1
|
Pineda É, Fernández A, Curcio CL, Fernandes de Souza J, Vafaei A, Gómez JF. Potentially inappropriate medication on communitydwelling older adults: Longitudinal analysis using the International Mobility in Aging Study. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:207-216. [PMID: 39088533 PMCID: PMC11314927 DOI: 10.7705/biomedica.6992] [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: 04/19/2023] [Accepted: 03/18/2024] [Indexed: 08/03/2024]
Abstract
Introduction Medications are a fundamental part of the treatment of multiple pathologies. However, despite their benefits, some are considered potentially inappropriate medications for older people given their safety profile. Epidemiological data differences related to potentially inappropriate medications make it difficult to determine their effects on elderly people. Objective To estimate the prevalence and types of potentially inappropriate medications using the 2019 Beers Criteria® in a cohort of adults older than 65 years. Materials and methods We performed an observational, multicenter, retrospective, longitudinal study of a four-year follow-up of potentially inappropriate medications in community-dwelling older adults. Results We followed 820 participants from five cities for four years (2012-2016) and evaluated them in three different moments (m1 = 2012, m2 = 2014, and m3 = 2016). The average age was 69.07 years, and 50.9% were women. The potentially inappropriate medication prevalence in the participants was 40.24%. The potentially inappropriate medications' mean among the studied subjects in the first moment was 1.65 (SD = 0.963), in the second was 1.73 (SD = 1.032), and in the third was 1.62 (SD = 0.915). There were no statistical differences between measurements (Friedman test, value = 0.204). The most frequent potentially inappropriate medications categories were gastrointestinal (39.4%), analgesics (18.8%), delirium-related drugs (15.4%), benzodiazepines (15.2%), and cardiovascular (14.2%). Conclusions About half of the population of the community-dwelling older adults had prescriptions of potentially inappropriate medications in a sustained manner and without significant variability over time. Mainly potentially inappropriate medications were gastrointestinal and cardiovascular drugs, analgesics, delirium-related drugs, and benzodiazepines.
Collapse
Affiliation(s)
- Édison Pineda
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, ColombiaUniversidad de CaldasUniversidad de CaldasManizalesManizales
- Grupo de Investigación en Gerontología y Geriatría, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, ColombiaUniversidad de CaldasUniversidad de CaldasManizalesManizales
| | - Alejandra Fernández
- Hospital Alma Mater de Antioquia, Medellín, ColombiaHospital Alma Mater de AntioquiaHospital Alma Mater de AntioquiaMedellínMedellín
| | - Carmen Lucía Curcio
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, ColombiaUniversidad de CaldasUniversidad de CaldasManizalesManizales
- Grupo de Investigación en Gerontología y Geriatría, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, ColombiaUniversidad de CaldasUniversidad de CaldasManizalesManizales
| | - Juliana Fernandes de Souza
- Laboratório de Fisioterapia e Saúde Coletiva, Departamento de Fisioterapia da Universidade Federal de Pernambuco, Recife, BrasilUniversidade Federal de PernambucoUniversidade Federal de PernambucoRecifeBrazil
| | - Afshin Vafaei
- School of Health Studies, Western University, Kingston, ON, CanadaWestern UniversityWestern UniversityKingstonCanada
| | - José Fernando Gómez
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, ColombiaUniversidad de CaldasUniversidad de CaldasManizalesManizales
- Grupo de Investigación en Gerontología y Geriatría, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, ColombiaUniversidad de CaldasUniversidad de CaldasManizalesManizales
| |
Collapse
|
2
|
Colalillo JM. Geriatric emergency medicine: Complexity evolves with age. Emerg Med Australas 2024; 36:159-161. [PMID: 38155493 DOI: 10.1111/1742-6723.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Affiliation(s)
- James M Colalillo
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| |
Collapse
|
3
|
