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Kummer I, Reissigová J, Lukačišinová A, Ortner Hadžiabdić M, Stuhec M, Liperoti R, Finne-Soveri H, Onder G, van Hout H, Fialová D. Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents. Ann Med 2024; 56:2357232. [PMID: 38833339 DOI: 10.1080/07853890.2024.2357232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
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Affiliation(s)
- Ingrid Kummer
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Jindra Reissigová
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, The Czech Republic
| | - Anna Lukačišinová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
| | - Maja Ortner Hadžiabdić
- Center for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein van Hout
- Departments of General Practice and Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, The Czech Republic
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Ivan SJ, Roebuck EH, Sinks AL, Robinson MM, Clark PE, Gaston KE, Matulay JT, Riggs SB. It's complicated: The relationship of non-narcotic medications and postoperative opioid use in radical cystectomy patients. Urol Oncol 2024; 42:332.e1-332.e9. [PMID: 38735799 DOI: 10.1016/j.urolonc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/31/2024] [Accepted: 03/10/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The effect of individual non-narcotic analgesics in cystectomy enhanced recovery after surgery (ERAS) is unknown. Additionally, many non-narcotic medications are associated with side effects pertinent to the cystectomy population. To better understand the actual use and utility of these medications, we sought to characterize the association between non-narcotic medications and milligram morphine equivalent (MME) narcotic score during the postoperative inpatient stay. METHODS We reviewed 260 consecutive ERAS cystectomy patients. The MME impact of non-narcotic compliance and cumulative dose of medication received was evaluated separately with general linear models. We also assessed relationship of non-narcotic compliance to patient reported pain score, length of stay (LOS), and time to return of bowel function (ROBF) and performed manual review of postoperative documentation to identify reasons for medication noncompliance. RESULTS Compliance with postoperative acetaminophen, gabapentin, and ketorolac was low. There was an inverse relationship between ketorolac dose and MME on postoperative day 1 (-0.026 MME/mg; P = 0.004) and postoperative day 2 (-0.33 MME/mg; P < 0.001). Compliance with ketorolac was associated with lower MME on postoperative day 1 (26.1 MME v. 33.6 MME; P = 0.023). There were no such associations identified with gabapentin or acetaminophen. Gabapentin compliance was associated with earlier ROBF (3.7 days v. 4.3 days; P = 0.006). Ketorolac compliance was associated with lower pain score on POD1 (3.25 VAS v. 4.07 VAS; P = 0.019) and POD2 (3.05 VAS v. 3.85 VAS; P = 0.040) There was no association between medication compliance and LOS. The most common reasons identified for non-compliance with gabapentin and ketorolac were renal function concerns (38% and 40% respectively), bleeding concerns with ketorolac (20%) and concerns for neurologic adverse effect with gabapentin (16%). CONCLUSION Compliance with non-narcotic medications in our ERAS cystectomy protocol was poor. There was a modest association with ketorolac and postoperative MME but no association with gabapentin or acetaminophen. Further study will clarify the role of these medications for cystectomy patients. Component specific analysis of protocolized care is valuable and may alter care pathways.
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Affiliation(s)
- Samuel J Ivan
- Department of Urology, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Emily H Roebuck
- Department of Urology, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Alexander L Sinks
- Department of Urology, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Myra M Robinson
- Department of Cancer Biostatistics, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Peter E Clark
- Department of Urology, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Kris E Gaston
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Justin T Matulay
- Department of Urology, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC
| | - Stephen B Riggs
- Department of Urology, Carolinas Medical Center, Atrium Health, Levine Cancer Institute, Charlotte, NC.
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Pitrou I, D'Aiuto C, Lunghi C, Guénette L, Berbiche D, Bertrand K, Vasiliadis HM. Changes in self-rated physical and mental health and life satisfaction associated with opioid and potentially inappropriate opioid prescribing in primary care older adults. Fam Pract 2024; 41:442-450. [PMID: 37119373 DOI: 10.1093/fampra/cmad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE To examine changes in life satisfaction and physical and mental health associated with opioid and potentially inappropriate opioid prescribing (PIOP) among older adults. METHODS Secondary data analysis from the Étude sur la Santé des Aînés (ESA)-Services study. The sample consisted of 945 older adults recruited in primary care with available health survey information linked to administrative medical record data. The exposure of interest was categorized as no prescription, opioid prescription, and PIOP, defined using the Beers criteria. Outcomes were self-rated physical health, mental health, and life satisfaction measured at baseline and at a 3-year follow-up. Generalized estimating equations were used to examine 3-year changes in outcomes as a function of opioid prescribing. Analyses were adjusted for covariates relating to health, psychosocial, and sociodemographic factors as well as duration/frequency of opioid prescribing. Analyses were conducted in the overall sample and in non-cancer patients. RESULTS The sample had an average age of 73.1 years; the majority was Canadian-born (96.3%) while females made up over half (55.4%) the sample. Compared to not receiving an opioid prescription, PIOP was associated with a deterioration in physical health (ORadjusted = 0.65; 95%CI = 0.49, 0.86), but not mental health and life satisfaction. In non-cancer patients, PIOP was associated with poorer physical health (ORadjusted = 0.59; 95%CI = 0.40, 0.87) and opioid prescribing was marginally associated with improved life satisfaction (ORadjusted = 1.58; 95%CI = 0.96, 2.60). CONCLUSION PIOP was associated with a deterioration in physical health. Patient-centred chronic pain management and the effect on health and well-being require further study in older adults.
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Affiliation(s)
- Isabelle Pitrou
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
- Charles-Le Moyne Research Center (CRCLM), Longueuil, Canada
| | - Carina D'Aiuto
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
- Charles-Le Moyne Research Center (CRCLM), Longueuil, Canada
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Canada
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec, Canada
- Department of Medical and surgical sciences, University of Bologna, Bologna, Italy
| | - Line Guénette
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec, Canada
- Faculty of Pharmacy, Laval University, Quebec, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
- Charles-Le Moyne Research Center (CRCLM), Longueuil, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
- Charles-Le Moyne Research Center (CRCLM), Longueuil, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
- Charles-Le Moyne Research Center (CRCLM), Longueuil, Canada
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Riley K, Yap K, Foley G, Lambe J, Lund S. Impact of a clinical decision support system on identifying drug-related problems and making recommendations to providers during community pharmacist-led medication reviews in Ontario, Canada: A pilot study. J Eval Clin Pract 2024. [PMID: 39138861 DOI: 10.1111/jep.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/17/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To evaluate the impact of a clinical decision support system (CDSS) to identify drug-related problems (DRPs) during community pharmacist medication reviews. DESIGN Pilot 3-phase (group), open-label study. SETTING AND PARTICIPANTS Two community pharmacies in Sarnia, Ontario, with pharmacists providing medication reviews to patients. STUDY PROCEDURES Five pharmacists participated in three phases (groups). During Phase 1, pharmacists conducted medication reviews in 25 adult patients using the usual approaches. In Phase 2, pharmacists were trained to use a CDSS to identify DRPs, and then conducted medication reviews using the tool in a different group of 25 adult patients. In Phase 3, pharmacists conducted medication reviews without the aid of the CDSS in 25 additional adult patients. MAIN OUTCOME MEASURES The primary outcome was recommendation to the primary care physician to alter pharmacotherapy based on medication review, assessed using mean number and frequency (yes/no) of recommendations by patient. Secondary outcomes included number of potential DRPs, actual DRPs, medication review duration time, pharmacist's perceptions of the CDSS and patient satisfaction with medication review. RESULTS The mean number of recommendations to primary care physicians to alter pharmacotherapy per patient in Phases 1, 2 and 3 did not differ: 1.0 (SD = I.2) versus 1.5 (1.0) versus 1.5 (1.0), respectively; p = 0.223. The percentage of patients with a pharmacy recommendation sent to physicians across the phases, however, differed: 52% versus 80% versus 88%, respectively; p = 0.010, with more in Phases 2 and 3 compared to 1. There were more potential DRPs in group 2 compared to other groups. There were no differences in actual DRPs and medication review time. Pharmacists had positive attitudes about the CDSS. Patients were generally satisfied with their medication review. CONCLUSIONS This small pilot study provides some preliminary evidence for performance and feasibility of a CDSS to identify DRPs that pharmacists will act on. Future research is recommended to validate these findings in a larger sample.
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Affiliation(s)
- Karen Riley
- Hogan Pharmacy Partners LTD, Sarnia, Ontario, Canada
- KD Riley Pharmacist Professional Corporation, Sarnia, Ontario, Canada
| | - Katherine Yap
- Hogan Pharmacy Partners LTD, Sarnia, Ontario, Canada
| | - Gaelan Foley
- Hogan Pharmacy Partners LTD, Sarnia, Ontario, Canada
| | - John Lambe
- Hogan Pharmacy Partners LTD, Sarnia, Ontario, Canada
| | - Sean Lund
- Hogan Pharmacy Partners LTD, Sarnia, Ontario, Canada
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O'Connell J, Gorman A, Burke É, Deb S, Henman MC, McCallion P, McCarron M, Mullally T, Mulryan N, O'Dwyer M, Ryan C. OPTIMA-ID: development and validation of a medicine optimization tool for older adults with intellectual disability. Expert Rev Clin Pharmacol 2024:1-15. [PMID: 39138862 DOI: 10.1080/17512433.2024.2390913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Older people (i.e. ≥40 years) with intellectual disability have unique medication needs and may experience high levels of potentially inappropriate prescribing. Despite the availability of tools to optimize older adults' prescriptions, there is no comprehensive tool specifically for use in older adults with intellectual disability. We aimed to develop a tool for this purpose: Optimizing Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability (OPTIMA-ID). RESEARCH DESIGN AND METHODS A draft tool was developed based on literature review and clinical expertise. Focus groups with healthcare professionals and people with intellectual disability were conducted to refine the tool. The tool was presented electronically to an expert panel for Delphi validation. Median level of agreement and 75th percentile values were used to establish if consensus was reached. Criteria were accepted, rejected, revised or removed to develop the final tool. RESULTS Following two Delphi rounds, consensus on the content of OPTIMA-ID was reached for 67 prescribing criteria, 63 of which were agreed upon after Round 1 and a further 4 criteria accepted after Round 2. CONCLUSIONS OPTIMA-ID contains 67 criteria that can optimize medications for older people with intellectual disability. Its effectiveness, feasibility and impact on patient outcomes need to be established.
