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Amrouch C, Vetrano DL, Damiano C, Dai L, Calderón-Larrañaga A, Grymonprez M, Proietti M, Lip GYH, Johnsen SP, Wastesson JW, Johnell K, De Smedt D, Petrovic M. Potentially inappropriate prescribing in polymedicated older adults with atrial fibrillation and multimorbidity: a Swedish national register-based cohort study. Front Pharmacol 2024; 15:1476464. [PMID: 39318774 PMCID: PMC11420530 DOI: 10.3389/fphar.2024.1476464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Current research on potentially inappropriate prescribing (PIP) in polymedicated older adults with atrial fibrillation (AF) and multimorbidity is predominantly focused on PIP of oral anticoagulants (OAC). Our study aimed to assess (i) the overall prevalence of PIP in older multimorbid adults with AF, (ii) potential associated factors of PIP, and (iii) the association of PIP with adverse health outcomes in a nationwide sample of Swedish older adults. Methods Swedish national registries were linked to establish a cohort with a 2-year follow-up of older adults (≥65y) who, on 1 January 2017, had a diagnosis of AF and had at least one comorbidity (n = 203,042). PIP was assessed using the reduced STOPP/START version 2 screening tool. The STOPP criteria identify potentially inappropriate prescribed medications (PIM), while the START criteria identify potential prescribing omissions (PPO). PIP is identified as having at least one PIM and/or PPO. Cox regression analyses were conducted to examine the association between PIP and adverse health outcomes: mortality, hospitalisation, stroke, bleeding, and falls. Results PIP was highly prevalent in older adults with AF, with both polypharmacy (69.6%) and excessive polypharmacy (85.9%). In the study population, benzodiazepines (22.9%), hypnotic Z-medications (17.8%) and analgesics (8.7%) were the most frequent PIM. Anticoagulants (34.3%), statins (11.1%), vitamin D and calcium (13.4%) were the most frequent PPO. Demographic factors and polypharmacy were associated with different PIM and PPO categories, with the nature of these associations differing based on the specific type of PIM and PPO. The co-occurrence of PIM and PPO, compared to appropriate prescribing, was associated with an increased risk of adverse health outcomes compared to all appropriately prescribed medications: cardiovascular (CV) (Hazard ratio (HR) [95% confidence interval] = 1.97 [1.88-2.07]) and overall mortality (HR = 2.09 [2.03-2.16]), CV (HR = 1.34 [1.30-1.37]) and overall hospitalisation (HR = 1.48 [1.46-1.51]), stroke (HR = 1.93 [1.78-2.10]), bleeding (HR = 1.10 [1.01-1.21]), and falls (HR = 1.63 [1.56-1.71]). Conclusion The present study reports a high prevalence of PIP in multimorbid polymedicated older adults with AF. Additionally, a nuanced relationship between prescribing patterns, patient characteristics, and adverse health outcomes was observed. These findings emphasise the importance of implementing tailored interventions to optimise medication management in this patient population.
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Affiliation(s)
- Cheima Amrouch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Davide Liborio Vetrano
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Cecilia Damiano
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Lu Dai
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Maxim Grymonprez
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren P Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jonas W Wastesson
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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Borrelli EP. Assessing the prevalence of Beers medication utilization in the Medicare Part D population in 2020. J Am Geriatr Soc 2024; 72:2800-2806. [PMID: 38709112 DOI: 10.1111/jgs.18943] [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: 02/04/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Medication utilization has been increasing in the U.S. year-over-year for several decades. As older adults take more medications, there is a higher risk of them being exposed to drug-drug or drug-disease interactions. The American Geriatrics Society in 2019 updated their Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults. The objective of this study was to assess the prevalence of utilization of medications included in the 2019 Beers Criteria. METHODS An analysis was conducted using the Medicare Part D Provider Utilization and Payment Data Public Use File for calendar-year 2020. Medications identified in the 2019 Beers Criteria were applied to the analysis. Two categories of medications were assessed: (1) "Avoid" and (2) "Use With Caution." RESULTS In 2020, 56 million prescriptions were dispensed to Medicare patients 65 years and older that are recommended to be avoided without exception (4.7% of all prescriptions) totaling $957 million in medication costs. The most utilized medication classes in this category were benzodiazepines (25,949,994 prescriptions), "Z-drugs" (6,204,909 prescriptions), long-acting sulfonylureas (5,306,577 prescriptions), 1st-generation antihistamines (5,049,289 prescriptions), and tricyclic antidepressants (4,190,062 prescriptions). Additionally, 135 million prescriptions were dispensed to Medicare beneficiaries 65 years and older for medications which the Beers Criteria states to use caution (11.3% of all prescriptions) exceeding $2.85 billion in medication costs. The most utilized medications for this category were diuretics (74,599,126 prescriptions), selective serotonin reuptake inhibitors (30,033,121 prescriptions), serotonin and norepinephrine reuptake inhibitors (11,858,968 prescriptions), tramadol (11,450,878 prescriptions), and mirtazapine (5,737,304 prescriptions). CONCLUSION Even with the existence of the AGS Beers Criteria for PIM Use in Older Adults and its continued updated versions, 16% of medications dispensed to Medicare Part D were potentially inappropriate. Future studies are needed to assess if this has led to worsened outcomes among older adults who utilized these PIM.