Brannigan R, Hughes JE, Moriarty F, Wallace E, Kirke C, Williams D, Bennett K, Cahir C. Potentially Inappropriate Prescribing and Potential Prescribing Omissions and Their Association with Adverse Drug Reaction-Related Hospital Admissions. J Clin Med 2024; 13:323. [PMID: 38256457 PMCID: PMC10816937 DOI: 10.3390/jcm13020323] [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: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND This study aimed to determine the prevalence of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) and their association with ADR-related hospital admissions in patients aged ≥ 65 years admitted acutely to the hospital. METHODS Information on medications and morbidities was extracted from the Adverse Drug Reactions in an Ageing Population (ADAPT) cohort (N = 798: N = 361 ADR-related admissions; 437 non-ADR-related admissions). PIP and PPOs were assessed using Beers Criteria 2019 and STOPP/START version 2. Multivariable logistic regression (adjusted odds ratios (aOR), 95%CI) was used to examine the association between PIP, PPOs and ADR-related admissions, adjusting for covariates (age, gender, comorbidity, polypharmacy). RESULTS In total, 715 (90%; 95% CI 87-92%) patients had ≥1 Beers Criteria, 555 (70%; 95% CI 66-73%) had ≥ 1 STOPP criteria and 666 patients (83%; 95% CI 81-86%) had ≥ 1 START criteria. Being prescribed at least one Beers (aOR = 1.66, 95% CI = 1.00-2.77), or meeting STOPP (aOR = 1.07, 95% CI = 0.79-1.45) or START (aOR = 0.72; 95%CI = 0.50-1.06) criteria or the number of PIP/PPO criteria met was not significantly associated with ADR-related admissions. Patients prescribed certain drug classes (e.g., antiplatelet agents, diuretics) per individual PIP criteria were more likely to have an ADR-related admission. CONCLUSION There was a high prevalence of PIP and PPOs in this cohort but no association with ADR-related admissions.
Collapse
Affiliation(s)
- Ross Brannigan
- School of Population Health, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland; (R.B.); (K.B.)
| | - John E. Hughes
- School of Population Health, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland; (R.B.); (K.B.)
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Emma Wallace
- Department of General Practice, University College Cork, T12 R229 Cork, Ireland;
| | - Ciara Kirke
- National Quality and Patient Safety Directorate at Health Service Executive, D08 W2A8 Dublin, Ireland;
| | - David Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
- Department of Geriatric and Stroke Medicine Beaumont Hospital, D05 E840 Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland; (R.B.); (K.B.)
| | - Caitriona Cahir
- School of Population Health, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland; (R.B.); (K.B.)
| |
Collapse
|
4
|
Tampaki M, Livada A, Fourka MN, Lazaridou E, Kotsani M, Benetos A, Sfikakis PP, Kravvariti E. Inappropriate prescribing in geriatric rural primary care: impact on adverse outcomes and relevant risk factors in a prospective observational cohort study. Aging Clin Exp Res 2023; 35:1901-1907. [PMID: 37428424 PMCID: PMC10460359 DOI: 10.1007/s40520-023-02475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Several tools have revealed an association between potentially inappropriate medications (PIM) and adverse outcomes, but the one most fitted for the rural population has not been determined. AIMS We investigated the performance of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) in identifying inappropriate prescribing and its association with adverse outcomes among older rural primary health care users. METHODS A cohort of consenting outpatients aged ≥ 65 years in a rural Greek primary care center was assessed for PIM and potential prescribing omissions (PPO) using the START/STOPP version 2 criteria. Medications, comorbidities, functional status, and laboratory data were recorded along with 6-month incidence of emergency department visits, hospitalization, and death prospectively. RESULTS Among 104 participants (median age 78 years, 49.1% women, receiving a median of 6 drugs), PPO was found in 78% and PIMs in 61%. PIM was multivariately correlated with multimorbidity (p = 0.029) and polypharmacy (p < 0,001), while drug-PPO was only associated with multimorbidity (p = 0.039). The number of PIM predicted emergency department visits and hospitalizations at 6-month follow-up (p value 0.011), independent of age, sex, frailty, comorbidities, and total medication number. DISCUSSION The START/STOPP tool is useful in identifying inappropriate prescribing patterns leading to increased utilization of acute care services in older adults followed at a rural primary care setting. CONCLUSION Inappropriate prescribing as identified by the START/STOPP criteria is prevalent among older adults with multimorbidity in rural primary care, and independently associated with future acute care visits.