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Affiliation(s)
- Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Ashleigh Gorman
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Éilish Burke
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Shoumitro Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Martin Charles Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Tara Mullally
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Niamh Mulryan
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Cristín Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Gotfried MH, Auerbach SH, Dang-Vu TT, Mishima K, Kumar D, Moline M, Malhotra M. Efficacy and safety of insomnia treatment with lemborexant in older adults: analyses from three clinical trials. Drugs Aging 2024:10.1007/s40266-024-01135-8. [PMID: 39120786 DOI: 10.1007/s40266-024-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Insomnia is more common as people age. Several common hypnotics used to treat insomnia often do not adequately alleviate sleep issues in older adults and may be associated with negative residual effects such as an increased risk of falls, cognitive impairment, automobile accidents, and lack of response to auditory stimuli. The objective of these analyses of three clinical studies was to investigate the efficacy and safety of the dual orexin-receptor antagonist lemborexant (LEM) in older adults. METHODS Study E2006-G000-304 (Study 304; NCT02783729) was a randomized, double-blind, placebo (PBO)-controlled, active-comparator trial where subjects with insomnia disorder received LEM 5 mg (LEM5), LEM 10 mg (LEM10), zolpidem tartrate extended-release 6.25 mg (ZOL), or PBO for 30 days. In crossover Study E2006-E044-106 (Study 106; NCT02583451), healthy subjects (good sleepers) received LEM 2.5 mg, LEM5, LEM10, or PBO for eight nights or zopiclone on days 1 and 8 (and PBO on days 2-7). In crossover Study E2006-A001-108 (Study 108; NCT03008447), healthy subjects received a single dose of LEM5, LEM10, PBO, or ZOL. Sleep assessments included polysomnography-based latency to persistent sleep (LPS), wake after sleep onset (WASO), WASO in the second half of the night (WASO2H), sleep efficiency, postural stability, middle-of-the-night and next-day cognitive performance, middle-of-the-night auditory awakening threshold and return-to-sleep latency, and driving performance. RESULTS Overall, 453 of 1006 (45%; Study 304), 24 of 48 (50%; Study 106), and 28 of 56 (50%; Study 108) subjects were aged ≥ 65 years. In Study 304, LEM decreased (improved) LPS, WASO, and WASO2H from baseline more than ZOL and PBO; subjects treated with LEM had greater increases in sleep efficiency (improved) than with ZOL or PBO. In both Studies 304 and 108, postural stability was not impaired at waketime in subjects who received LEM compared with PBO. At waketime, LEM did not impair memory compared with PBO. In Study 108, following middle-of-the-night awakening, LEM and ZOL did not affect subjects' ability to awaken to auditory stimuli; LEM did not affect tests of memory and attention. In Study 106, LEM did not impair next-day driving performance in healthy elderly compared with PBO. LEM was well tolerated in subjects aged ≥ 65 years. CONCLUSIONS LEM provided benefits on sleep variables without next-morning residual effects in subjects aged ≥ 65 years, supporting LEM as a treatment option for older adults with insomnia. TRIAL REGISTRATION NUMBERS AND DATES OF REGISTRATION Study 304: ClinicalTrials.gov identifier, NCT02783729, date of registration, 26 May 2016. Study 106: ClinicalTrials.gov identifier, NCT02583451, date of registration, 22 October 2015. Study 108: ClinicalTrials.gov identifier, NCT03008447, date of registration, 2 January 2017.
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Affiliation(s)
| | - Sanford H Auerbach
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Thien Thanh Dang-Vu
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Le Centre integre universitaire de sante et de services sociaux (CIUSSS), Centre-Sud-de-l'île-de-Montréal, Montreal, QC, Canada
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Dinesh Kumar
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA
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Yang S, Huang S, Hincapie-Castillo JM, Ke X, Ding H, Sher MR, Jones B, Wilson DL, Lo-Ciganic WH. Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011-2018. J Clin Med 2024; 13:4549. [PMID: 39124815 PMCID: PMC11312945 DOI: 10.3390/jcm13154549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Chronic cough (CC), characterized as a cough lasting >8 weeks, is a common multi-factorial syndrome in the community, especially in older adults. Methods: Using a pre-existing algorithm to identify patients with CC within the 2011-2018 Medicare beneficiaries, we examined trends in gabapentinoid use through repeated cross-sectional analyses and identified distinct utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Individuals without CC but with any respiratory conditions related to cough served as a comparator group. Results: Among patients with CC, gabapentinoid use increased from 18.6% in 2011 to 24.1% in 2018 (p = 0.002), with a similar upward trend observed in the non-CC cohort but with overall lower usage (14.7% to 18.4%; p < 0.001). Patients with CC had significantly higher burdens of respiratory and non-respiratory comorbidities, as well as greater healthcare service and medication use compared to the non-CC cohort. The GBTM analyses identified three distinct gabapentinoid utilization trajectories for CC and non-CC patients: no use (77.3% vs. 84.5%), low use (13.9% vs. 10.3%), and high use (8.8% vs. 5.2%). Conclusions: Future studies are needed to evaluate the safety and effectiveness of gabapentinoid use in patients with refractory or unexplained CC in real-world settings.
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Affiliation(s)
- Seonkyeong Yang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Shu Huang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Juan M. Hincapie-Castillo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Xuehua Ke
- Merck & Co., Inc., Rahway, NJ 07065, USA (H.D.)
| | - Helen Ding
- Merck & Co., Inc., Rahway, NJ 07065, USA (H.D.)
| | | | - Bobby Jones
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Wei-Hsuan Lo-Ciganic
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- North Florida/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, FL 32608, USA
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8
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Gumport NB, Tully IA, Tutek J, Dietch JR, Zulman DM, Rosas LG, Simpson N, Manber R. Patient perceptions of digital and therapist-led CBT for insomnia: A qualitative study. Behav Sleep Med 2024:1-16. [PMID: 39096163 DOI: 10.1080/15402002.2024.2386611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
OBJECTIVES Technology has the potential to increase access to evidence-based insomnia treatment. Patient preferences/perceptions of automated digital cognitive behavior therapy for insomnia (CBTI) and telehealth-delivered CBTI remain largely unexplored among middle-aged and older adults. Using a qualitative approach, the current study describes patients' reasons for participating in the clinical trial, preferences for digital CBTI (dCBTI) versus therapist-led CBTI, patient attitudes toward dCBTI, and patient attitudes toward telehealth-delivered therapist-led CBTI. METHOD Middle-aged and older adults (N = 80) completed a semi-structured interview before CBTI exposure. Qualitative responses were coded, and themes were inductively extracted. RESULTS Most (62.5%) of the participants expressed a preference for therapist-led CBTI to dCBTI. Convenience was the most commonly reported advantage of dCBTI (n = 55) and telehealth-delivered CBTI (n = 65). Decreasing transit time and pandemic-related health concerns were identified as advantages to dCBTI and telehealth-delivered CBTI. Lack of human connection and limited personalization were perceived as disadvantages of dCBTI. Only three participants reported technological barriers to dCBTI and telehealth-delivered CBTI. CONCLUSION Findings suggest that, despite an overall preference for therapist-led treatment, most middle-aged and older adults are open to dCBTI. As both dCBTI and telehealth-delivered CBTI are perceived as convenient, these modalities offer the potential to increase access to insomnia care.
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Affiliation(s)
- Nicole B Gumport
- Division of Primary Care and Population Health, Stanford University, Stanford, USA
| | - Isabelle A Tully
- Division of Primary Care and Population Health, Stanford University, Stanford, USA
| | - Joshua Tutek
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, USA
| | - Donna M Zulman
- Division of Primary Care and Population Health, Stanford University, Stanford, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Stanford, USA
| | - Norah Simpson
- Division of Primary Care and Population Health, Stanford University, Stanford, USA
| | - Rachel Manber
- Division of Primary Care and Population Health, Stanford University, Stanford, USA
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Cohen M, Spyropoulos AC, Goodman SG, Spinler SA, Bonaca MP, Redling TM, Visveswaran G, Sohal S. Rivaroxaban Versus Apixaban: A Comparison Without a Simple Solution. Mayo Clin Proc Innov Qual Outcomes 2024; 8:321-328. [PMID: 38974528 PMCID: PMC11223068 DOI: 10.1016/j.mayocpiqo.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Affiliation(s)
- Marc Cohen
- Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ
- Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| | - Alex C. Spyropoulos
- Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Institute of Health System Science, The Feinstein Institutes for Medical Research, New York, NY
| | - Shaun G. Goodman
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital Professor and Heart & Stroke Foundation of Ontario (Polo), Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Consultant, Ontario, Canada
- Canadian Heart Research Centre, Canadian VIGOUR Centre Ontario, Canada
| | - Sarah A. Spinler
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY
| | - Marc P. Bonaca
- Division of Cardiology and Vascular Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Theresa M. Redling
- Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ
- Division of Geriatric Health and Disease Management, Cooperman Barnabas Medical Center Maida Geriatric Institute, Livingston, NJ
| | - Gautam Visveswaran
- Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ
- Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| | - Sumit Sohal
- Division of Cardiology, Department of Medicine, Yale New Haven Hospital, New Haven, CT
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10
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Coulson HC, Brown M, Burke K, Griffith E, Shadiack V, Garner HR, Foushee JA. Common outpatient diagnoses and associated treatments logged by osteopathic medical students within a geriatric population. J Osteopath Med 2024; 124:337-344. [PMID: 38641919 DOI: 10.1515/jom-2022-0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/02/2024] [Indexed: 04/21/2024]
Abstract
CONTEXT Clinical clerkships provide osteopathic medical students the opportunity to participate in the diagnosis and treatment of commonly encountered medical conditions. Appropriate management of these conditions may include pharmacotherapy and/or nonpharmacologic interventions, such as osteopathic manipulative treatment (OMT). Opportunities may exist to expand the utilization of OMT in the management of common conditions, particularly for geriatric patients, who are at increased risk for adverse outcomes from pharmacologic treatments. OBJECTIVES This study aimed to assess the most common diagnoses and corresponding treatments logged by osteopathic medical students within an ambulatory geriatric population. METHODS Patient encounters logged electronically by osteopathic medical students were retrospectively reviewed to determine the most commonly reported diagnostic codes and their treatments. Logged interventions were filtered to include patients over the age of 65 years who were seen on family medicine rotations within an ambulatory setting. The top 10 diagnoses were sorted and assessed to determine the associated treatments, including medications, procedures, and OMT. RESULTS Between January 2018 and June 2020, a total of 11,185 primary diagnoses were logged pertaining to the defined patient population. The most frequently documented diagnoses were essential hypertension (n=1,420; 12.7 %), encounter for well examination (n=1,144; 10.2 %), type 2 diabetes mellitus (n=837; 7.5 %), hyperlipidemia (n=346; 3.1 %), chronic obstructive pulmonary disease (COPD; n=278; 2.5 %), osteoarthritis (OA; n=221; 2.0 %), low back pain (LBP; n=202; 1.8 %), pain in joint (n=187; 1.7 %), hypothyroidism (n=164; 1.5 %), and urinary tract infections (n=160; 1.4 %). Three of the top 10 logged diagnoses were musculoskeletal in nature (OA, LBP, and pain in joint). Pharmacotherapy was reported as the predominant treatment for musculoskeletal conditions, with OMT being logged as a treatment for 10.9 % (n=50) of those cases. The most commonly logged medication class in the management of patients with those musculoskeletal conditions was nonsteroidal anti-inflammatory drugs (NSAIDs; n=128; 27.9 %), while opioids were the second most frequently documented class of medications (n=65; 14.2 %). CONCLUSIONS Musculoskeletal complaints were commonly logged by osteopathic medical students within the studied population. Opioids were documented as a treatment for musculoskeletal conditions more frequently than OMT. As such, opportunities exist to expand the utilization of OMT during clinical clerkships and to decrease the frequency of prescribed medications for pain management.
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Affiliation(s)
- Hannah C Coulson
- Pathologist at HCT Pathology Services, University of Maryland Shore Medical Center, Easton, MD, USA
| | - Miriam Brown
- Pathology, Microbiology, and Immunology Resident, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Burke
- Family and Community Medicine Resident, Penn State Health, Hershey, PN, USA
| | - Emma Griffith
- Internal Medicine Resident, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Victoria Shadiack
- Assistant Chair Principles of Primary Care and OMM, Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC, USA
| | - Harold R Garner
- Consultant, Illinois College of Osteopathic Medicine (proposed) at the Chicago School, Chicago, IL, USA
| | - Jaime A Foushee
- Department Chair for Biomedical Sciences; Discipline Chair for Pharmacology and Associate Professor, Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC, USA
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11
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Novais T, Reallon E, Martin J, Barral M, Krolak-Salmon P, Coste MH, Zenagui H, Garnier-Crussard A, Hoegy D, Mouchoux C. Clinical impact of an individualised clinical pharmacy programme into the memory care pathway of older people: an observational study. Int J Clin Pharm 2024; 46:889-898. [PMID: 38642248 DOI: 10.1007/s11096-024-01723-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia. AIM To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint. METHOD This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient's hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool. RESULTS Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12). CONCLUSION The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.