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Affiliation(s)
- Eric P Borrelli
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, USA
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3
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Amrouch C, Amrouch S, Dai L, Calderón-Larrañaga A, Wastesson JW, Johnell K, Vetrano DL, De Smedt D, Petrovic M. Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort. Eur Geriatr Med 2024; 15:1149-1158. [PMID: 38753270 DOI: 10.1007/s41999-024-00990-3] [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: 03/20/2024] [Accepted: 05/04/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE The STOPP/START criteria are frequently applied in observational studies to assess potentially inappropriate prescribing in older adults. This study aimed to assess the applicability of the three available STOPP/START versions in two distinct data sources. METHODS To evaluate the applicability of the three versions of STOPP/START criteria, we used two observational data sources: (i) Integrated Swedish administrative health registries (ISHR) encompassing routinely collected health data and (ii) the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K), based on health professional-led clinical assessments. The Anatomical Therapeutic Classification code (ATC) was used to categorise medications. Diseases were categorised using the international classification of diseases version 10 (ICD10). RESULTS The first STOPP/START version demonstrated an applicability rate of 80% in ISHR and 84% in SNAC-K. The second version demonstrated an applicability of 64% in ISHR and 74% in SNAC-K. The third version showed an applicability of 66% in ISHR and 77% in SNAC-K. Challenges in applicability included broad definitions, vague terminology, and the lack of information on disease severity, symptomatic traits, and stability of certain conditions. CONCLUSION The applicability of the STOPP/START criteria in observational studies seems to have decreased in more recent versions of the tool. Population-based studies with comprehensive clinical assessments may offer higher applicability compared to studies based on administrative data. Future versions of the STOPP/START criteria should prioritise clear and unambiguous definitions to improve their applicability in research and promote result generalisability and comparability.
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Affiliation(s)
- Cheima Amrouch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
| | - Souad Amrouch
- Department of Medicine, Antwerp University, Antwerp, Belgium
| | - Lu Dai
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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Camacho EM, Penner LS, Taylor A, Guthrie B, Avery AJ, Ashcroft DM, Morales DR, Rogers G, Chuter A, Elliott RA. Estimating the economic effect of harm associated with high risk prescribing of oral non-steroidal anti-inflammatory drugs in England: population based cohort and economic modelling study. BMJ 2024; 386:e077880. [PMID: 39048136 PMCID: PMC11268384 DOI: 10.1136/bmj-2023-077880] [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] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES To quantify prevalence, harms, and NHS costs in England of problematic oral non-steroidal anti-inflammatory drug (NSAID) prescribing in high risk groups. DESIGN Population based cohort and economic modelling study. SETTING Economic models estimating patient harm associated with NSAID specific hazardous prescribing events, and cost to the English NHS, over a 10 year period, were combined with trends of hazardous prescribing event to estimate national levels of patient harm and NHS costs. PARTICIPANTS Eligible participants were prescribed oral NSAIDs and were in five high risk groups: older adults (≥65 years) with no gastroprotection; people who concurrently took oral anticoagulants; or those with heart failure, chronic kidney disease, or a history of peptic ulcer. MAIN OUTCOME MEASURES Prevalence of hazardous prescribing events, by each event and overall, discounted quality adjusted life years (QALYs) lost, and cost to the NHS in England of managing harm. RESULTS QALY losses and cost increases were observed for each hazardous prescribing event (v no hazardous prescribing event). Mean QALYs per person were between 0.01 (95% credibility interval (CI) 0.01 to 0.02) lower with history of peptic ulcer, to 0.11 (0.04 to 0.19) lower with chronic kidney disease. Mean cost increases ranged from a non-statistically significant £14 (€17; $18) (95% CI -£71 to £98) in heart failure, to a statistically significant £1097 (£236 to £2542) in people concurrently taking anticoagulants. Prevalence of hazardous prescribing events per 1000 patients ranged from 0.11 in people who have had a peptic ulcer to 1.70 in older adults. Nationally, the most common hazardous prescribing event (older adults with no gastroprotection) resulted in 1929 (1416 to 2452) QALYs lost, costing £2.46m (£0.65m to £4.68m). The greatest impact was in people concurrently taking oral anticoagulants: 2143 (894 to 4073) QALYs lost, costing £25.41m (£5.25m to £60.01m). Over 10 years, total QALYs lost were estimated to be 6335 (4471 to 8658) and an NHS cost for England of £31.43m (£9.28m to £67.11m). CONCLUSIONS NSAIDs continue to be a source of avoidable harm and healthcare cost in these five high risk populations, especially in inducing an acute event in people with chronic condition and people taking oral anticoagulants.
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Affiliation(s)
- Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK
| | - Leonie S Penner
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK
| | - Amy Taylor
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Daniel R Morales
- Clinical Research Fellow, Population Health and Genomics, University of Dundee, DD1 4HN, UK; Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Gabriel Rogers
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK
| | - Antony Chuter
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Patient author
| | - Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
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Lunghi C, Domenicali M, Vertullo S, Raschi E, De Ponti F, Onder G, Poluzzi E. Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals. Drug Saf 2024:10.1007/s40264-024-01453-1. [PMID: 38990488 DOI: 10.1007/s40264-024-01453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
The growing complexity of geriatric pharmacotherapy necessitates effective tools for mitigating the risks associated with polypharmacy. The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria have been instrumental in optimizing medication management among older adults. Despite their large adoption for improving the reduction of potentially inappropriate medications (PIM) and patient outcomes, the implementation of STOPP/START criteria faces notable challenges. The extensive number of criteria in the latest version and time constraints in primary care pose practical difficulties, particularly in settings with a high number of older patients. This paper critically evaluates the challenges and evolving implications of applying the third version of the STOPP/START criteria across various clinical settings, focusing on the European healthcare context. Utilizing a "Questions & Answers" format, it examines the criteria's implementation and discusses relevant suitability and potential adaptations to address the diverse needs of different clinical environments. By emphasizing these aspects, this paper aims to contribute to the ongoing discourse on enhancing medication safety and efficacy in the geriatric population, and to promote more person-centred care in an aging society.
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Affiliation(s)
- Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec, Quebec, Canada.