Collapse
Affiliation(s)
- Maria Tampaki
- Postgraduate Medical Studies in Geriatric Syndromes and Physiology of Aging, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Livada
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Maria-Niki Fourka
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Elli Lazaridou
- Primary Medical Care Unit of Marmari, S. Evia, General Hospital of Karystos, Karystos, Greece
| | - Marina Kotsani
- Pôle « Maladies du Vieillissement, Gérontologie Et Soins Palliatifs », Université de Lorraine, CHRU-Nancy, Nancy, France
- Hellenic Society for the Study and Research of Aging, Athens, Greece
| | - Athanase Benetos
- Pôle « Maladies du Vieillissement, Gérontologie Et Soins Palliatifs », and INSERM DCAC u1116, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias St., Goudi, 11527, Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic and Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias St., Goudi, 11527, Athens, Greece.
| |
Collapse
|
5
|
Ghassab-Abdollahi N, Nadrian H, Saadati F, Ashazadeh F, Shaseb E, Hashemiparast M, Allahverdipour H. Global Mapping of Potentially Inappropriate Prescribing for Older Adults in Community Settings: An Umbrella Review. Korean J Fam Med 2023; 44:189-204. [PMID: 37491985 PMCID: PMC10372802 DOI: 10.4082/kjfm.23.0032] [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: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 07/27/2023] Open
Abstract
Potentially inappropriate prescribing (PIP) is a major public health concern with several undesirable health consequences for older adults. In this overview, we aimed to map and gather information from existing literature to provide a better insight into the prevalence of PIP among community dwellers. Electronic databases were searched from their inception to April 2022. The quality of the included systematic reviews (SRs) was assessed using the assessment of multiple systematic reviews checklist. The degree of overlap within the SRs was also evaluated (2% overlap). All SRs on the prevalence of PIP in older individuals in community settings were included, and a narrative approach was used to synthesize data. Nineteen SRs comprising 548 primary studies met the inclusion criteria, and the average quality of the included SRs was moderate. More than half (50.5%) of the primary studies were conducted in Europe, followed by the United States (22.8%), and Asia (18.9%). Thirty different criteria were used in the primary studies to estimate the prevalence of PIP. The most widely used criteria were those presented in Beers (41.8%) and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) (21.8%) criteria. Benzodiazepines, nonsteroidal anti-inflammatory drugs, and antidepressants were the most frequently reported PIPs. A considerable variation in the prevalence of PIP ranging from 0% to 98% was reported by SRs. However, there is a high degree of uncertainty regarding the extent of PIP in community settings. To identify knowledge-to-action gaps, SR authors should consider the differences in prevalence of PIP according to settings, applied tools, data sources, geographical areas, and specific pathologies. There is also a need for primary and SR studies from low- and middle-income countries regarding the prevalence of PIP.
Collapse
Affiliation(s)
- Nafiseh Ghassab-Abdollahi
- Department of Geriatric Health, Faculty of Health Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haidar Nadrian
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Saadati
- Department of Health Education & Promotion, Faculty of Health Science, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Ashazadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Shaseb
- Drug Applied Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Mina Hashemiparast
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
- Department of Health Education & Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
6
|
Jun K, Lee S, Lee AY, Ah YM, Lee JY. Development of a medication review tool for residents in Korean long-term care facilities. Ther Adv Chronic Dis 2022; 13:20406223221128444. [PMID: 36225669 PMCID: PMC9549204 DOI: 10.1177/20406223221128444] [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: 01/25/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Residents in long-term care facilities (LTCFs) are likely to suffer from drug-related problems, such as inappropriate polypharmacy and potential prescribing omissions due to multimorbidity and high-level frailty. Medication reviews are thus necessary to identify and resolve drug-related problems in LTCF residents. In this study, we aimed to develop a medication review tool for older adults in LTCFs in Korea. METHODS We did a systematic review to identify previously developed explicit criteria and devised preliminary potentially inappropriate medications (PIMs) list for the LTCF elderly from previous tools. Each item on this list was categorized into 23 underlying diseases/conditions, and the interventions necessary for each PIM were included. A two-round modified Delphi survey was performed sequentially for consensus evaluation of clinical appropriateness and feasibility of the list items by 12 experts (seven physicians in different specialties and five pharmacists specialized in geriatrics) and seven pharmacists, respectively. RESULTS We identified 22 existing tools and devised a preliminary PIM list including 100 items. Ninety-one items were derived from the two-round Delphi survey for clinical appropriateness. In the feasibility test, 77 items were integrated into the final medication review tool for the LTCF elderly. The final list was composed of items relating to PIMs in general (18), potential drug interactions (14), PIMs under specific diseases/conditions (26), a need for dose adjustment (2), and potential omissions (17). CONCLUSIONS We developed a disease-category-based explicit medication review tool for detecting PIM use for LTCF residents. This tool may be helpful in implementing medication review practices to assist pharmacists or physicians for the elderly in LTCFs. Further research is required to validate the effectiveness of our tool in clinical practice.