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Affiliation(s)
- Teddy Novais
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon 1, Lyon, France.
| | - Elsa Reallon
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
| | | | | | - Pierre Krolak-Salmon
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Marie-Hélène Coste
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
| | - Hanane Zenagui
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
| | - Antoine Garnier-Crussard
- Day-Care Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, Lyon, France
- Clinical and Research Memory Center of Lyon, Lyon Institute for Aging, Hospices Civils de Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Delphine Hoegy
- Pharmaceutical Unit, Groupement Hospitalier Est, University Hospital of Lyon, Lyon, France
- Health, Systemic, Process (P2S), Research Unit 4129, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Christelle Mouchoux
- Pharmaceutical Unit, Lyon Institute for Aging, Charpennes Hospital, University Hospital of Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon 1, Lyon, France
- Eduwell Team, Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
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12
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Huang L, Zhang T, Wang K, Chang B, Fu D, Chen X. Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients. Pain Ther 2024; 13:745-766. [PMID: 38836984 PMCID: PMC11254899 DOI: 10.1007/s40122-024-00619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.
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Affiliation(s)
- Li Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kaixin Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Bingcheng Chang
- The Second Affiliated Hospital of Guizhou, University of Traditional Chinese Medicine, Guiyang, 550003, China
| | - Daan Fu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
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13
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Jyrkkä J, Paulamäki J, Hartikainen S, Ahonen J, Antikainen R, Jauhonen HM, Jämsen E, Kössi A, Laurila J, Roitto HM, Söderling R, Tiihonen M, Huupponen R. Prescribing Appropriate Medicines to Older Adults: A Finnish Experience with the Web-Based Meds75+ Database. Drugs Aging 2024; 41:665-674. [PMID: 39085715 PMCID: PMC11322211 DOI: 10.1007/s40266-024-01131-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 08/02/2024]
Abstract
The Finnish web-based Meds75+ database supports rational, safe and appropriate prescribing to older adults in primary care. This article describes the content and updating process of Meds75+ and demonstrates its applicability in everyday clinical practice. Meds75+ contains a classification (A-D) and recommendation texts for 450-500 drug substances when used in the treatment of older adults aged 75 years or older. The content of Meds75+ is continually updated. Each assessment of a drug substance begins with a structured collection of available information and research evidence. After that, an interdisciplinary expert panel discusses the classification and recommendation using a consensus method. A rolling 3-year updating cycle guarantees that all drug substances are reviewed regularly. Most drug substances are classified as class A (41%) (suitable, e.g. bisoprolol) or as class C (37%) (suitable with specific precautions, e.g. ibuprofen). One-fifth (20%) of the substances are in class D (avoid use, e.g. diazepam). Most commonly, older adults have purchased substances affecting the alimentary tract and metabolism (17%), the nervous system (16%) and the cardiovascular system (15%). In Finland, the proportion of older adults using class D substances (37%) has not changed between the years 2019 and 2022. Meds75+ has potential to support safer and more effective use of medications for older adults, since it offers up-to-date information on drug substances for healthcare professionals.
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Affiliation(s)
- Johanna Jyrkkä
- Development and Information Services, Finnish Medicines Agency, Kuopio/Tampere, P.O. Box 55, FI-00034, Fimea, Finland.
| | - Jasmin Paulamäki
- Development and Information Services, Finnish Medicines Agency, Kuopio/Tampere, P.O. Box 55, FI-00034, Fimea, Finland
| | | | - Jouni Ahonen
- Hospital Pharmacy, Kuopio University Hospital, Kuopio, Finland
| | - Riitta Antikainen
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Center for Geriatrics and General Medicine, Oulu University Hospital, Oulu, Finland
| | - Hanna-Mari Jauhonen
- Ministry of Social Affairs and Health, Council for Choices in Health Care in Finland (COHERE Finland), Helsinki, Finland
| | - Esa Jämsen
- Faculty of Medicine (Clinicum), University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
| | - Anniina Kössi
- Development and Information Services, Finnish Medicines Agency, Kuopio/Tampere, P.O. Box 55, FI-00034, Fimea, Finland
| | - Jouko Laurila
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Center for Geriatrics and General Medicine, Oulu University Hospital, Oulu, Finland
| | - Hanna-Maria Roitto
- Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Riikka Söderling
- Division of Geriatrics, Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Risto Huupponen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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14
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Su CH, Huang KH, Yang Y, Gau SY, Chung NJ, Wu PT, Tsai TH, Lee CY. Cumulative Dose Effects of H1 Antihistamine Use on the Risk of Dementia in Patients With Allergic Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2155-2165. [PMID: 38935035 DOI: 10.1016/j.jaip.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/23/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND H1 antihistamines (AHs), categorized as first-generation antihistamines (FGAs) or second-generation antihistamines (SGAs), possess anticholinergic properties linked to heightened dementia risk. OBJECTIVES To explore dementia risk in patients with allergic rhinitis using AHs. METHODS Taiwanese patients with new-onset allergic rhinitis (2011-2017) constituted the study population (677,971 with FGAs or SGAs, 36,081 without AHs). AH use was measured in cumulative defined daily dose (cDDD). Patients were grouped by cDDD (nonuser, <60 cDDD, 60-120 cDDD, and >120 cDDD). A Cox proportional hazard model assessed the AH-dementia association. Sensitivity analysis explored AH effects on dementia risk across subgroups and associations between specific AHs and dementia types. RESULTS FGAs in patients with allergic rhinitis were associated with elevated dementia risk. At less than 60 cDDD, adjusted hazard ratio (aHR) was 1.13 (95% CI, 1.09-1.17); at 60 to 120 cDDD, aHR was 1.29 (95% CI, 1.21-1.38); and at more than 120 cDDD, aHR was 1.51 (95% CI, 1.42-1.62). SGAs also raised dementia risk. At less than 60 cDDD, aHR was 1.11 (95% CI, 1.05-1.17); at 60 to 120 cDDD, aHR was 1.19 (95% CI, 1.12-1.26); and at more than 120 cDDD, aHR was 1.26 (95% CI, 1.19-1.33). CONCLUSIONS Patients with allergic rhinitis on FGAs or SGAs face an escalating dementia risk with increasing cumulative dosage. Moreover, FGAs exhibit a higher dementia risk compared with SGAs. Nevertheless, extensive clinical trials are imperative for confirming the association between FGA use, SGA use, and dementia risk.
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Affiliation(s)
- Chun-Hung Su
- Department of Internal Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yih Yang
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ning-Jen Chung
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Po-Tseng Wu
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan; Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan; Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan.
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15
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Hu Q, Zhao M, Teng F, Lin G, Jin Z, Xu T. A model for identifying potentially inappropriate medication used in older people with dementia: a machine learning study. Int J Clin Pharm 2024; 46:937-946. [PMID: 38980590 PMCID: PMC11286713 DOI: 10.1007/s11096-024-01730-0] [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: 12/21/2023] [Accepted: 03/21/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Older adults with dementia often face the risk of potentially inappropriate medication (PIM) use. The quality of PIM evaluation is hindered by researchers' unfamiliarity with evaluation criteria for inappropriate drug use. While traditional machine learning algorithms can enhance evaluation quality, they struggle with the multilabel nature of prescription data. AIM This study aimed to combine six machine learning algorithms and three multilabel classification models to identify correlations in prescription information and develop an optimal model to identify PIMs in older adults with dementia. METHOD This study was conducted from January 1, 2020, to December 31, 2020. We used cluster sampling to obtain prescription data from patients 65 years and older with dementia. We assessed PIMs using the 2019 Beers criteria, the most authoritative and widely recognized standard for PIM detection. Our modeling process used three problem transformation methods (binary relevance, label powerset, and classifier chain) and six classification algorithms. RESULTS We identified 18,338 older dementia patients and 36 PIMs types. The classifier chain + categorical boosting (CatBoost) model demonstrated superior performance, with the highest accuracy (97.93%), precision (95.39%), recall (94.07%), F1 score (95.69%), and subset accuracy values (97.41%), along with the lowest Hamming loss value (0.0011) and an acceptable duration of the operation (371s). CONCLUSION This research introduces a pioneering CC + CatBoost warning model for PIMs in older dementia patients, utilizing machine-learning techniques. This model enables a quick and precise identification of PIMs, simplifying the manual evaluation process.
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Affiliation(s)
- Qiaozhi Hu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengnan Zhao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Fei Teng
- School of Information Science and Technology, Southwest Jiaotong University, Chengdu, China
| | - Gongchao Lin
- School of Information Science and Technology, Southwest Jiaotong University, Chengdu, China
| | - Zhaohui Jin
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
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16
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Saeed D, Carter G, Miller R, Darcy C, Miller K, Madden K, McKee H, Agnew J, Crawford P, Parsons C. Development and Delphi consensus validation of the Medication-Related Fall screening and scoring tool. Int J Clin Pharm 2024; 46:977-986. [PMID: 38753075 PMCID: PMC11286707 DOI: 10.1007/s11096-024-01734-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/30/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Falls are a significant public health problem and constitute a major cause of injuries and mortality. Risk factors for falls are multifactorial and include medication use. AIM To develop and investigate the content validity of the Medication-Related fall (MRF) screening and scoring tool. METHOD The MRF tool was developed from clinical practice guidelines addressing medication-related problems, and additional medications identified by specialist pharmacists across a region of the United Kingdom (Northern Ireland). Medication classes were categorised according to their 'potential to cause falls' as: high-risk (three points), moderate-risk (two points) or low-risk (one point). The overall medication-related falls risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of surveys were conducted using SurveyMonkey®. Twenty-two experts from 10 countries determined their agreement with the falls risk associated with each medication on a 5-point Likert scale. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round. RESULTS Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool; ten were classified as high-risk, eight as moderate-risk and one as low-risk. CONCLUSION The MRF tool is simple and has the potential to be integrated into medicines optimisation to reduce falls risk and negative fall-related outcomes. The score from the MRF tool can be used as a clinical parameter to assess the need for medication review and clinical interventions.
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Affiliation(s)
- Dima Saeed
- School of Pharmacy, Queen's University Belfast, Belfast, UK
- School of Pharmacy, Middle East University, Amman, Jordan
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ruth Miller
- Western Health and Social Care Trust, Londonderry, UK
| | - Carmel Darcy
- Western Health and Social Care Trust, Londonderry, UK
| | - Karen Miller
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Kevin Madden
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Hilary McKee
- Northern Health and Social Care Trust, Antrim, UK
| | - Jayne Agnew
- Southern Health and Social Care Trust, Craigavon, UK
| | | | - Carole Parsons
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
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D'Aiuto C, Lunghi C, Guénette L, Berbiche D, Bertrand K, Vasiliadis HM. Risk of Mortality Associated with Potentially Inappropriate Medication Use Including Opioids in Older Adults. Drug Saf 2024; 47:799-807. [PMID: 38722482 DOI: 10.1007/s40264-024-01429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION AND OBJECTIVE As the population ages, understanding the potential risks associated with inappropriate medication use becomes increasingly important. Given the lack of studies in this area, our objective was to study the risk of mortality associated with potentially inappropriate medication use involving opioids in community-dwelling older adults. METHODS Data came from a longitudinal study on older adults aged ≥ 65 years recruited in primary care clinics between 2011 and 2013 with an average follow-up of 4.25 years. Older adults were excluded if they used an opioid or had a malignant tumor diagnosis in the year before the study survey. A nested case-control within a cohort of older adults with at least one opioid claim during follow-up was used to evaluate the risk of all-cause mortality. Four controls per case were matched on follow-up time using risk-set sampling, i.e., while still at risk of death when their matched case died. The risk of mortality was estimated using conditional logistic regression analyses. Exposure to potentially inappropriate medication use involving opioids, defined using the Beers 2019 criteria, was assessed from provincial drug claims data in the 0-90 days before death. RESULTS In a cohort of 472 community-dwelling older adults with an incident episode of opioid use, there were 40 cases matched to 160 controls. Exposure to inappropriate medication use involving opioids in the 90 days before death was associated with an increased risk of mortality (odds ratio 6.81, 95% confidence interval 1.69-27.47), after adjusting for potential confounders. CONCLUSIONS Exposure to inappropriate medication use involving opioids in the 90 days before death is associated with an increased risk of mortality in older adults. These findings can be used to encourage safer pain management strategies in older adults.