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Stefano Vertullo
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
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Schuster BG, Faisal S, L Gagnon C. A new curricular framework for an interprofessional approach to deprescribing: Why and how pharmacists should lead the way. Can Pharm J (Ott) 2024; 157:101-103. [PMID: 38737361 PMCID: PMC11086733 DOI: 10.1177/17151635241239924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/09/2023] [Indexed: 05/14/2024]
Affiliation(s)
| | - Sadaf Faisal
- Research Centre, Institut universitaire de gériatrie de Montréal
| | - Camille L Gagnon
- Research Centre, Institut universitaire de gériatrie de Montréal
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Li M, Lv G, Lee TY, Wu J, Lu K. Economic and clinical burdens and associated health disparities in HIV/AIDS management using big data: potentially inappropriate use and deprescribing of benzodiazepines. AIDS Care 2024; 36:604-611. [PMID: 33213189 DOI: 10.1080/09540121.2020.1842320] [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: 07/27/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to examine factors, healthcare utilization, and medical costs associated with potentially inappropriate use of benzodiazepines in persons living with HIV (PLWH). We used big data from Medicare claims in 2017. Potentially inappropriate use of benzodiazepines was defined as having any benzodiazepine claims in individuals 65+ years or having benzodiazepine claims for more than four weeks in individuals 18-64 years. Logistic regressions, zero-inflated negative binomial regressions, and generalized linear models were used. This study included 1,211 PLWH and 235 (19.41%) had potentially inappropriate use of benzodiazepines. PLWH who were 65+ years (OR: 0.56; 95% CI: 0.33, 0.96), non-Hispanic blacks (OR: 0.29; 95% CI: 0.20, 0.41), or Hispanics (OR: 0.55; 95% CI: 0.35, 0.88) were less likely to use benzodiazepines inappropriately. PLWH who had potentially inappropriate use of benzodiazepines had more inpatient (IRR: 1.46; 95% CI: 1.10, 1.94), outpatient (IRR: 1.14; 95% CI 1.02, 1.28), and emergency room (IRR: 1.32; 95% CI: 1.03, 1.68) visits. Potentially inappropriate use of benzodiazepines was associated with higher total (β: 0.16; 95% CI: 0.07, 0.25), Medicare (β: 0.18; 95% CI: 0.07, 0.28), and out-of-pocket (β: 0.21; 95% CI: 0.05, 0.36) costs. This study provides real-world evidence to support deprescribing benzodiazepines in PLWH.
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Affiliation(s)
- Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gang Lv
- General Surgery Department, 1st Medical Center of PLA General Hospital, Beijing, China
| | - Tai-Ying Lee
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Jun Wu
- Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
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Rockwell MS, Oyese EG, Singh E, Vinson M, Yim I, Turner JK, Epling JW. Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings. BMJ Open 2024; 14:e078808. [PMID: 38631836 PMCID: PMC11029194 DOI: 10.1136/bmjopen-2023-078808] [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: 08/12/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) utilisation persists at undesirable rates worldwide. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research. DESIGN Scoping review. DATA SOURCES PubMed, CINAHL, Embase, Cochrane Central and Google Scholar (1 January 2000 to 31 May 2022). STUDY SELECTION Studies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilisation in healthcare settings. DATA EXTRACTION Using Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilisation. RESULTS From 7818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the USA (35.3%), with randomised controlled trial as the most common design (55.9%). Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%) but were rarely (14.9%) guided by an implementation model, framework or theory. Academic detailing, clinical decision support or electronic medical record interventions, performance reports and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients' age (55.8%), history of gastrointestinal disorders (47.1%), or history of kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter (OTC) NSAIDs in addition to prescription. The majority of studies (76.2%) reported a reduction in the utilisation of potentially harmful NSAIDs. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation. CONCLUSION Many varied interventions to de-implement potentially harmful NSAIDs have been applied in healthcare settings worldwide. Based on these findings and identified knowledge gaps, further efforts to comprehensively evaluate the effectiveness of interventions and the combination of intervention characteristics associated with effective de-implementation are needed. In addition, future work should be guided by de-implementation theory, focus on OTC NSAIDs and incorporate patient-focused strategies and outcomes, including the evaluation of unintended consequences of the intervention.
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Affiliation(s)
- Michelle S Rockwell
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Emma G Oyese
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Eshika Singh
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Matthew Vinson
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Isaiah Yim
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Jamie K Turner
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - John W Epling
- Family and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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9
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Catalá-López F, Ridao M, Tejedor-Romero L, Caulley L, Hutton B, Husereau D, Alonso-Arroyo A, Bernal-Delgado E, Drummond MF, Moher D. Transparency, openness, and reproducible research practices are frequently underused in health economic evaluations. J Clin Epidemiol 2024; 165:111208. [PMID: 37939742 DOI: 10.1016/j.jclinepi.2023.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/15/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness, and reproducibility. STUDY DESIGN AND SETTING We evaluated a random sample of health economic evaluations indexed in MEDLINE during 2019. We included articles written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years, and/or disability-adjusted life years. Reproducible research practices, openness, and transparency in each article were extracted in duplicate. We explored whether reproducible research practices were associated with self-report use of a guideline. RESULTS We included 200 studies published in 147 journals. Almost half were published as open access articles (n = 93; 47%). Most studies (n = 150; 75%) were model-based economic evaluations. In 109 (55%) studies, authors self-reported use a guideline (e.g., for study conduct or reporting). Few studies (n = 31; 16%) reported working from a protocol. In 112 (56%) studies, authors reported the data needed to recreate the incremental cost-effectiveness ratio for the base case analysis. This percentage was higher in studies using a guideline than studies not using a guideline (72/109 [66%] with guideline vs. 40/91 [44%] without guideline; risk ratio 1.50, 95% confidence interval 1.15-1.97). Only 10 (5%) studies mentioned access to raw data and analytic code for reanalyses. CONCLUSION Transparency, openness, and reproducible research practices are frequently underused in health economic evaluations. This study provides baseline data to compare future progress in the field.