Collapse
Affiliation(s)
- Kwanghee Jun
- College of Pharmacy, Seoul National University,
Seoul, Republic of Korea
| | - Soojin Lee
- College of Pharmacy, Seoul National University,
Seoul, Republic of Korea
| | - Ah young Lee
- College of Pharmacy, Seoul National University,
Seoul, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University,
Gyeongsan, Republic of Korea
| | | |
Collapse
|
7
|
Ó Ciardha D, Blake AM, Creane D, Callaghan MÓ, Darker C. Can a practice pharmacist improve prescribing safety and reduce costs in polypharmacy patients? A pilot study of an intervention in an Irish general practice setting. BMJ Open 2022; 12:e050261. [PMID: 35623753 PMCID: PMC9150158 DOI: 10.1136/bmjopen-2021-050261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs. SETTING Four-doctor suburban general practice. PARTICIPANTS Inclusion criteria: patients receiving 10+ repeat drugs per month. EXCLUSION CRITERIA deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study. INTERVENTION Pharmacist conducting holistic medication reviews in the study group over a 6-month period. PRIMARY OUTCOME MEASURES Anonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated. RESULTS In total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing. CONCLUSIONS This study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.
Collapse
Affiliation(s)
- Darach Ó Ciardha
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Anne-Marie Blake
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Dylan Creane
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Michael Ó Callaghan
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Catherine Darker
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| |
Collapse
|
8
|
Zeng Y, Yu Y, Liu Q, Su S, Lin Y, Gu H, Chen S, Li P, Xu T, Sun N, Lin T, Huang Q, Fan Y, Wang F, Yan S. Comparison of the prevalence and nature of potentially inappropriate medication use in geriatric outpatients between tertiary and community healthcare settings: a multicenter cross-sectional study. Int J Clin Pharm 2022; 44:619-629. [PMID: 35212907 DOI: 10.1007/s11096-022-01380-0] [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: 11/30/2021] [Accepted: 01/22/2022] [Indexed: 11/05/2022]
Abstract
Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65 years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.
Collapse
Affiliation(s)
- Yan Zeng
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yongpei Yu
- Department of Biostatistics, Peking University Clinical Research Institution, Beijing, China
| | - Qingyang Liu
- Department of Clinical Pharmacy, Capital Medical University, Beijing, China
| | - Su Su
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongyan Gu
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shicai Chen
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Tong Xu
- Department of Pharmacy, Taiyanggong Community Health Center, Beijing, China
| | - Naizhao Sun
- Department of Pharmacy, Datun Community Health Center, Beijing, China
| | - Tao Lin
- Department of Pharmacy, Ganjiakou Community Health Center, Beijing, China
| | - Qian Huang
- Department of Pharmacy, Konggang Community Health Center, Beijing, China
| | - Yujie Fan
- Department of Pharmacy, Guangnei Community Health Center, Beijing, China
| | - Fengzhi Wang
- Department of Data Management, Peking University Clinical Research Institute, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China.
| |
Collapse
|
9
|
González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Factors Associated with Medication Non-Adherence among Patients with Multimorbidity and Polypharmacy Admitted to an Intermediate Care Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9606. [PMID: 34574530 PMCID: PMC8464705 DOI: 10.3390/ijerph18189606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022]
Abstract
Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients' multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80-28.84, p < 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95-15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients' experiences related to medication management. Thus, the relationship between patients' self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.
Collapse
Affiliation(s)
- Javier González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain
| | - Núria Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de la Santa Creu de Vic, 08500 Barcelona, Spain
| | - Carles Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, 08500 Barcelona, Spain;
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
| | - Joan Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic—Central University of Catalonia (UVIC-UCC), 08500 Barcelona, Spain; (D.S.-S.); (N.M.-B.); (J.E.-P.)
- Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de la Santa Creu de Vic, 08500 Barcelona, Spain
| |
Collapse
|
10
|
González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Molist-Brunet N, Codina-Jané C, Espaulella-Panicot J. Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity. Eur J Clin Pharmacol 2021; 78:127-137. [PMID: 34448906 DOI: 10.1007/s00228-021-03207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. METHODS Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs. RESULTS Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001). CONCLUSION Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.
Collapse
Affiliation(s)
- J González-Bueno
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain. .,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Pharmacy Department, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- Epidemiology Unit, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - N Molist-Brunet
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
| | - C Codina-Jané
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain
| |
Collapse
|
11
|
Manias E, Kabir MZ, Maier AB. Inappropriate medications and physical function: a systematic review. Ther Adv Drug Saf 2021; 12:20420986211030371. [PMID: 34349978 PMCID: PMC8287273 DOI: 10.1177/20420986211030371] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/17/2021] [Indexed: 01/10/2023] Open
Abstract
Background and aims: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. Results: In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Conclusion: Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Plain language summary Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.
Collapse
Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Md Zunayed Kabir
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @ Age Melbourne, The Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
| |
Collapse
|
12
|
Amorim WW, Passos LC, Gama RS, Souza RM, Graia LT, Macedo JC, Santos DB, Oliveira MG. Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil. SAO PAULO MED J 2021; 139:107-116. [PMID: 33825769 PMCID: PMC9632519 DOI: 10.1590/1516-3180.2020.0411.r1.18112020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.
Collapse
Affiliation(s)
- Welma Wildes Amorim
- MD, PhD. Internal Medicine Professor, Medicine Course, Department of Natural Sciences, Vitória da Conquista Campus, Universidade Estadual do Sudoeste da Bahia (UESB), Vitória da Conquista (BA), Brazil.
| | - Luiz Carlos Passos
- MD, PhD. Internal Medicine Professor, Postgraduate Program on Medicine and Health, Department of Internal Medicine, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | - Romana Santos Gama
- BPharm. Master's Student, Postgraduate Program on Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | - Renato Morais Souza
- BPharm. Research Assistant, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia (UFBA), Vitória da Conquista (BA), Brazil.
| | - Lucas Teixeira Graia
- BPharm. Research Assistant, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia (UFBA), Vitória da Conquista (BA), Brazil.
| | - Jéssica Caline Macedo
- BPharm. Master's Student, Master's Program on Collective Health, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia (UFBA), Vitória da Conquista (BA), Brazil.
| | - Djanilson Barbosa Santos
- PhD. Epidemiology Professor, Department of Collective Health, Universidade Federal do Recôncavo da Bahia (UFRB), Santo Antônio de Jesus (BA), Brazil.
| | - Marcio Galvão Oliveira
- BPharm, PhD. Evidence-Based Healthcare Professor, Master's Program on Collective Health, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia, Vitória da Conquista (BA), Brazil.
| |
Collapse
|
13
|
Mack DS, Baek J, Tjia J, Lapane KL. Statin Discontinuation and Life-Limiting Illness in Non-Skilled Stay Nursing Homes at Admission. J Am Geriatr Soc 2020; 68:2787-2796. [PMID: 33270223 PMCID: PMC8127623 DOI: 10.1111/jgs.16777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/05/2020] [Accepted: 07/18/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To estimate 30-day statin discontinuation among newly admitted nursing home residents overall and within categories of life-limiting illness. DESIGN Retrospective cohort using Minimum Data Set 3.0 nursing home admission assessments from 2015 to 2016 merged to Medicare administrative data files. SETTING U.S. Medicare- and Medicaid-certified nursing home facilities (n = 13,092). PARTICIPANTS Medicare fee-for-service beneficiaries, aged 65 years and older, newly admitted to nursing homes for non-skilled nursing facility stays on statin pharmacotherapy at the time of admission (n = 73,247). MEASUREMENTS Residents were categorized using evidence-based criteria to identify progressive, terminal conditions or limited prognoses (<6 months). Discontinuation was defined as the absence of a new Medicare Part D claim for statin pharmacotherapy in the 30 days following nursing home admission. RESULTS Overall, 19.9% discontinued statins within 30 days of nursing home admission, with rates that varied by life-limiting illness classification (no life-limiting illness: 20.5%; serious illness: 18.6%; receipt of palliative care consult: 34.5%; clinician designated as end-of-life: 45.0%). Relative to those with no life-limiting illness, risk of 30-day statin discontinuation increased with life-limiting illness severity (serious illness: adjusted risk ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02-1.10; palliative care index diagnosis: aRR = 1.15; 95% CI = 1.10-1.21; palliative care consultation: aRR = 1.58; 95% CI = 1.43-1.74; clinician designated as end of life: aRR = 1.59; 95% CI = 1.42-1.79). Nevertheless, most remained on statins after entering the nursing home regardless of life-limiting illness status. CONCLUSION Statin use continues in a large proportion of Medicare beneficiaries after admission to a nursing home. Additional deprescribing research, which identifies how to engage nursing home residents and healthcare providers in a process to safely and effectively discontinue medications with questionable benefits, is warranted.