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Affiliation(s)
- Carina D'Aiuto
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Line Guénette
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Québec City, QC, Canada
- Faculty of Pharmacy, Laval University, Québec City, QC, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada.
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18
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Jónsdóttir F, Blöndal AB, Guðmundsson A, Bates I, Stevenson JM, Sigurðsson MI. Potentially inappropriate medication use before and after admission to internal medicine for older patients and polypharmacy. Am J Med 2024:S0002-9343(24)00475-3. [PMID: 39094842 DOI: 10.1016/j.amjmed.2024.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND With the aging of the population and the increase in chronic diseases, there is an inherent risk of polypharmacy and inappropriate medication use. The study aimed to determine the prevalence and incidence of potentially inappropriate medication use and its correlation with polypharmacy. METHODS A retrospective, population-based cohort study among patients ≥65 years hospitalized at The National University Hospital of Iceland from 2010-2020. Data on medication usage were retrieved from the National Prescription Medicine Registry. Based on the number of medications filled in in the year prior to admission and post-discharge, participants were categorized non-polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). The prevalence and incidence of potentially inappropriate medication use was assessed based on the 2019 Beers criteria. Regression models were used to correlate sociodemographic, clinical, and pharmacoepidemiologic variables and the odds of new potentially inappropriate medication use. RESULTS The cohort comprised 55,859 patients (48.5% male) with a median [IQR] age of 80 [73-86] years. The prevalence of inappropriate medication use in the year preceding admission was 34.0%, 77.7%, and 96.4% for patients with non-polypharmacy, polypharmacy, and hyper-polypharmacy. The incidence of new potentially inappropriate medication use was 46.7% (95% CI 45.6%-47.6%) among those with no potentially inappropriate medication use pre-admission. Factors associated with higher odds of new potentially inappropriate medication use after discharge were the use of multi-dose dispensing services, dementia, polypharmacy, and hyper-polypharmacy. CONCLUSIONS AND RELEVANCE An increased emphasis is needed to review and reevaluate the appropriateness of medication use among older population in internal medicine. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05756400.
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Affiliation(s)
- Freyja Jónsdóttir
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland; Pharmacy Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Anna B Blöndal
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland; Development Centre for Primary Healthcare in Iceland, Reykjavik, Iceland
| | - Aðalsteinn Guðmundsson
- Division of Geriatrics, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ian Bates
- School of Pharmacy, University College London, United Kingdom
| | - Jennifer M Stevenson
- Institute of Pharmaceutical Science, King's College, London, United Kingdom; Pharmacy Department, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Martin I Sigurðsson
- Division of Anaesthesia and Intensive Care Medicine, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
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19
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Elsten EECM, Pot IE, Geijteman ECT, Hedman C, van der Heide A, van der Kuy H, Fürst CJ, Eychmüller S, van Zuylen L, van der Rijt CCD. 'Recommendations for deprescribing of medication in the last phase of life: an international Delphi study'. J Pain Symptom Manage 2024:S0885-3924(24)00909-6. [PMID: 39094669 DOI: 10.1016/j.jpainsymman.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
CONTEXT Medications may become inappropriate for patients in the last phase of life and may even compromise their quality of life. OBJECTIVE To find consensus on recommendations regarding deprescribing of medications for adult patients with a life expectancy of six months or less. METHODS Experts working in palliative care or other relevant disciplines were asked to participate in this international Delphi study. Existing tools for deprescribing of medication in the last phase of life were integrated in a list of 42 recommendations regarding potential deprescription of various medication types. In two Delphi rounds, experts were asked to rate their agreement with each recommendation on a 5-point Likert-scale (strongly agree - strongly disagree). Recommendations were accepted, if at least 70% of the experts (strongly) agreed, the interquartile range (IQR) was one or less, and less than 10% strongly disagreed. RESULTS 47 experts from 10 countries participated (response rate 53%). In most cases (76%), consensus was reached on deprescribing recommendations for patients with a life expectancy of six months or less. The highest level of consensus was reached for recommendations on the deprescription of diuretics in case of decreasing fluid intake or increasing fluid loss, lipid modifying agents if prescribed for primary prevention, and vitamin K antagonists and direct oral anticoagulants in case of high bleeding risk. CONCLUSION A high level of consensus was reached on recommendations on potential deprescription of several medications for patients with a life expectancy of six months or less.
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Affiliation(s)
- E E C M Elsten
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - I E Pot
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands.
| | - E C T Geijteman
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands
| | - C Hedman
- R & D department, Stockholms Sjukhem Foundation, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - H van der Kuy
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C J Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - S Eychmüller
- University Center for Palliative Care, University Hospital Inselspital Bern, Bern, Switzerland
| | - L van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands
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20
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Ramos KA, de Oliveira Duarte YA, Freitas RL, Boing AC, Santos JLF, Bof de Andrade F. Effect of the use of potentially inappropriate medications on the mortality of Brazilian older adults: SABE cohort study. Geriatr Nurs 2024; 59:256-260. [PMID: 39089144 DOI: 10.1016/j.gerinurse.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/24/2024] [Accepted: 07/13/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVE Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults. METHODS Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying. RESULTS PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99). CONCLUSION The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.
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Affiliation(s)
- Karina Alves Ramos
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30.190-002, Brazil
| | | | - Renata Lara Freitas
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30.190-002, Brazil
| | | | | | - Fabíola Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30.190-002, Brazil.
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21
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Tlili NE, Robert L, Gerard E, Lemaitre M, Vambergue A, Beuscart JB, Quindroit P. A systematic review of the value of clinical decision support systems in the prescription of antidiabetic drugs. Int J Med Inform 2024; 191:105581. [PMID: 39106772 DOI: 10.1016/j.ijmedinf.2024.105581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The management of chronic diabetes mellitus and its complications demands customized glycaemia control strategies. Polypharmacy is prevalent among people with diabetes and comorbidities, which increases the risk of adverse drug reactions. Clinical decision support systems (CDSSs) may constitute an innovative solution to these problems. The aim of our study was to conduct a systematic review assessing the value of CDSSs for the management of antidiabetic drugs (AD). MATERIALS AND METHODS We systematically searched the scientific literature published between January 2010 and October 2023. The retrieved studies were categorized as non-specific or AD-specific. The studies' quality was assessed using the Mixed Methods Appraisal Tool. The review's results were reported in accordance with the PRISMA guidelines. RESULTS Twenty studies met our inclusion criteria. The majority of AD-specific studies were conducted more recently (2020-2023) compared to non-specific studies (2010-2015). This trend hints at growing interest in more specialized CDSSs tailored for prescriptions of ADs. The nine AD-specific studies focused on metformin and insulin and demonstrated positive impacts of the CDSSs on different outcomes, including the reduction in the proportion of inappropriate prescriptions of ADs and in hypoglycaemia events. The 11 nonspecific studies showed similar trends for metformin and insulin prescriptions, although the CDSSs' impacts were not significant. There was a predominance of metformin and insulin in the studied CDSSs and a lack of studies on ADs such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. CONCLUSION The limited number of studies, especially randomized clinical trials, interested in evaluating the application of CDSS in the management of ADs underscores the need for further investigations. Our findings suggest the potential benefit of applying CDSSs to the prescription of ADs particularly in primary care settings and when targeting clinical pharmacists. Finally, establishing core outcome sets is crucial for ensuring consistent and standardized evaluation of these CDSSs.
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Affiliation(s)
- Nour Elhouda Tlili
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
| | - Laurine Robert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Institut de Pharmacie, CHU Lille, F-59000 Lille, France
| | - Erwin Gerard
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Institut de Pharmacie, CHU Lille, F-59000 Lille, France
| | - Madleen Lemaitre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, F-59000, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, F-59000, Lille, France; European Genomic Institute for Diabetes, Lille University School of Medicine, F-59000 Lille, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Paul Quindroit
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
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22
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Ron D, Deiner S. Postoperative Delirium and Neurocognitive Disorders: Updates for Providers Caring for Cancer Patients. Curr Oncol Rep 2024:10.1007/s11912-024-01584-9. [PMID: 39052230 DOI: 10.1007/s11912-024-01584-9] [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: 07/15/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW To provide up to date information on postoperative delirium and neurocognitive disorders in surgical cancer patients. RECENT FINDINGS Established risk factors such as age, psychosocial factors, comorbidities, frailty and preexisting cognitive decline continue to exhibit associations with perioperative neurocognitive disorders (PND); novel risk factors identified recently include microbiome composition and vitamin D deficiency. Prevention measures include cognitive prehabilitation, perioperative geriatric assessment and multidisciplinary care, dexmedetomidine and multimodal analgesic techniques. Studies investigating ciprofol, remimazolam, esketamine, ramelteon and suvorexant have shown encouraging results. Controversy remains regarding the use of inhalational versus intravenous general anesthesia. Innovative approaches to address PND are a rapidly developing area of research, but more studies are needed to identify effective prevention and management interventions. Despite challenges and controversy in the field, implementation of best practice can reduce the detrimental impact of PND on patients, caregivers, and society at large.
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Affiliation(s)
- Donna Ron
- Department of Community and Family Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Stacie Deiner
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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23
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Bishop MA, Chang HY, Kitchen C, Pandya CJ, Brown D, Weiner JP, Shermock KM, Gudzune KA. Validation of an algorithm to prioritize patients for comprehensive medication management in primary care settings. Int J Clin Pharm 2024:10.1007/s11096-024-01770-6. [PMID: 39042353 DOI: 10.1007/s11096-024-01770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Comprehensive medication management (CMM) programs optimize the effectiveness and safety of patients' medication regimens, but CMM may be underutilized. Whether healthcare claims data can identify patients appropriate for CMM is not well-studied. AIM Determine the face validity of a claims-based algorithm to prioritize patients who likely need CMM. METHOD We used claims data to construct patient-level markers of "regimen complexity" and "high-risk for adverse effects," which were combined to define four categories of claims-based CMM-need (very likely, likely, unlikely, very unlikely) among 180 patient records. Three clinicians independently reviewed each record to assess CMM need. We assessed concordance between the claims-based and clinician-review CMM need by calculating percent agreement as well as kappa statistic. RESULTS Most records identified as 'very likely' (90%) by claims-based markers were identified by clinician-reviewers as needing CMM. Few records within the 'very unlikely' group (5%) were identified by clinician-reviewers as needing CMM. Interrater agreement between CMM-based algorithm and clinician review was moderate in strength (kappa = 0.6, p < 0.001). CONCLUSION Claims-based pharmacy measures may offer a valid approach to prioritize patients into CMM-need groups. Further testing of this algorithm is needed prior to implementation in clinic settings.
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Affiliation(s)
- Martin A Bishop
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hsien-Yen Chang
- Johnson and Johnson Innovative Medicine, Titusville, NJ, USA
| | - Christopher Kitchen
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, MD, USA
| | - Chintan J Pandya
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dannielle Brown
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth M Shermock
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kimberly A Gudzune
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Soerensen AL, Haase Juhl M, Krogh ML, Grønkjær M, Kristensen JK, Olesen AE. Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study. JMIR Res Protoc 2024; 13:e56277. [PMID: 39042875 PMCID: PMC11303903 DOI: 10.2196/56277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel. OBJECTIVE This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients. METHODS The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement. RESULTS The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions. CONCLUSIONS The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study's contribution lies in generating evidence for deprescribing practices and influencing best practices in health care. TRIAL REGISTRATION ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56277.
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Affiliation(s)
- Ann Lykkegaard Soerensen
- Department of Pharmacology, Aalborg University Hospital, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Marie Haase Juhl
- Department of Pharmacology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Marlene Lunddal Krogh
- Department of Pharmacology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Pharmacology, Aarhus University, Aarhus, Denmark
| | - Mette Grønkjær
- Department of Clinical Medicine, Faculty of Medicine, University of Aalborg, Aalborg, Denmark
- The Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | - Anne Estrup Olesen
- Department of Pharmacology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, University of Aalborg, Aalborg, Denmark
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25
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Angelo Marques Carizio F, do Vale de Souza I, de Oliveira AM, Corrêa Melo MM, Barbosa Zanetti MO, Rossi Varallo F, Régis Leira-Pereira L. Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00099-0. [PMID: 39043496 DOI: 10.1016/j.farma.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.