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Affiliation(s)
- Ferrán Catalá-López
- Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain; Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain; Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada.
| | - Manuel Ridao
- Institute for Health Research in Aragon (IISA), Zaragoza, Spain; Data Science for Health Services and Policy Research, Aragon Health Sciences Institute (IACS), Zaragoza, Spain; Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
| | - Laura Tejedor-Romero
- Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain; Preventive Medicine Unit, La Princesa University Teaching Hospital, Madrid, Spain; Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Madrid, Spain
| | - Lisa Caulley
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada; Otolaryngology-Head and Neck Surgery Department, Ottawa Hospital, Ottawa, Ontario, Canada; Department of Clinical Medicine and Otolaryngology-Head and Neck Surgery, Aarhus University, Aarhus, Denmark
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Don Husereau
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Institute of Health Economics, Edmonton, Alberta, Canada
| | - Adolfo Alonso-Arroyo
- Department of History of Science and Documentation, University of Valencia, Valencia, Spain; Information and Social and Health Research (UISYS) Joint Research Unit, Spanish National Research Council (CSIC), University of Valencia, Valencia, Spain
| | - Enrique Bernal-Delgado
- Data Science for Health Services and Policy Research, Aragon Health Sciences Institute (IACS), Zaragoza, Spain; Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
| | | | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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10
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Rockwell MS, Oyese EG, Singh E, Vinson M, Yim I, Turner JK, Epling JW. A Scoping Review of Interventions to De-implement Potentially Harmful Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in Healthcare Settings. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.29.23293362. [PMID: 37546911 PMCID: PMC10402245 DOI: 10.1101/2023.07.29.23293362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Objectives Potentially harmful nonsteroidal anti-inflammatory drugs (NSAIDs) utilization persists at undesirable rates throughout the world. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research. Design Scoping review. Data Sources PubMed, CINAHL, Embase, Cochrane Central, and Google Scholar (2000-2022). Study Selection Studies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilization in healthcare settings. Data Extraction Using Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilization. Results From 7,818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the U.S. (35.3%), with randomized controlled trial as the most common design (55.9%). The majority of studies (76.2%) reported a reduction in the utilization of potentially harmful NSAIDs. Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%). Academic detailing, clinical decision support or electronic medical record interventions, performance reports, and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients' age (55.8%) or history of gastrointestinal disorders (47.1%) or kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter NSAIDs in addition to prescription. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation. Conclusion Many varied interventions are effective in de-implementing potentially harmful NSAIDs in healthcare settings. Efforts to adapt, scale, and disseminate these interventions are needed. In addition, future interventions should address over-the-counter NSAIDs, which are broadly available and widely used. Evaluating unintended consequences of interventions, including patient-focused outcomes, is another important priority.
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Affiliation(s)
- Michelle S Rockwell
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Emma G Oyese
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Eshika Singh
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | | | - Isaiah Yim
- Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Jamie K Turner
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Roanoke, VA
| | - John W Epling
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
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11
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Farrell B, Raman-Wilms L, Sadowski CA, Mallery L, Turner J, Gagnon C, Cole M, Grill A, Isenor JE, Mangin D, McCarthy LM, Schuster B, Sirois C, Sun W, Upshur R. A Proposed Curricular Framework for an Interprofessional Approach to Deprescribing. MEDICAL SCIENCE EDUCATOR 2023; 33:551-567. [PMID: 37261023 PMCID: PMC10226933 DOI: 10.1007/s40670-022-01704-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/02/2023]
Abstract
Deprescribing involves reducing or stopping medications that are causing more harm than good or are no longer needed. It is an important approach to managing polypharmacy, yet healthcare professionals identify many barriers. We present a proposed pre-licensure competency framework that describes essential knowledge, teaching strategies, and assessment protocols to promote interprofessional deprescribing skills. The framework considers how to involve patients and care partners in deprescribing decisions. An action plan and example curriculum mapping exercise are included to help educators assess their curricula, and select and implement these concepts and strategies within their programs to ensure learners graduate with competencies to manage increasingly complex medication regimens as people age. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01704-9.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8 Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON Canada
| | - Lalitha Raman-Wilms
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- Centre On Aging, Winnipeg, MB Canada
| | - Cheryl A. Sadowski
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB Canada
| | - Laurie Mallery
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Justin Turner
- Faculty of Pharmacy, University of Montreal, Montreal, QC Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - Camille Gagnon
- Canadian Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC Canada
| | - Mollie Cole
- Canadian Gerontological Nursing Association, Calgary, AB Canada
| | - Allan Grill
- Dept. of Family & Community Medicine, University of Toronto, Toronto, ON Canada
- Markham Family Health Team, Markham, ON Canada
- Ontario Renal Network, Toronto, Canada
| | - Jennifer E. Isenor
- College of Pharmacy, Faculty of Health and Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Dee Mangin
- David Braley & Nancy Gordon Chair in Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON Canada
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Lisa M. McCarthy
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8 Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON Canada
- Institute for Better Health and Pharmacy Department, Trillium Health Partners, Mississauga, ON Canada
- Leslie Dan Faculty of Pharmacy & Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
- Women’s College Research Institute, Toronto, ON Canada
| | - Brenda Schuster
- College of Medicine (Regina Campus), University of Saskatchewan, Regina, Saskachewan Canada
| | - Caroline Sirois
- Centre d’excellence Sur Le Vieillissement de Québec & VITAM - Research Centre On Sustainable Health, Québec, Canada
- Faculty of Pharmacy, Université Laval, Québec, Canada
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Bridgepoint Collaboratory for Research and Innovation, Toronto, ON Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON Canada
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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12
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Robinson EG, Hedna K, Hakkarainen KM, Gyllensten H. Healthcare costs of adverse drug reactions and potentially inappropriate prescribing in older adults: a population-based study. BMJ Open 2022; 12:e062589. [PMID: 36153031 PMCID: PMC9511550 DOI: 10.1136/bmjopen-2022-062589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To describe the distribution of costs based on potentially inappropriate prescribing (PIP) and adverse drug reaction (ADR) status in terms of total direct costs and costs caused by ADRs, among older adults. DESIGN A retrospective cohort study was conducted among older adults, identified from a random sample of the general Swedish population. PIP was identified based on the Screening Tool of Older Persons' Prescriptions (STOPP) criteria and ADRs were identified using the Howard criteria. Causality between PIP and ADRs was evaluated using Hallas' criteria. Prevalence-based direct healthcare costs were calculated for the 3-month study period, including the total cost for healthcare and drugs, and the cost caused by ADRs. SETTING All care levels, including primary care, other outpatient care and inpatient care. PARTICIPANTS 813 adults ≥65 years. PRIMARY OUTCOME MEASURES The prevalence and cost of PIP and ADRs. RESULTS Total direct cost for persons with PIP was approximately twice the total cost of those without PIP (€1958 (€1428-€2616) vs €881 (€817-€1167), p=0.0020). The costs caused by ADRs was 10 times higher among persons with PIP, compared with those without PIP (€270 (€86-€545) vs €27 (€10-€61), p=0.047). For persons with ADRs caused by PIP, total direct costs were €4646 (€2617-€7931). This group represented 8% of the study population and used 25% of the costs. The main cost driver in all studied patient groups was healthcare contacts. CONCLUSIONS Older persons with PIP and ADRs had high healthcare costs, particularly when ADRs were caused by PIP. Since these costs appear to be substantial, the potential savings by preventing their occurrence may, to a certain degree, cover the added cost of such activities. Further studies should be undertaken to provide further evidence on the costs of PIP, ADRs and ADRs caused by PIP.
