methods to reduce prescribing errors in elderly patients with multimorbidity. Clin Interv Aging 2016; 11:857-66. [PMID: 27382268 PMCID: PMC4922820 DOI: 10.2147/cia.s80280] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers' lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people's prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in older multimorbid people. The European Union-funded SENATOR and OPERAM clinical trials commencing in 2016 will examine the impact of customized software engines in reducing medication-related morbidity, avoidable excess cost, and rehospitalization in older multimorbid people.
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Affiliation(s)
- Amanda H Lavan
- Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Paul F Gallagher
- Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Denis O’Mahony
- Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland
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20
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Chau SH, Jansen APD, van de Ven PM, Hoogland P, Elders PJM, Hugtenburg JG. Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. Int J Clin Pharm 2015; 38:46-53. [PMID: 26597955 PMCID: PMC4733134 DOI: 10.1007/s11096-015-0199-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
Background Knowledge of drug-related problems (DRPs) identified in the medication of home-dwelling elderly patients with polypharmacy has been based predominantly on medication reviews conducted in research settings rather than in daily practice. Objective To evaluate the prevalence of DRPs identified by means of a clinical medication review (CMR) and the implementation rate of proposed interventions in a large group of older patients with polypharmacy in the daily practice of community pharmacies. Setting 318 Dutch community pharmacies. Method A cross-sectional study based on CMR-data of 3807 older patients (≥65 years) with polypharmacy (≥5 drugs) completed between January and August 2012. Data were extracted from community pharmacists’ databases and entailed: year of birth, gender, dispensing data, number and nature of identified DRPs, consultations performed, proposed and implemented interventions. Main outcome measure Prevalence of DRPs, drug classes involved in overtreatment and undertreatment, and proposed and implemented interventions. Results A median of two DRPs (interquartile range 1–4; mean 3.0) was identified per patient. The DRP-categories overtreatment (25.5 %) and undertreatment (15.9 %) were found most frequently. 46.2 % of the proposed interventions to solve DRPs were implemented as proposed, in 22.4 % of cases, the intervention differed from the proposal. In 31.3 % of cases no intervention was implemented. Conclusion By conducting a CMR community pharmacists identified a median of two DRPs in older patients with polypharmacy. Overtreatment and undertreatment accounted for 41.4 % of the DRPs identified. In dealing with DRPs, pharmacists proposed a variety of interventions of which the majority (69.9 %) was either implemented or led to alternative interventions. A set of explicit criteria should be applied during a CMR to solve and prevent DRPs.
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Affiliation(s)
- Sek Hung Chau
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Aaltje P D Jansen
- The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Petra Hoogland
- Department of Pharmaceutical Affairs, Service Apotheek Beheer B.V., Enter, The Netherlands
| | - Petra J M Elders
- The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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21
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Mayorga E, Golnik K, Palis G. One-Year Progress in Ophthalmic Education: Annual Review. Asia Pac J Ophthalmol (Phila) 2015; 4:388-98. [PMID: 26716435 DOI: 10.1097/apo.0000000000000162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to update the practicing ophthalmologist on the English language literature about medical education from the prior year. DESIGN A search of English language literature was performed on PubMed from January 1, 2014, to December 31, 2014. METHODS Because the search using the main topic of the review "medical education" came up with 7394 citations, authors finally decided to narrow the search to 3 topics of their interest:1. Current state of competency-based education and teaching methods of competencies. This section included ophthalmic/ophthalmology education, core competencies, competency-based education, teaching strategies, tools and methods in medical education.2. E-learning. This section included e-learning, online learning, online teaching, Web-based teaching, Web-based learning, and flipped classroom.3. ASSESSMENTS This section included assessment of medical students, residents, fellows, faculty, attending physicians, and medical teachers, assessment of medical student ophthalmology programs, ophthalmology residency programs, residency programs, and fellowship programs. RESULTS The authors reviewed and summarized articles published in 2014 examining or describing the 3 main areas of the review described previously. CONCLUSIONS This review updates the comprehensive ophthalmologist on advances in ophthalmic medical education. Ophthalmic educators could apply the ideas presented in this review according to their possibilities in their own settings and programs.