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Affiliation(s)
- Fabiana Angelo Marques Carizio
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabella do Vale de Souza
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Alan Maicon de Oliveira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Madalena Corrêa Melo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Olívia Barbosa Zanetti
- Department of Psychiatric Nursing and Human Sciences, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Leonardo Régis Leira-Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Le HV, Van BW, Shahzad H, Teng P, Punatar N, Agrawal G, Wise B. Fracture liaison service-a multidisciplinary approach to osteoporosis management. Osteoporos Int 2024:10.1007/s00198-024-07181-7. [PMID: 39020092 DOI: 10.1007/s00198-024-07181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024]
Abstract
A fracture liaison service is a systems-level multidisciplinary approach designed to reduce subsequent fracture risk in patients who recently sustained fragility fractures. It is estimated that one in three women and one in five men over the age of 50 years old have osteoporosis. Nonetheless, only 9 to 20% of patients who sustain an initial fragility fracture eventually receive any osteoporosis treatment. With the aim of preventing subsequent fractures, a fracture liaison service (FLS) works through identifying patients presenting with fragility fractures to the hospital and providing them with easier access to osteoporosis care through referrals for bone health and fracture risk assessment and recommendation or initiation of osteoporosis treatment. Currently, there are four major types of FLS models ranging from services that only identify at-risk patients and inform and educate the patient but take no further part in communicating their findings to other stakeholders in patients' care, to services that identify, investigate, and initiate treatment at the other end of the spectrum. In this article, we review the benefits, challenges, and outcomes of FLS in the American healthcare system with further exploration of the roles each member of the multidisciplinary team can play in improving patients' bone health.
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Affiliation(s)
- Hai V Le
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St #1700, Sacramento, CA, 95817, USA.
| | - Benjamin W Van
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St #1700, Sacramento, CA, 95817, USA
| | - Hania Shahzad
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St #1700, Sacramento, CA, 95817, USA
| | - Polly Teng
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St #1700, Sacramento, CA, 95817, USA
- Department of Endocrinology, University of California Davis School of Medicine, Sacramento, USA
| | - Nisha Punatar
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, USA
| | - Garima Agrawal
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, USA
| | - Bart Wise
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, 4860 Y St #1700, Sacramento, CA, 95817, USA
- Department of Rheumatology, University of California Davis School of Medicine, Sacramento, USA
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Kim H, Hong SH. Potentially inappropriate medication as a predictor of poor prognosis of COVID-19 in older adults: a South Korean nationwide cohort study. BMJ Open 2024; 14:e073367. [PMID: 39019633 PMCID: PMC11256064 DOI: 10.1136/bmjopen-2023-073367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To investigate the association between exposure to potentially inappropriate medication (PIM) and poor prognosis of COVID-19 in older adults, controlling for comorbidity and sociodemographic factors. DESIGN AND SETTING Nationwide retrospective cohort study based on the national registry of COVID-19 patients, established through the linkage of South Korea's national insurance claims database with the Korea Disease Control and Prevention Agency registry of patients with COVID-19, up to 31 July 2020. PARTICIPANTS A total of 2217 COVID-19 patients over 60 years of age who tested positive between 20 January 2022 and 4 June 2020. Exposure to PIM was defined based on any prescription record of PIM during the 30 days prior to the date of testing positive for COVID-19. PRIMARY OUTCOME MEASURES Mortality and utilisation of critical care from the date of testing positive until the end of isolation. RESULTS Among the 2217 COVID-19 patients over 60 years of age, 604 were exposed to PIM prior to infection. In the matched cohort of 583 pairs, PIM-exposed individuals exhibited higher rates of mortality (19.7% vs 9.8%, p<0.0001) and critical care utilisation (13.4% vs 8.9%, p=0.0156) compared with non-exposed individuals. The temporal association of PIM exposure with mortality was significant across all age groups (RR=1.68, 95% CI: 1.23~2.24), and a similar trend was observed for critical care utilisation (RR: 1.75, 95% CI: 1.26~2.39). The risk of mortality and critical care utilisation increased with exposure to a higher number of PIMs in terms of active pharmaceutical ingredients and drug categories. CONCLUSION Exposure to PIM exacerbates the poor outcomes of older patients with COVID-19 who are already at high risk. Effective interventions are urgently needed to address PIM exposure and improve health outcomes in this vulnerable population.
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Affiliation(s)
- Hyungmin Kim
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- National Health Insurance Service, Wonju, Republic of Korea
| | - Song Hee Hong
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Huang H, Zhang L, Yang Y, Huang L, Lu X, Li J, Yu H, Cheng S, Xiao J. Construction and application of medication reminder system: intelligent generation of universal medication schedule. BioData Min 2024; 17:23. [PMID: 39010132 PMCID: PMC11247871 DOI: 10.1186/s13040-024-00376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Patients with chronic conditions need multiple medications daily to manage their condition. However, most patients have poor compliance, which affects the effectiveness of treatment. To address these challenges, we establish a medication reminder system for the intelligent generation of universal medication schedule (UMS) to remind patients with chronic diseases to take medication accurately and to improve safety of home medication. METHODS To design medication time constraint with one drug (MTCOD) for each drug and medication time constraint with multi-drug (MTCMD) for each two drugs in order to better regulate the interval and time of patients' medication. Establishment of a medication reminder system consisting of a cloud database of drug information, an operator terminal for medical staff and a patient terminal. RESULTS The cloud database has a total of 153,916 pharmaceutical products, 496,708 drug interaction data, and 153,390 pharmaceutical product-ingredient pairs. The MTCOD data was 153,916, and the MTCMD data was 8,552,712. An intelligent UMS medication reminder system was constructed. The system can read the prescription information of patients and provide personalized medication guidance with medication timeline for chronic patients. At the same time, patients can query medication information and get remote pharmacy guidance in real time. CONCLUSIONS Overall, the medication reminder system provides intelligent medication reminders, automatic drug interaction identification, and monitoring system, which is helpful to monitor the entire process of treatment in patients with chronic diseases.
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Affiliation(s)
- Hangxing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- College of Medicine, Wuhan University of Science and Technology, Wuhan, 430000, Hubei, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yongyu Yang
- Department of Pharmacy, The Second People's Hospital of Beihai, Beihai, 536000, Guangxi, China
| | - Ling Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xikui Lu
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Jingyang Li
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Huimin Yu
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Shuqiao Cheng
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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King SE, Ruopp MD, Mac CT, O'Malley KA, Meyerson JL, Lefers L, Bean JF, Driver JA, Schwartz AW. Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility. J Am Geriatr Soc 2024. [PMID: 39007623 DOI: 10.1111/jgs.19083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs. METHODS A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods. Clinical (life-sustaining treatment, falls, disruptive behaviors, and medication deprescribing) and quality outcomes (rehospitalization, emergency department utilization, and discharge to the community) in addition to patient satisfaction were compared pre- and post-AFHS implementation (bed days of care [BDOC] 17413) to post-implementation (BDOC 20880). RESULTS Clinical outcomes demonstrated improvements in the 4Ms, including: (1) what matters: 14% increase in life-sustaining treatment documentation (82%-96%; p < 0.01); (2) mobility: reduction in fall rate by 34% (8.15 falls/1000 BDOC to 5.41; p < 0.01); (3) mentation: decrease in disruptive behavior reporting system (DBRS) by 62% (5.11 DBRS/1000 BDOC to 1.96; p = 0.04); (4) medications: 53% increase in average potentially inappropriate medications (PIMs) deprescribing (0.38-0.80 interventions/patient; p < 0.01). Quality outcomes improved including rehospitalization (25.6%-17.9%) and emergency department utilization (5.3%-2.8%) within 30 days of admission. Patient satisfaction scores improved from a mean of 77.2 (n = 31, scale 1-100) to 81.3 (n = 42). CONCLUSIONS Implementation of the AFHS initiative in a SNF was associated with improved clinical and quality outcomes and patient satisfaction. We describe here a sustainable, interprofessional approach to implementing the AFHS in a SNF.
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Affiliation(s)
- Sarah E King
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Marcus D Ruopp
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chi T Mac
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Kelly A O'Malley
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
| | - Jordana L Meyerson
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay Lefers
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
- Department of PM&R, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jane A Driver
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Sprake E, Kung J, Graham M, Tsuyuki R, Gibson W. Deprescribing for older adults during acute care admission: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00330. [PMID: 39005222 DOI: 10.11124/jbies-23-00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
OBJECTIVE The objective of this scoping review is to understand the current body of knowledge regarding deprescribing in adults aged 60 and over in acute care settings, including the deprescribing activities that are being undertaken, and the feasibility, challenges, and outcomes of the practice. INTRODUCTION Polypharmacy is prevalent amongst older adults, despite risks to patients. Much of the existing research on deprescribing has occurred in the outpatient context, with recent research emerging on the unique opportunity that acute care may provide. INCLUSION CRITERIA This review will include deprescribing in adults aged 60 and older in acute care. It will consider deprescribing occurring during inpatient admission and at the time of discharge from hospital. METHODS The JBI method for scoping reviews will guide this review. A search of MEDLINE (Ovid), Scopus, Web of Science, CINAHL (EBSCOhost), Embase (Ovid), and the Cochrane Database will be undertaken from inception to present with no language restrictions. Qualitative, quantitative, and mixed method studies, clinical practice guidelines, and opinion papers will be considered for inclusion. Systematic reviews and scoping reviews will be excluded. Google Scholar and a general Google search will be conducted for gray literature. Two reviewers will assess articles for inclusion and any disagreements will be discussed and resolved by discussion or a third reviewer, if required. Findings will be presented in the scoping review using a narrative approach with supporting quantitative data in a tabular format according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR). REVIEW REGISTRATION Open Science Framework https://osf.io/pb7aw/.
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Affiliation(s)
- Erika Sprake
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Janice Kung
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Michelle Graham
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ross Tsuyuki
- Department of Medicine, EPICORE Center, University of Alberta, Edmonton, AB, Canada
| | - William Gibson
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Ieong C, Chen T, Chen S, Gao X, Yan K, He W, Hong H, Gu Y, Chen X, Yuan G. Differences of anticholinergic drug burden between older hospitalized patients with and without delirium: a systematic review and meta-analysis based on prospective cohort studies. BMC Geriatr 2024; 24:599. [PMID: 38997670 PMCID: PMC11241997 DOI: 10.1186/s12877-024-05197-6] [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: 11/29/2023] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVES This review aims to comprehensively summarize the differences in anticholinergic drug burden (ADB) scores between older hospitalized patients with and without delirium. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library and CINAHL EBSCOhost databases to identify prospective cohort studies exploring the relationship between ADB and the occurrence of delirium in older hospitalized patients. The primary outcome of the review was the mean ADB scores for the delirium and non-delirium groups, and the secondary outcome was the scores for the subsyndromal and non-delirium groups. The standardized mean difference (SMD) and corresponding 95% confidence intervals (95% CI) were incorporated using a fixed-effect method. Moreover, we performed subgroup analysis according to the admission type, age, the ADB scale type and the ADB classification. RESULTS Nine prospective cohort studies involving 3791 older patients with a median age of 75.1 (71.6-83.9) were included. The ADB score was significantly higher in the delirium group than in the non-delirium group (SMD = 0.21, 95%CI 0.13-0.28). In subgroup analysis, the age subgroup was split into < 75 and ≥ 75 according to the median age of the older people. There were significant differences in ADB scores between older people with delirium and those without delirium in various subgroups: surgical (SMD = 0.20, 95%CI 0.12-0.28), internal medicine (SMD = 0.64, 95%CI 0.25-1.02), age < 75 (SMD = 0.17, 95%CI 0.08-0.26), age ≥ 75 (SMD = 0.27, 95%CI 0.15-0.39), ADS scale (SMD = 0.13, 95%CI 0.13-0.40), ARS scale (SMD = 0.15, 95%CI 0.03-0.26), ACB scale (SMD = 0.13, 95%CI 0.01-0.25), pre-admission ADB (SMD = 0.24, 95%CI 0.05-0.43) and ADB during hospitalization (SMD = 0.20, 95%CI 0.12-0.27). CONCLUSIONS We found a quantitative relationship between ADB and delirium in older patients admitted for internal medicine and surgery. And this relationship remained significant in different age, ADB scale type and ADB classification subgroups. However, the actual difference in ADB scores between patients with delirium and without delirium was small. More high-quality observational studies should be conducted to explore the impact of ADB on delirium and subsyndromal delirium. CLINICAL TRIAL REGISTRATION The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42022353649].