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Affiliation(s)
| | - Khedidja Hedna
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Goteborg, Sweden
- Statistikkonsulterna AB, Gothenburg, Sweden
| | - Katja M Hakkarainen
- Global Database Studies (GloDaSt), IQVIA, Mölndal, Sweden
- Epidemiology & Real-World Science, RWE Scientific Affairs, Parexel International, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
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13
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Plácido AI, Aguiar A, Piñeiro-Lamas M, Varallo F, Figueiras A, Herdeiro MT, Roque F. Assessment of Potentially Inappropriate Medications Using the EU (7)-PIM List, in a Sample of Portuguese Older Adults' Residents in Nursing Homes. Risk Manag Healthc Policy 2022; 15:1343-1352. [PMID: 35860675 PMCID: PMC9289568 DOI: 10.2147/rmhp.s346300] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Abstract Prescription of potentially inappropriate medication (PIM) in older adults is associated with poor clinical outcomes. The EU (7)-PIM list was created for the European market to improve pharmacotherapy in older adults. Purpose This work aims to characterize the medication profile and assess the presence of PIM, using the EU (7)-PIM list in older adults’ residents at nursing homes. Methods Retrospective data were collected from the anonymized nursing home records. After PIM identification, a descriptive analysis was performed, and a generalized linear model for dependent negative binomial-type variables was constructed to assess the risk of PIM. Results Of the 210 participants (mean age 85.10), 82.40% were polymedicated. PIM was observed in 86.4% participants (mean per patient = 2.30± 0.10). The most common PIM were proton pump inhibitors (n = 121, 57.62%), followed by anxiolytics (n = 96, 45.71%). 64.30% of all patients take 2–4 PIM and 5.80% take five or more PIM. The occurrence of PIM is influenced by the number of prescribed medicines (RR 1.14; 95% CI 1.1.-1.17) and the presence of digestive system diseases (RR 1.05; 95% CI 1.0–1.09). Conclusion The high prevalence of PIM observations highlights the necessity of the implementation of guidelines to prevent PIM.
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Affiliation(s)
- Ana Isabel Plácido
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Guarda, Portugal
| | - Ana Aguiar
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Guarda, Portugal
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.,Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Fabiana Varallo
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.,Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED-UA), Department of Medical Sciences, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Guarda, Portugal.,Health Sciences Research Centre, University of Beira Interior (CICS-UBI) Covilhã, Covilhã, Portugal
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14
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Kwon J, Squires H, Franklin M, Young T. Systematic review and critical methodological appraisal of community-based falls prevention economic models. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:33. [PMID: 35842721 PMCID: PMC9287934 DOI: 10.1186/s12962-022-00367-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Falls impose significant health and economic burdens on community-dwelling older persons. Decision modelling can inform commissioning of alternative falls prevention strategies. Several methodological challenges arise when modelling public health interventions including community-based falls prevention. This study aims to conduct a systematic review (SR) to: systematically identify community-based falls prevention economic models; synthesise and critically appraise how the models handled key methodological challenges associated with public health modelling; and suggest areas for further methodological research. METHODS The SR followed the 2021 PRISMA reporting guideline and covered the period 2003-2020 and 12 academic databases and grey literature. The extracted methodological features of included models were synthesised by their relevance to the following challenges: (1) capturing non-health outcomes and societal intervention costs; (2) considering heterogeneity and dynamic complexity; (3) considering theories of human behaviour and implementation; and (4) considering equity issues. The critical appraisal assessed the prevalence of each feature across models, then appraised the methods used to incorporate the feature. The methodological strengths and limitations stated by the modellers were used as indicators of desirable modelling practice and scope for improvement, respectively. The methods were also compared against those suggested in the broader empirical and methodological literature. Areas of further methodological research were suggested based on appraisal results. RESULTS 46 models were identified. Comprehensive incorporation of non-health outcomes and societal intervention costs was infrequent. The assessments of heterogeneity and dynamic complexity were limited; subgroup delineation was confined primarily to demographics and binary disease/physical status. Few models incorporated heterogeneity in intervention implementation level, efficacy and cost. Few dynamic variables other than age and falls history were incorporated to characterise the trajectories of falls risk and general health/frailty. Intervention sustainability was frequently based on assumptions; few models estimated the economic/health returns from improved implementation. Seven models incorporated ethnicity- and severity-based subgroups but did not estimate the equity-efficiency trade-offs. Sixteen methodological research suggestions were made. CONCLUSION Existing community-based falls prevention models contain methodological limitations spanning four challenge areas relevant for public health modelling. There is scope for further methodological research to inform the development of falls prevention and other public health models.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England UK
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England UK
| | - Matthew Franklin
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England UK