Collapse
Affiliation(s)
- Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jennifer Tjia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
14
|
Brunetti E, Isaia G, Bo M. Comment on: "Potentially Inappropriate Medications, Drug-Drug Interactions, and Anticholinergic Burden in Elderly Hospitalized Patients: Does an Association Exist with Post-Discharge Health Outcomes?". Drugs Aging 2020; 38:89-91. [PMID: 33210272 DOI: 10.1007/s40266-020-00818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Enrico Brunetti
- Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Molinette, Corso Bramante 88, 10126, Turin, Italy.
| | - Gianluca Isaia
- Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Molinette, Corso Bramante 88, 10126, Turin, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Molinette, Corso Bramante 88, 10126, Turin, Italy
| |
Collapse
|
15
|
AL‐Musawe L, Torre C, Guerreiro JP, Rodrigues AT, Raposo JF, Mota‐Filipe H, Martins AP. Polypharmacy, potentially serious clinically relevant drug-drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life. Pharmacol Res Perspect 2020; 8:e00621. [PMID: 32618136 PMCID: PMC7332581 DOI: 10.1002/prp2.621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 01/13/2023] Open
Abstract
The aim of the study is to investigate the patterns of polypharmacy, clinical-relevant drug-drug interactions (DDIs), and potentially inappropriate medicines (PIMs), and whether polypharmacy, potential serious clinically-relevant DDIs, or PIMs can be associated with low quality of life (QoL) index scores of older adults with type 2 diabetes (T2D). A cross-sectional study was conducted using data of 670 elderly T2D sub-cohort from a nationwide pharmacy-based intensive monitoring study of inception cohort of T2D in Portugal. 72.09% were found on polypharmacy (≥5 medicines). Participants on polypharmacy were mostly females (P = .0115); more obese (P = .0131); have more comorbid conditions (P < .0001); more diabetes complications (P < .0001); and use more of glucose lowering drugs (P = .0326); insulin (P < .0001); chronic medicines (P < .0001); and have higher diabetes duration (P = .0088) than those without polypharmacy. 10.59% of the participants were found to have potential serious clinically relevant DDIs. The most frequent drug-combinations were angiotensin-converting enzyme (ACE) inhibitors with angiotensin-receptor blockers (ARBs), aspirin with Selective serotonin reuptake inhibitors (SSRIs), and clopidogrel with calcium channel blockers. PIMs are found in 36.11% of the participants. The most common PIMs were benzodiazepines, long-acting sulfonylureas, and iron overdose. The adjusted multivariate models show that Polypharmacy, PIMs, and potential serious clinically relevant DDIs were associated with lower QoL index scores (OR 1.80 95% CI 1.15-2.82), (OR 1.57 95% CI 1.07-2.28), and (OR 1.34 95% CI 0.73-2.48) respectively. The study shows that polypharmacy, potential serious clinical-relevant DDIs, and PIMs may correlate with risk of reduced health related QoL outcome of older adults with T2D.
Collapse
Affiliation(s)
| | - Carla Torre
- Faculty of PharmacyUniversity of LisbonLisbonPortugal
| | | | | | - Joao Filipe Raposo
- Nova Medical SchoolNova University of LisbonLisbonPortugal
- Portuguese Diabetes Association (APDP)LisbonPortugal
| | | | | |
Collapse
|