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Affiliation(s)
- Chifong Ieong
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tingjia Chen
- Healthcare Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sai Chen
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiang Gao
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kemin Yan
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen He
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hua Hong
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Gu
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Yuan
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Cavanah LR, Goldhirsh JL, Huey LY, Piper BJ. National patterns of paroxetine use among US Medicare patients from 2015-2020. Front Psychiatry 2024; 15:1399493. [PMID: 39050917 PMCID: PMC11266311 DOI: 10.3389/fpsyt.2024.1399493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Paroxetine is an older "selective" serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in an anticholinergic adverse-effect profile, especially among older adults (65+). Methods Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. States' annual prescription rate, corrected per thousand Part D enrollees, outside a 95% confidence interval were considered significantly different from the average. Results Nationally, there was a steady decrease in population-corrected paroxetine prescriptions (-34.52%) and spending (-29.55%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequently elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the most paroxetine, relative to the number of providers in that specialty, from 2015-2020. Discussion Despite the American Geriatrics Society's prohibition against paroxetine use in older adults and many effective treatment alternatives, paroxetine was still commonly used in the US in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.
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Affiliation(s)
- Luke R. Cavanah
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | | | - Leighton Y. Huey
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Behavioral Health Initiative, Scranton, PA, United States
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Center for Pharmacy Innovation and Outcomes, Danville, PA, United States
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Jiang LG, McGinnis C, Benton E, Nawa E, Stern M, Xi W, Sharma R, Daniels B. Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data. J Am Geriatr Soc 2024. [PMID: 38979847 DOI: 10.1111/jgs.19080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/16/2024] [Accepted: 06/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge. METHODS High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. RESULTS Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall. CONCLUSIONS A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.
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Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Christina McGinnis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Emily Benton
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Emilee Nawa
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael Stern
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Wenna Xi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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Heinzmann J, Rossen ML, Efthimiou O, Baumgartner C, Wertli MM, Rodondi N, Aubert CE, Liechti FD. Risk Factors for Falls Among Hospitalized Medical Patients - A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01077-3. [PMID: 38972474 DOI: 10.1016/j.apmr.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To identify and quantify risk factors for in-hospital falls in medical patients. DATA SOURCES Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) were systematically screened until April 11, 2023, to identify relevant articles. STUDY SELECTION All titles and abstracts of the retrieved articles were independently screened by 2 researchers who also read the full texts of the remaining articles. Quantitative studies that assessed risk factors for falls among adult patients acutely hospitalized were included in the review. Publications that did not capture internal medicine patients or focused on other specific populations were excluded. DATA EXTRACTION Information on study characteristics and potential risk factors were systematically extracted. Risk of bias was assessed using the Quality in Prognosis Studies tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology guidelines were followed for reporting. DATA SYNTHESIS The main outcome was any in-hospital falls. Using a random-effects meta-analysis model, association measures for each risk factor reported in 5 or more studies were pooled. Separate analyses according to effect measure and studies adjusted for sex and age at least were performed. Of 5067 records retrieved, 119 original publications from 25 countries were included. In conclusion, 23 potential risk factors were meta-analyzed. Strong evidence with large effect sizes was found for a history of falls (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.63-3.96; I2, 91%), antidepressants (pooled OR, 2.25; 95% CI, 1.92-2.65; I2, 0%), benzodiazepines (OR, 1.97; 95% CI, 1.68-2.31; I2, 0%), hypnotics-sedatives (OR, 1.90; 95% CI, 1.53-2.36; I2, 46%), and antipsychotics (OR, 1.61; 95% CI, 1.33-1.95; I2, 0%). Furthermore, evidence of associations with male sex (OR, 1.22, 95% CI, 0.99-1.50; I2, 65%) and age (OR, 1.17, 95% CI, 1.02-1.35; I2, 72%) were found, but effect sizes were small. CONCLUSIONS The comprehensive list of risk factors, which specifies the strength of evidence and effect sizes, could assist in the prioritization of preventive measures and interventions.
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Affiliation(s)
- Jeannelle Heinzmann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Michael L Rossen
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern
| | - Orestis Efthimiou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
| | - Maria M Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern; Institute of Primary Health Care (BIHAM), University of Bern, Bern
| | - Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern.
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Takeshima M, Yoshizawa K, Ogasawara M, Kudo M, Itoh Y, Ayabe N, Shibata N, Mishima K. Association between benzodiazepine anxiolytic polypharmacy and concomitant psychotropic medications in Japan: a retrospective cross-sectional study. Front Psychiatry 2024; 15:1405049. [PMID: 39026522 PMCID: PMC11254787 DOI: 10.3389/fpsyt.2024.1405049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Guidelines for various psychiatric disorders recommend short-term use of benzodiazepine anxiolytic monotherapy in few cases. Contrarily, benzodiazepine anxiolytic polypharmacy (BAP) is not recommended in any case. However, BAP is often used in real world. Therefore, this study aimed to determine the association between BAP and concomitant use of psychotropic medications. Method This retrospective cross-sectional study used claims data from the Japan Medical Data Center. Medical information of health insurance subscribers treated with benzodiazepine anxiolytics in June 2019 was extracted. Prescription of two or more benzodiazepine anxiolytics was defined as BAP. Binary logistic regression analysis was performed to investigate the factors associated with BAP, using age group, sex, type of subscriber, and number of concomitant hypnotics, antidepressants, and antipsychotics (none, one, and two or more) as covariates. Result The eligible participants were 104,796 adults who were prescribed benzodiazepine anxiolytics. Among them, 12.6% were prescribed two or more drugs. Logistic regression analysis revealed that BAP was significantly associated with those who received hypnotic monotherapy (adjusted odds ratio [aOR]: 1.04, 95% confidence interval [CI]: 1.001-1.09, p=0.04), antidepressant monotherapy and polypharmacy (aOR: 1.57, 95% CI: 1.51-1.63, p<0.001 and aOR: 1.98, 95% CI: 1.88-2.09, p<0.001, respectively), and antipsychotic monotherapy and polypharmacy (aOR: 1.12, 95% CI: 1.07-1.19, p<0.001 and aOR: 1.41, 95% CI: 1.30-1.54, p<0.001, respectively). Conversely, lower BAP was associated with those who received hypnotic polypharmacy (aOR: 0.86, 95% CI: 0.81-0.91, p<0.001). Discussion This study showed that the greater the number of concomitant antidepressants and antipsychotics, the greater the association with BAP. Since combination therapy with antidepressants or antipsychotics is generally not recommended, patients receiving combination therapy with these medications may be resistant to pharmacotherapy. Therefore, implementing the recommended non-pharmacological treatments may reduce BAP.
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Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mizuki Kudo
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoko Ayabe
- Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Nana Shibata
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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Allary A, Proulx-Tremblay V, Bélanger C, Hudon C, O'Connor K, Roberge P, Vasiliadis HM, Desrosiers C, Cruz-Santiago D, Grenier S. Long-term effects of benzodiazepine discontinuation among older adults: potential improvements on depressive symptoms. Aging Ment Health 2024:1-9. [PMID: 38952209 DOI: 10.1080/13607863.2024.2372473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To examine how change in benzodiazepine (BZD) use is linked to changes in depressive symptoms intensity, worry intensity, and sleep quality over 16 months. METHOD Data come from a larger randomised controlled trial (RCT) named the 'Programme d'Aide du Succès au SEvrage (PASSE-60+)' study (NCT02281175). Seventy-three participants age 60 years and older took part in a 4-month discontinuation programme and were assessed four times over 16 months. Change in BZD use was defined as the difference in reported mg/day between two assessments. Control variables were RCT discontinuation group; BZD use at T1; and either depressive symptoms, worry intensity, or sleep quality at T1. Hierarchical multiple regressions were used to analyse data. RESULTS In the short term, right after the discontinuation programme, sleep quality worsened with lower BZD use. This link was no longer significant at the 3- and 12-month follow-up. In the long term, depressive symptoms lowered with lower BZD use. No change was found in worry intensity in relation to BZD use at all measurement times. CONCLUSION Discontinuation may improve depressive symptoms. Our study also questions the long-term effectiveness of BZD use, since long-term discontinuation was not linked with change in worry intensity and sleep quality.
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Affiliation(s)
- Arnaud Allary
- Département de psychologie, Université du Québec à Montréal (UQAM), Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
| | - Virginie Proulx-Tremblay
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
- Département de psychologie, Université de Montréal, Québec, Canada
| | - Claude Bélanger
- Département de psychologie, Université du Québec à Montréal (UQAM), Québec, Canada
| | - Carol Hudon
- École de psychologie de l'Université Laval, Québec, Canada
- Centre de recherche CERVO, Québec, Canada
| | - Kieron O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d'urgence à l'Université de Sherbrooke, Québec, Canada
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Helen-Maria Vasiliadis
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Caroline Desrosiers
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
| | - Diana Cruz-Santiago
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
- Département de médecine familiale et de médecine d'urgence, Université de Montréal, Québec, Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Québec, Canada
- Département de psychologie, Université de Montréal, Québec, Canada
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Kato T, Minamisawa M, Miura T, Kanai M, Oyama Y, Hashizume N, Yokota D, Taki M, Senda K, Nishikawa K, Wakabayashi T, Fujimori K, Karube K, Sakai T, Inoue M, Yoda H, Sunohara D, Okina Y, Nomi H, Kanzaki Y, Machida K, Kashiwagi D, Ueki Y, Saigusa T, Ebisawa S, Okada A, Motoki H, Kuwahara K. Impact of hyper-polypharmacy due to non-cardiovascular medications on long-term clinical outcomes following endovascular treatment for lower limb artery disease: A sub-analysis of the I-PAD Nagano registry. J Cardiol 2024:S0914-5087(24)00128-X. [PMID: 38964712 DOI: 10.1016/j.jjcc.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 06/20/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Lower limb artery disease (LEAD) is accompanied by multiple comorbidities; however, the effect of hyperpolypharmacy on patients with LEAD has not been established. This study investigated the associations between hyperpolypharmacy, medication class, and adverse clinical outcomes in patients with LEAD. METHODS This study used data from a prospective multicenter observational Japanese registry. A total of 366 patients who underwent endovascular treatment (EVT) for LEAD were enrolled in this study. The primary endpoints were major adverse cardiac events (MACE), including myocardial infarction, stroke, and all-cause death. RESULTS Of 366 patients with LEAD, 12 with missing medication information were excluded. Of the 354 remaining patients, 166 had hyperpolypharmacy (≥10 medications, 46.9 %), 162 had polypharmacy (5-9 medications, 45.8 %), and 26 had nonpolypharmacy (<5 medications, 7.3 %). Over a 4.7-year median follow-up period, patients in the hyperpolypharmacy group showed worse outcomes than those in the other two groups (log-rank test, p < 0.001). Multivariate analysis revealed that the total number of medications was significantly associated with an increased risk of MACE (hazard ratio per medication increase 1.07, 95 % confidence interval 1.02-1.13 p = 0.012). Although an increased number of non-cardiovascular medications was associated with an elevated risk of MACE, the increase in cardiovascular medications was not statistically significant (log-rank test, p = 0.002 and 0.35, respectively). CONCLUSIONS Hyperpolypharmacy due to non-cardiovascular medications was significantly associated with adverse outcomes in patients with LEAD who underwent EVT, suggesting the importance of medication reviews, including non-cardiovascular medications.