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15
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de Juan-Roldán JI, Castillo-Jimena M, González-Hevilla A, Sánchez-Sánchez C, García-Ruiz AJ, Gavilán-Moral E. Cross-cultural adaptation and psychometric validation of a Spanish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. BMJ Open 2022; 12:e050678. [PMID: 35450888 PMCID: PMC9024262 DOI: 10.1136/bmjopen-2021-050678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Successful deprescribing depends largely on factors related to the patient. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed with the objective of evaluating the beliefs and attitudes of older adults and caregivers towards deprescribing. The present study was designed to validate a Spanish version of the rPATD questionnaire, both the versions for older adults and for caregivers, through a qualitative validation phase and the analysis of its psychometric properties. DESIGN Cross-sectional validation study. SETTING Primary care settings in Málaga (Spain). PARTICIPANTS A sample of 120 subjects (60 patients with polypharmacy and 60 caregivers of patients with polypharmacy) were enrolled in the study. MAIN OUTCOME MEASURES In the qualitative validation stage, the rPATD questionnaire was translated/back-translated and subjected to a cross-cultural adaptation to evaluate its face validity and feasibility. Next, its psychometric properties were assessed. Confirmatory factor analysis was used to evaluate construct validity. Internal consistency was determined using Cronbach's alpha test. Criterion validity through pre-established hypotheses from the Beliefs about Medicines Questionnaire (BMQ) Specific-Concerns Scale, and test-retest reliability were analysed. RESULTS Confirmatory factor analysis verified the four-factor structure of the original rPATD questionnaire, with items loading into four factors: involvement, burden, appropriateness and concerns about stopping. The Cronbach's alpha coefficient of the factors ranged from 0.683 to 0.879. The burden, appropriateness and concerns about stopping factors were significantly correlated with the BMQ Specific-Concerns Score, except for the concerns about stopping factor in the older adults' version. The consistency of the items between administration times (test-retest reliability) showed weighted Cohen's kappa values ranging from moderate (>0.4) to very good (>0.8). CONCLUSIONS The Spanish version of the rPATD questionnaire is a feasible, valid and reliable instrument to evaluate attitudes towards deprescribing in Spanish-speaking patients and caregivers.
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Affiliation(s)
- Jose Ignacio de Juan-Roldán
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
- Laboratory of Innovative Practices in Polymedication and Health, Plasencia, Cáceres, Spain
- Centro de Emergencias Sanitarias 061, Málaga, Andalusia, Spain
| | - Marcos Castillo-Jimena
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
- Group C-08: Multiprofesional Teaching Unit of Community and Family Care, Health District Málaga-Guadalhorce, Biomedical Research Institute of Málaga -IBIMA-, Málaga, Spain
- Primary Care Health Centre Campillos, Northern Málaga Integrated Healthcare Area, Andalusian Health Service, Campillos, Málaga, Spain
| | - Alba González-Hevilla
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
- Group C-08: Multiprofesional Teaching Unit of Community and Family Care, Health District Málaga-Guadalhorce, Biomedical Research Institute of Málaga -IBIMA-, Málaga, Spain
| | | | - Antonio J García-Ruiz
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
| | - Enrique Gavilán-Moral
- Laboratory of Innovative Practices in Polymedication and Health, Plasencia, Cáceres, Spain
- Primary Care Health Office Mirabel, Extremadura Health Service, Cáceres, Spain
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16
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Salari P, O’Mahony C, Henrard S, Welsing P, Bhadhuri A, Schur N, Roumet M, Beglinger S, Beck T, Jungo KT, Byrne S, Hossmann S, Knol W, O’Mahony D, Spinewine A, Rodondi N, Schwenkglenks M. Cost-effectiveness of a structured medication review approach for multimorbid older adults: Within-trial analysis of the OPERAM study. PLoS One 2022; 17:e0265507. [PMID: 35404990 PMCID: PMC9000111 DOI: 10.1371/journal.pone.0265507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Inappropriate polypharmacy has been linked with adverse outcomes in older, multimorbid adults. OPERAM is a European cluster-randomized trial aimed at testing the effect of a structured pharmacotherapy optimization intervention on preventable drug-related hospital admissions in multimorbid adults with polypharmacy aged 70 years or older. Clinical results of the trial showed a pattern of reduced drug-related hospital admissions, but without statistical significance. In this study we assessed the cost-effectiveness of the pharmacotherapy optimisation intervention. Methods We performed a pre-planned within-trial cost-effectiveness analysis (CEA) of the OPERAM intervention, from a healthcare system perspective. All data were collected within the trial apart from unit costs. QALYs were computed by applying the crosswalk German valuation algorithm to EQ-5D-5L-based quality of life data. Considering the clustered structure of the data and between-country heterogeneity, we applied Generalized Structural Equation Models (GSEMs) on a multiple imputed sample to estimate costs and QALYs. We also performed analyses by country and subgroup analyses by patient and morbidity characteristics. Results Trial-wide, the intervention was numerically dominant, with a potential cost-saving of CHF 3’588 (95% confidence interval (CI): -7’716; 540) and gain of 0.025 QALYs (CI: -0.002; 0.052) per patient. Robustness analyses confirmed the validity of the GSEM model. Subgroup analyses suggested stronger effects in people at higher risk. Conclusion We observed a pattern towards dominance, potentially resulting from an accumulation of multiple small positive intervention effects. Our methodological approaches may inform other CEAs of multi-country, cluster-randomized trials facing presence of missing values and heterogeneity between centres/countries.