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Affiliation(s)
- Eduardo Mayorga
- From the *International Council of Ophthalmology, San Francisco, CA; †School of Medicine and Eye Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; ‡University of Cincinnati; and §Cincinnati Eye Institute, Cincinnati, OH
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22
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Keijsers CJPW, Ross S. A pharmacological approach to education. Br J Clin Pharmacol 2015; 80:329-30. [PMID: 26095016 DOI: 10.1111/bcp.12700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Sarah Ross
- Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK
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Jubraj B, Marvin V, Poots AJ, Patel S, Bovill I, Barnett N, Issen L, Bell D. A pilot survey of junior doctors' attitudes and awareness around medication review: time to change our educational approach? Eur J Hosp Pharm 2015; 22:243-248. [PMID: 26246893 PMCID: PMC4516007 DOI: 10.1136/ejhpharm-2015-000664] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives Our aim was to explore junior doctors’ attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medication review was distributed among all 42 foundation year one (FY1) doctors at the Chelsea and Westminster Hospital NHS Foundation Trust in November 2014. Descriptive statistics were used for analysis. Results Twenty doctors completed the survey (48%). Of those, 17 believed that it was the pharmacist's duty to review medicines; and 15 of 20 stated the general practitioner (GP). Sixteen of 20 stated that they would consult a senior doctor first before stopping medication. Eighteen of 20 considered the GP and consultant to be responsible for alterations, rather than themselves. Sixteen of 20 respondents were not aware of the availability of a medication review tool. Seventeen of 20 felt that more support from senior staff would help them become involved with medication review. Conclusions Junior doctors report feeling uncomfortable altering mediations without consulting a senior first. They appear to be building confidence with prescribing in their first year but not about the medication review process or questioning the drugs already prescribed. Consideration should be given to what we have termed a ‘bottom-up’ educational approach to provide early experience of and change the culture around medication review, to include the education of undergraduate and foundation doctors and pharmacists.
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Affiliation(s)
- Barry Jubraj
- Pharmacy Department , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK ; National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC NWL) , London , UK
| | - Vanessa Marvin
- Pharmacy Department , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK ; Pharmacy Department , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK
| | - Alan J Poots
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC NWL) , London , UK
| | - Shreena Patel
- Department of Pharmacy , King's College London , London , UK
| | - Iñaki Bovill
- Department of Medicine for the Elderly , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK
| | - Nina Barnett
- Pharmacy Department , London North West Healthcare NHS Trust (Northwick Park Hospital) , London , UK
| | - Laurel Issen
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC NWL) , London , UK
| | - Derek Bell
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC NWL) , London , UK
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24
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Delgado Silveira E, Montero Errasquín B, Muñoz García M, Vélez-Díaz-Pallarés M, Lozano Montoya I, Sánchez-Castellano C, Cruz-Jentoft AJ. [Improving drug prescribing in the elderly: a new edition of STOPP/START criteria]. Rev Esp Geriatr Gerontol 2015; 50:89-96. [PMID: 25466971 DOI: 10.1016/j.regg.2014.10.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 06/04/2023]
Abstract
Inappropriate use of drugs in older patients may have an adverse impact on several individual health outcomes, such as increasing the prevalence of adverse drug reactions, morbidity and mortality, and geriatric syndromes, as well as on health care systems, such as increased costs and longer hospital stays. Explicit criteria of drug appropriateness are increasingly used to detect and prevent inappropriate use of drugs, either within a comprehensive geriatric assessment or as tool used by different multidisciplinary geriatric teams. STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition (recently published in English) of the STOPP-START criteria is presented here. A review of all the papers published in Spain using the former version of these criteria is also presented, with the intention of promoting their use and for research in different health care levels.
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Affiliation(s)
- E Delgado Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - M Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - I Lozano Montoya
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - A J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España.
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