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Affiliation(s)
- Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yushi Oyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiology, Nagano Red-Cross Hospital, Nagano, Japan
| | | | - Minami Taki
- Department of Cardiology, Saku General Hospital, Saku, Japan
| | - Keisuke Senda
- Department of Cardiology, Aizawa Hospital, Matsumoto, Japan
| | - Ken Nishikawa
- Department of Cardiology, Joetsu General Hospital, Joetsu, Japan
| | | | - Koki Fujimori
- Department of Cardiology, Suwa Red-Cross Hospital, Suwa, Japan
| | - Kenichi Karube
- Department of Cardiology, Okaya City Hospital, Okaya, Japan
| | - Takahiro Sakai
- Department of Cardiology, Ina Central Hospital, Ina, Japan
| | - Minami Inoue
- Department of Cardiology, Ina Central Hospital, Ina, Japan
| | - Hidetsugu Yoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Sunohara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiteru Okina
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidetomo Nomi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keisuke Machida
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Kashiwagi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Léguillon R, Grosjean J, Roca F, Barat E, Varin R, Lejeune E, Kerdelhué G, Darmoni S, Charlet J, Laroche ML. Variability in the prevalence of inappropriate medication use among older adults: A review highlighting the importance of screening methods and database types. Br J Clin Pharmacol 2024; 90:1559-1575. [PMID: 38752677 DOI: 10.1111/bcp.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools. METHODS This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods. RESULTS This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria. CONCLUSIONS This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules' impact on public health implications.
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Affiliation(s)
- Romain Léguillon
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Department of Pharmacy, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Julien Grosjean
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Frédéric Roca
- Normandy University, UniRouen, Inserm UMR1096 EnVI, FHU REMOD-VHF, Rouen, France
- Department of Geriatric Medicine, Rouen University Hospital, Rouen, France
| | - Eric Barat
- Department of Pharmacy, Rouen University Hospital, Rouen, France
- Normandie University, UNICAEN, Inserm U1086, Caen, France
| | - Rémi Varin
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Emeline Lejeune
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Gaëthan Kerdelhué
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Stéfan Darmoni
- Department of Digital Health, Rouen University Hospital, Rouen, France
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Jean Charlet
- Laboratoire D'Informatique Médicale et D'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Marie Laure Laroche
- VieSanté Unit - UR 24134, Omega Health Institut, Limoges University, Limoges, France
- Pharmacovigilance and Pharmacoepidemiology Center, Limoges University Hospital, Limoges, France
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Eriksson J, Rimes-Stigare C, Rysz S, von Oelreich E. Benzodiazepine Dependence After Cardiothoracic Intensive Care: A Nationwide Cohort Study. Ann Thorac Surg 2024; 118:268-274. [PMID: 37977256 DOI: 10.1016/j.athoracsur.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/26/2023] [Accepted: 11/06/2013] [Indexed: 11/19/2023]
Abstract
BACKGROUND This study aimed to describe benzodiazepine use after cardiothoracic intensive care unit (ICU) care, including factors associated with new long-term high-potency benzodiazepine use after critical care, and to determine whether benzodiazepine use is associated with an increased risk of death. METHODS A nationwide retrospective cohort study was conducted of all cardiothoracic ICU patients in Sweden between 2010 and 2018. All patients older than 18 years who survived the first 3 months after admission to a cardiothoracic ICU were eligible for inclusion. A total of 36,135 patients were screened, and 4163 were ineligible. RESULTS In the final study cohort of 31,972 benzodiazepine-naive patients admitted to critical care, 578 patients had persistent high-potency benzodiazepine use. The proportion of new persistent benzodiazepine users was 5% in the first 3 months after ICU care, followed by a decline to a consistent level of 2% at 2 years of follow-up. Factors associated with persistent benzodiazepine use included higher age, female sex, psychiatric and somatic comorbidities, substance abuse, and preadmission opioid and low-potency benzodiazepine use. Adjusted hazard ratio for death 6 to 18 months after admission for new persistent benzodiazepine users was 2.2 (95% CI, 1.5-3.1; P < .001). CONCLUSIONS High-potency benzodiazepine consumption is increased 2 years after admission to cardiothoracic ICU care despite lack of support for long-term use of benzodiazepines. Being older and female, prior opioid use, and comorbid conditions were among risk factors for persistent benzodiazepine use. Persistent benzodiazepine users had an increased risk of death.
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Affiliation(s)
- Jesper Eriksson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Claire Rimes-Stigare
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Rysz
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Erik von Oelreich
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Machado TRL, de Pádua CAM, de Miranda Drummond PL, Silveira LP, Malta JS, Dos Santos RMM, Costa NL, Reis AMM. Factors associated with potentially inappropriate medications in elderly with multiple myeloma. J Oncol Pharm Pract 2024; 30:873-879. [PMID: 37525611 DOI: 10.1177/10781552231190009] [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: 08/02/2023]
Abstract
INTRODUCTION Elderly with cancer often have multimorbidity, which determines a higher risk of polypharmacy. This is related to negative clinical results such as adverse drug reaction and emergence service visits. Furthermore, polypharmacy increases the risk of using potentially inappropriate medications. OBJECTIVE To evaluate the use of potentially inappropriate medication in elderly with multiple myeloma and associated factors. METHODS The study was conducted with older adults with multiple myeloma treated at outpatient oncology and hematology services in a southeastern Brazilian capital. Potentially inappropriate medications were classified using the American Geriatric Society/Beers 2019 Criteria. Variables were described using frequency and proportions, performing multiple logistic regression to identify factors associated with the use of potentially inappropriate medications. RESULTS One hundred fifty-three older adults with multiple myeloma were included, with a median age of 70.9 years. The median number of medications was 8, and 63% of patients used polypharmacy. More than half (54%) of the patients used potentially inappropriate medications, and proton pump inhibitors (46%) and benzodiazepines (8%) were the most employed therapeutic classes. Older adults who used potentially inappropriate medications differed from those who did not use them in the following characteristics: income up to three minimum wages, higher schooling level, private service, multimorbidity, hypertension, cardiovascular disease, chronic kidney disease, depression, adverse event, and polypharmacy. Higher schooling levels and polypharmacy were independently associated with the use of potentially inappropriate medications in the multivariate analysis. CONCLUSION Potentially inappropriate medication use was high in patients with multiple myeloma studied. The use of polypharmacy and higher schooling levels were independently and positively associated with the use of potentially inappropriate medications.
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Affiliation(s)
- Taisa R L Machado
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cristiane A M de Pádua
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula L de Miranda Drummond
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Fundação Ezequiel Dias, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia P Silveira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jéssica S Malta
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Naiane L Costa
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriano M M Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Vandenberg AE, Hwang U, Das S, Genes N, Nyamu S, Richardson L, Ezenkwele U, Legome E, Richardson C, Belachew A, Leong T, Kegler M, Vaughan CP. Scaling the EQUIPPED medication safety program: Traditional and hub-and-spoke implementation models. J Am Geriatr Soc 2024; 72:2184-2194. [PMID: 38259070 DOI: 10.1111/jgs.18746] [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: 07/31/2023] [Revised: 11/09/2023] [Accepted: 12/09/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence-informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (ED) providers to adults aged 65 and older at discharge. We aimed to scale-up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub-and-spoke implementation model at three new EDs within a health system that had previously implemented EQUIPPED (hub). We hypothesized that implementation speed would increase under the hub-and-spoke model without cost to PIM reduction or site engagement. METHODS We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12-month baseline to 12-month post-implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation. RESULTS The proportion of PIMs at all four sites declined significantly from pre- to post-EQUIPPED: at traditional site 1 from 8.9% (8.1-9.6) to 3.6% (3.6-9.6) (p < 0.001); at spread site 1 from 12.2% (11.2-13.2) to 7.1% (6.1-8.1) (p < 0.001); at spread site 2 from 11.3% (10.1-12.6) to 7.9% (6.4-8.8) (p = 0.045); and at spread site 3 from 16.2% (14.9-17.4) to 11.7% (10.3-13.0) (p < 0.001). Time to implement was equivalent at all sites across both models. Interview data, reflecting a wide scope of responsibilities for the champion at the traditional site and a narrow scope at the spoke sites, indicated disproportionate barriers to engagement at the spoke sites. CONCLUSIONS EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID-19 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real-world conditions. The hub-and-spoke model offers an effective way to scale-up EQUIPPED though a speed or quality advantage could not be shown.
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Affiliation(s)
- Ann E Vandenberg
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ula Hwang
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
- James J. Peters VA Medical Center GRECC, Bronx, New York, USA
| | - Shamie Das
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas Genes
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sylviah Nyamu
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ugo Ezenkwele
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Legome
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Belachew
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michelle Kegler
- Department of Behavioural, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Camille P Vaughan
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Birmingham/Atlanta VA GRECC, Atlanta, Georgia, USA
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Ramdin C, Mina G, Nelson L, Mazer-Amirshahi M. Benzodiazepine Discharge Prescriptions From Emergency Departments Across the United States Between 2012 and 2019: A National Analysis. J Addict Med 2024; 18:451-457. [PMID: 38776422 DOI: 10.1097/adm.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED). METHODS This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable. RESULTS Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend ( P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older. CONCLUSION Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.
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Affiliation(s)
- Christine Ramdin
- From the Department of Emergency Medicine, Rutgers New Jersey Medical School (CR, GM, LN, MM-A); School of Medicine, Georgetown University; and Department of Emergency Medicine, MedStar Washington Hospital Center (MM-A)
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Meyers G, Bubalo J, Eckstrom E, Winsnes K, Carpenter PA, Artz A, Lin RJ. Transplantation-Associated Altered Mentation and Encephalopathy: A New Classification for Acute Neurocognitive Changes Associated with Hematopoietic Cell Transplantation from the ASTCT Committee on Practice Guidelines. Transplant Cell Ther 2024; 30:646-662. [PMID: 38663768 DOI: 10.1016/j.jtct.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/16/2024]
Abstract
Acute encephalopathy, manifesting clinically as delirium, is a common but often unrecognized complication of hematopoietic cell transplantation (HCT). Delirium can occur in patients of any age and is observed after autologous or allogeneic HCT. Although delirium has been studied primarily during initial HCT hospitalizations in recipients of myeloablative conditioning, recent investigations have identified delirium later post-transplantation and in recipients of reduced-intensity conditioning. Acute encephalopathy can be driven by infectious complications, medications, tissue damage, and/or organ dysfunction. Altered consciousness, either mild or profound, is often its only clinical manifestation. Identifying delirium is essential to overall HCT care, because patients who experience delirium have longer hospitalization and recovery times and are at risk for other poor post-HCT outcomes. Given the critical nature of this common complication and the ongoing expansion of HCT for more vulnerable populations, the American Society of Transplantation and Cellular Therapy (ASTCT) recommends intensifying research into post-HCT cognitive changes and establishing standardized definitions that encompass the full spectrum of altered consciousness for clinical care purposes and to provide benchmark endpoints for future research studies. To capture a range of acute neurocognitive changes specifically found in HCT patients (often referred to as acute encephalopathy), the ASTCT proposes a new diagnosis, transplantation-associated altered mentation and encephalopathy (TAME). The TAME diagnosis includes HCT patients who meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for delirium and those with acute neurocognitive changes who do not meet all the DSM-5 criteria for delirium (subsyndromal delirium). Early TAME is defined as occurring during conditioning or ≤100 days post-HCT, whereas late TAME occurs >100 days post-HCT in patients with additional HCT-related complications. This manuscript establishes clear diagnostic criteria and discusses factors that can potentially impact the development of TAME, as well as the workup and management of TAME.