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Affiliation(s)
- Paola Salari
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- * E-mail:
| | - Cian O’Mahony
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork University Hospital, Cork, Ireland
| | - Séverine Henrard
- Louvain Drug Research Institute, Clinical Pharmacy Research Group, UCLouvain, Brussels, Belgium
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - Paco Welsing
- Division of Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arjun Bhadhuri
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Nadine Schur
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Marie Roumet
- Clinical Trial Unit Bern, University of Bern, Bern, Switzerland
| | - Shanthi Beglinger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Thomas Beck
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork University Hospital, Cork, Ireland
| | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O’Mahony
- Department of Medicine (Geriatrics), University College Cork, Cork University Hospital, Cork, Ireland
| | - Anne Spinewine
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Pharmacy Department, CHU UCL Namur, Yvoir, Belgium
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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17
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Kwon J, Squires H, Franklin M, Lee Y, Young T. Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations. BMC Health Serv Res 2022; 22:316. [PMID: 35255898 PMCID: PMC8902781 DOI: 10.1186/s12913-022-07647-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Falls impose significant health and economic burdens among older populations, making their prevention a priority. Health economic models can inform whether the falls prevention intervention represents a cost-effective use of resources and/or meet additional objectives such as reducing social inequities of health. This study aims to conduct a systematic review (SR) of community-based falls prevention economic models to: (i) systematically identify such models; (ii) synthesise and critically appraise modelling methods/results; and (iii) formulate methodological and commissioning recommendations. METHODS The SR followed PRISMA 2021 guideline, covering the period 2003-2020, 12 academic databases and grey literature. A study was included if it: targeted community-dwelling persons aged 60 and over and/or aged 50-59 at high falls risk; evaluated intervention(s) designed to reduce falls or fall-related injuries; against any comparator(s); reported outcomes of economic evaluation; used decision modelling; and had English full text. Extracted data fields were grouped by: (A) model and evaluation overview; (B) falls epidemiology features; (C) falls prevention intervention features; and (D) evaluation methods and outcomes. A checklist for falls prevention economic evaluations was used to assess reporting/methodological quality. Extracted fields were narratively synthesised and critically appraised to inform methodological and commissioning recommendations. The SR protocol is registered in the Prospective Register of Systematic Reviews (CRD42021232147). RESULTS Forty-six models were identified. The most prevalent issue according to the checklist was non-incorporation of all-cause care costs. Based on general population, lifetime models conducting cost-utility analyses, seven interventions produced favourable ICERs relative to no intervention under the cost-effectiveness threshold of US$41,900 (£30,000) per QALY gained; of these, results for (1) combined multifactorial and environmental intervention, (2) physical activity promotion for women, and (3) targeted vitamin D supplementation were from validated models. Decision-makers should explore the transferability and reaches of interventions in their local settings. There was some evidence that exercise and home modification exacerbate existing social inequities of health. Sixteen methodological recommendations were formulated. CONCLUSION There is significant methodological heterogeneity across falls prevention models. This SR's appraisals of modelling methods should facilitate the conceptualisation of future falls prevention models. Its synthesis of evaluation outcomes, though limited to published evidence, could inform commissioning.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
| | - Matthew Franklin
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
| | - Yujin Lee
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL England
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
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18
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Anand P, Katyal J, Dey AB, Gupta YK. Characterization of potentially inappropriate medications use in Indian elderly population and their impact on quality of life using Beers criteria. Aging Med (Milton) 2022; 5:45-52. [PMID: 35309155 PMCID: PMC8917262 DOI: 10.1002/agm2.12194] [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: 10/25/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Polypharmacy is principal cause of potentially inappropriate medications (PIMs) in elderly patients, which include over prescribing, under prescribing, and misprescribing. Methods Elderly subjects (≥60 years), of either sex, receiving two or more medications for one or more chronic ailments, attending Geriatrics Outpatient Department (OPD), at All India Institute of Medical Sciences (AIIMS) New Delhi, were included. Their prescriptions were assessed for PIMs by using Beers criteria 2015 and were further followed up at least once in 6 months for adverse events, telephonically. The results were analyzed by using suitable regression models and correlation analysis. Results Three hundred eighty patients average age of 65.4 ± 4.7 years were enrolled. Eighty-eight percent of the people were having greater than or equal to two ailments. Each patient was prescribed 6.7 ± 2.1 medications with 65% of prescriptions having one or more PIMs. Out of the total prescribed drugs, 15% were satisfying Beers criteria for PIMs. There were 63 adverse drug reactions (ADRs) reported. A statistically significant correlation was observed among comorbidities, number of prescribed medications, PIMs, and ADRs. Quality of life (QOL) of the elderly patients was negatively corelated with polypharmacy and female sex. Conclusion A risk-benefit analysis of prescribed medications is part and parcel of prescribing, especially in elderly patients. In order to decrease further risks associated with inappropriate prescribing, there is need for indigenous guidelines and intensive training.