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Affiliation(s)
- Gabrielle Meyers
- Center for Hematologic Malignancies, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon.
| | - Joseph Bubalo
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Katrina Winsnes
- Division of Pediatrics Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Andrew Artz
- Division of Leukemia, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Richard J Lin
- Adult BMT and Cellular Therapy Services, Memorial Sloan Kettering Cancer Center, New York, New York
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Fosnight S, Soric MM, Smearman J, Graves E, Vazquez M, Herrington Z, Palladino C, Costello M, Knauss A. Investigation Into Potentially Inappropriate Prescribing Patterns of Loop Diuretics in a Nationally Representative Outpatient Population. Am J Ther 2024; 31:e347-e355. [PMID: 37820082 DOI: 10.1097/mjt.0000000000001644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Loop diuretic therapy effectively treats edema related to heart failure, chronic kidney disease, and liver impairment; however, evidence supporting other indications is lacking. For indications such as hypertension or dependent edema or treatment of adverse events associated with other medications, the benefits likely do not outweigh the risks, putting patients at an unacceptably high risk of poor outcomes. STUDY QUESTION What is the proportion of loop diuretic prescribing that occurs in the absence of a diagnosis of heart failure, chronic kidney disease, liver impairment, or other evidence-based indications? STUDY DESIGN This was a national, retrospective, cross-sectional investigation conducted using the National Ambulatory Care Survey from 2013 to 2016. Outpatient visits for patients aged 18 years or older prescribed with loop diuretics were included. MEASURES AND OUTCOMES The primary end point was the frequency of potentially inappropriate loop diuretic prescribing. The secondary end point was a multivariable regression model that identified predictors of potentially inappropriate loop diuretic utilization. RESULTS This analysis identified 5261 outpatient visits conducted during the study period in which loop diuretics were prescribed. Of these, 3648 visits (65.8% of weighted visits) were of patients without a history of heart failure, chronic kidney disease, or liver impairment. Positive predictors included age older than 65 years (odds ratio [OR] 1.71; 95% confidence interval [CI] 1.38-2.13), concomitant calcium channel blocker (OR 1.42; 95% CI, 1.09-1.84), sodium-containing medication use (OR 2.78; 95% CI, 1.23-6.25), and office visit with a cardiology specialist (OR 2.84; 95% CI, 2.31-3.50). CONCLUSIONS This analysis identified that loop diuretics are prescribed in the absence of evidence-based indications more frequently than they are prescribed for them. This prescribing pattern creates a unique opportunity for clinicians to optimize patient care. Further study of the outcomes associated with this prescribing pattern is warranted.
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Affiliation(s)
- Steven Fosnight
- Northeast Ohio Medical University College of Pharmacy, Rootstown, OH
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Sandín-López E, Galan-López IM, Candelas-Cancela E, Fernandez-Torres B. Prevalence and adverse effects of peri-operative potentially inappropriate medication in the elderly. Eur J Anaesthesiol 2024; 41:537-539. [PMID: 38666372 DOI: 10.1097/eja.0000000000001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Affiliation(s)
- Elena Sandín-López
- From the Department of Anaesthesia, University Hospital Virgen Macarena, Seville, Spain (ES-L, IMG-L, EC-C, BF-X)
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Andrade A, Nascimento T, Cabrita C, Leitão H, Pinto E. Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults. Healthcare (Basel) 2024; 12:1275. [PMID: 38998810 PMCID: PMC11241476 DOI: 10.3390/healthcare12131275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.
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Affiliation(s)
- Amanda Andrade
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Tânia Nascimento
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
| | - Catarina Cabrita
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Helena Leitão
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal
| | - Ezequiel Pinto
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
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Couret A, Gardette V, Renoux A, Lapeyre-Mestre M. Impact of modifications to antidementia drug reimbursement in France: Analysis of the FRA-DEM cohort. Br J Clin Pharmacol 2024. [PMID: 38925159 DOI: 10.1111/bcp.16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/03/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Alzheimer's disease and related diseases (ADRD) is a progressive and inexorable disease. In France, acetylcholinesterase inhibitors and memantine were reimbursed for subjects with ADRD, until 2 modifications of their reimbursement rate (2012, 2018). We aimed to study the consequences of these measures on ADRD subjects' healthcare use. METHODS We analysed data from the FRA-DEM cohort, including subjects with presumed incident ADRD identified since 2011 in the French health insurance system. We studied the healthcare use of subjects identified with incident ADRD in 2011, 2013, 2015, 2017 and 2019, notably the annual number of defined daily doses of various psychotropic groups. We performed 2 multivariate multinomial logistic regressions with the subcohort year as the dependent variable. RESULTS In total, 165 120 subjects were included. A progressive decrease in exposure to antidementia drugs was observed between 2011 and 2019. Consultations with private neurologists or psychiatrists, and exposure to risperidone, antidepressants and benzodiazepines increased in the 2019 subcohort, following the 2018 reimbursement withdrawal. Meanwhile, the use of nursing/allied healthcare and emergency care increased over the subcohort years, whereas we observed a decrease in general practitioner consultations. CONCLUSION These results suggest increases in private neurologist or psychiatrist consultations and exposure to recommended drugs after the reimbursement withdrawal, contrary to the fears expressed. However, antidementia drug exposure decreased long before the reimbursement modifications, probably due to the growing evidence of the modest effect of these drugs, and exposure to benzodiazepines increased after the reimbursement withdrawal.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
| | - Axel Renoux
- Centre d'Investigation Clinique 1436, Team MéDatAS "Méthodologie, Data management et Analyses Statistiques", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre d'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
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Ma Z, Xu M, Fu M, Huang T, Shi L, Zhang Y, Guan X. Association of potentially inappropriate medications with prognosis among older patients with non-small cell lung cancer. BMC Geriatr 2024; 24:550. [PMID: 38918727 PMCID: PMC11197362 DOI: 10.1186/s12877-024-05138-3] [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: 10/23/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) are common among older adults with cancer, but their association with overall survival (OS) among non-small cell lung cancer (NSCLC) patients remains unclear. This study aimed to investigate the association between the use of PIMs and OS in patients with NSCLC. METHODS In this cohort study, we included patients ≥ 65 years with newly diagnosed NSCLC from January 2014 to December 2020. Potentially inappropriate medication (PIM) is defined by the Beers criteria of 2019 at baseline and within six months following the initiation of systemic therapy. Multivariable Cox regression model was built to assess the association between PIMs and overall survival (OS). RESULTS We finally included 338 patients with a median follow-up for OS of 1777 days. The prevalence of patients receiving at least one PIM was 39.9% (135/338) and 61.2% (71/116) at baseline and after systemic therapy, respectively. The most important factor associated with PIM use was the number of prescribed medications (P < 0.001). Baseline PIM use and PIM after systemic therapy were significantly associated with inferior OS (476 days vs. 844 days, P = 0.044; and 633 days vs. 1600 days, P = 0.007; respectively). In multivariable analysis, both baseline PIM use and PIM after systemic therapy were independent predictors of poor prognosis (adjusted HR, 1.33; 95% CI, 1.01-1.75; P = 0.041; and adjusted HR, 1.86; 95% CI, 1.11-3.14; P = 0.020; respectively). CONCLUSIONS PIMs are prevalent among older patients with NSCLC and are independent predictors of NSCLC prognosis. There is an urgent need for clinicians to conduct medication reconciliation and appropriate deprescribing for this population, especially for patients with multiple PIMs.
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Affiliation(s)
- Zhuo Ma
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Man Xu
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100010, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
- International Research Center for Medicinal Administration, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Shin WY, Go TH, Kim JH. Trends in commonly used and potentially inappropriate medications in older Korean patients with polypharmacy. BMC Geriatr 2024; 24:542. [PMID: 38907201 PMCID: PMC11193228 DOI: 10.1186/s12877-024-05141-8] [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: 01/21/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Polypharmacy is a global public health concern. This study aimed to determine the prevalence of polypharmacy and trends in the use of commonly used and potentially inappropriate medications among older Korean patients. METHODS Individuals aged ≥ 65 years who were prescribed any medication between 2014 and 2018 were selected from the Korean National Health Information Database. Joinpoint regression analyses were used to determine trends in the age-adjusted polypharmacy rates by age group. The prescription rates of the most commonly used medications and the most commonly used potentially inappropriate medications were analysed by year or age group for patients with polypharmacy using the chi-square and proportion difference tests. RESULTS This study included 1,849,968 patients, 661,206 (35.7%) of whom had polypharmacy. Age-adjusted polypharmacy rates increased significantly between 2014 and 2018 (P = 0.046). Among patients with polypharmacy, the most commonly prescribed medications were aspirin (100 mg), atorvastatin, metformin, glimepiride, and rosuvastatin. The most commonly prescribed and potentially inappropriate medications were alprazolam, diazepam, amitriptyline, zolpidem, and dimenhydrinate. There was a significant decrease in the prescription rates for each of these drugs in 2018 compared with 2014 among patients with polypharmacy (all P < 0.001), whereas there was a significant increase in alprazolam prescription among patients aged ≥ 85 years when analysed by age group (P < 0.001). CONCLUSIONS This study revealed an increasing prevalence of polypharmacy among older adults. Additionally, it highlighted that the utilisation of commonly prescribed potentially inappropriate medications, such as benzodiazepines and tricyclic antidepressants, has remained persistent, particularly among patients aged ≥ 85 years who practiced polypharmacy. These findings provide evidence-based guidance for the development of robust polypharmacy management strategies to ensure medication safety among older adults.
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Affiliation(s)
- Woo-Young Shin
- Department of Family Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Tae-Hwa Go
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung-Ha Kim
- Department of Family Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
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Alhubaishi AA, Alkhaldi SO, Abanumay AJK, Alzaidy SM, Alqahtani AM, Badawoud AM, Ali AS, Almoharb HF, Alsharekh LM, Alshehri GH. The Prevalence of Prescribing Inappropriate Medications Among Older Adults in Saudi Arabia with Dementia Based on Beers Criteria: A Retrospective Study. Int J Gen Med 2024; 17:2801-2808. [PMID: 38912331 PMCID: PMC11192295 DOI: 10.2147/ijgm.s456091] [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: 03/26/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Background Dementia is a common neurogenerative disease among older adults. Therefore, they are more prone to potentially inappropriate medication (PIM), which is medication that causes more harm rather than protecting the health of an individual. Hence, the American Geriatrics Society (AGS) has recognized the risk of certain medication classes on this population and released PIM according to Beers criteria, which is a helpful guide for clinicians to ensure the safety of medication before it is prescribed. The aim of this study is to assess the prevalence of PIM use among older adults with dementia as a risk factor in comparison to other older adults without dementia. Methods A retrospective study was conducted in an outpatient setting in a tertiary hospital targeting elderly patients aged 65 years old or over from January 2020 to September 2022. A total of 598 patients were screened, and 270 patients met the inclusion criteria. The eligible patients were then divided into two groups: 168 were in a non-dementia group and 102 were in a dementia group. Results PIM use was reported in patients with and without dementia. The most inappropriate medication that was prescribed comprised atypical antipsychotics PIM for both patients with and without dementia. However, the prevalence was higher in the dementia group for quetiapine (75% vs 24% respectively), olanzapine (82% vs 17% respectively) or risperidone (92% vs 7%, respectively). Anticholinergics were highly prescribed in older adult without dementia as compared to dementia patient and was statistically significant for solifenacin (96% vs.3.6% respectively) and amitriptyline (88% vs 11% respectively). Conclusion Among elderly patients in outpatient care settings, the prevalence of PIM use is considered high in dementia patients for antipsychotics, while a higher use of benzodiazepine and anticholinergics was found in non-dementia patients.
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Affiliation(s)
- Alaa A Alhubaishi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Shahad O Alkhaldi
- PharmD Candidate, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Al-Jawhara K Abanumay
- PharmD Candidate, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sadeem M Alzaidy
- PharmD Candidate, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulhadi M Alqahtani
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amal M Badawoud
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulrahman S Ali
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Haya F Almoharb
- Department of Pharmacy, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Lolwa M Alsharekh
- Department of Pharmacy, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ghadah H Alshehri
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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