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Affiliation(s)
- Pooja Anand
- Department of PharmacologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Jatinder Katyal
- Department of PharmacologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Aparajit Ballav Dey
- Department of Geriatric MedicineAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
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19
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Romano S, Figueira D, Teixeira I, Perelman J. Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations. PHARMACOECONOMICS 2022; 40:269-295. [PMID: 34913143 DOI: 10.1007/s40273-021-01120-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain. OBJECTIVE This study seeks to identify and synthetise the economic evidence of deprescribing interventions among community-dwelling older adults. METHODS Full economic evaluation studies of deprescribing interventions, conducted in the community or primary care settings, in community-dwelling adults aged ≥ 65 years were systematically reviewed. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. The main outcome was the economic impact of the intervention from any perspective, converted into 2019 US Dollars. The World Health Organization threshold of 1 gross domestic product per capita was used to define cost effectiveness. Studies were appraised for methodological quality using the extended Consensus on Health Economics Criteria checklist. RESULTS Of 6154 articles identified by the search strategy, 14 papers assessing 13 different interventions were included. Most deprescribing interventions included some type of medication review with or without a supportive educational component (n = 11, 85%), and in general were delivered within a pharmacist-physician care collaboration. Settings included community pharmacies, primary care/outpatient clinics and patients' homes. All economic evaluations were conducted within a time horizon varying from 2 to 12 months with outcomes in most of the studies derived from a single clinical trial. Main health outcomes were reported in terms of quality-adjusted life-years, prevented number of falls and the medication appropriateness index. Cost effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932 per quality-adjusted life-year, a value above the country's World Health Organization threshold. Overall, 85% of the interventions were cost saving, dominated usual care or were cost effective considering 1 gross domestic product per capita. Nine studies scored > 80% (good) and two scored ≤ 50% (low) on critical quality appraisal. CONCLUSIONS There is a growing interest in economic evaluations of deprescribing interventions focused on community-dwelling older adults. Although results varied across setting, time horizon and intervention, most were cost effective according to the World Health Organization threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.
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Affiliation(s)
- Sónia Romano
- Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal.
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Débora Figueira
- Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Lisbon, Portugal
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20
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Roux B, Bezin J, Morival C, Noize P, Laroche ML. Prevalence and direct costs of potentially inappropriate prescriptions in France: a population-based study. Expert Rev Pharmacoecon Outcomes Res 2021; 22:627-636. [PMID: 34525899 DOI: 10.1080/14737167.2021.1981863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Potentially inappropriate prescriptions (PIPs) in the older population remain a growing public health concern due to the many associated adverse events increasing healthcare service use and health costs. This study aimed to assess the prevalence and direct costs of PIPs in older adults aged ≥65 years in France. METHODS A population-based cross-sectional study was conducted in 2017 using a representative sample of the French national healthcare reimbursement system database. PIPs were defined using the French REMEDI[e]S tool. Overall reimbursed direct costs and by PIP category were extrapolated to the French older population. RESULTS The overall PIP prevalence was estimated at 56.7% (95% CI: 56.4-57.0). Medications with an unfavorable benefit/risk ratio had the highest prevalence (34.0%, 95% CI: 33.7-34.3). Direct costs associated with PIPs represented 6.3% of the total reimbursed medication costs in 2017 (€507 million). Drug duplications were the main contributors to these costs (39.2% of the total reimbursed PIP costs, €199 million) and among all PIPs, proton pump inhibitors (>8 weeks) were the most expensive PIPs (€152 million). CONCLUSIONS PIP prevalence is still high among French older adults, with substantial direct costs. Large-scale interventions targeting the most prevalent and/or costly PIPs are needed to reduce their clinical and economic impacts.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France
| | - Julien Bezin
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1219, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France
| | - Camille Morival
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1219, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France
| | - Pernelle Noize
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1219, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.,Laboratoire Vie-Santé (Vieillissement Fragilité Prévention, e-Santé), IFR GEIST, Université de Limoges, Limoges, France
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21
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Khowaja AR, Krause C, Kennedy C, Ridout B, Carriere S, Mitton C. Cost-effectiveness of a Province-wide Quality Improvement Initiative for Reducing Potentially Inappropriate Use of Antipsychotics in Long-Term Care in British Columbia, Canada. PHARMACOECONOMICS - OPEN 2021; 5:491-504. [PMID: 33914292 PMCID: PMC8333184 DOI: 10.1007/s41669-021-00267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Potentially inappropriate use of antipsychotics (PIUA) raises serious concerns about safety, quality, and cost of care for residents in long-term care (LTC). OBJECTIVE This study aimed to estimate the cost-effectiveness of the Call for Less Antipsychotics in Long-Term Care (Clear) initiative compared with the status quo (pre-Clear, baseline). METHODS A model-based cost-utility analysis, from a public-payer perspective in British Columbia, was conducted using secondary data of residents in LTC homes from 2013 to 2019. Residents' health resource utilization and quality-adjusted life-year (QALY) measures were extracted from multiple administrative databases. Six Markov states were modelled for post-antipsychotic progression representing PIUA, appropriate use of antipsychotic, complete withdrawal, and death. The primary outcome was the incremental cost per QALY gained. RESULTS A cohort of 35,669 residents was included in the primary analysis. The Clear initiative, over 10 years, was estimated to have an incremental cost-effectiveness ratio (ICER) of CA$26,055 (2020 Canadian dollars) per QALY gained at an incremental cost of CA$5211 per resident and a QALY gain of 0.20. In the subgroup analyses, our findings were even more favourable for Clear wave 2 (ICER of CA$24,447 per QALY gained) and Clear wave 3 (ICER of CA$25,933 per QALY gained). At a willingness-to-pay of CA$50,000 per QALY gained, the probabilities of Clear waves 2 and 3 were 82% cost-effective. CONCLUSION This study demonstrated incremental costs and yielded favourable ICERs for Clear compared with the baseline. More research is needed to understand the level of support for individual care homes to sustain the Clear initiative in the long run.
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Affiliation(s)
- Asif Raza Khowaja
- Department of Health Sciences at Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
| | - Christina Krause
- BC Patient Safety & Quality Council and School of Population & Public Health, Faculty of Medicine at the University of British Columbia, Vancouver, Canada
| | - Colleen Kennedy
- Health System improvement, BC Patient Safety & Quality Council, Vancouver, Canada
| | - Ben Ridout
- Analytics and Strategic Initiatives, BC Patient Safety & Quality Council, Vancouver, Canada
| | - Sarah Carriere
- Health Systems Improvement, BC Patient Safety & Quality Council, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health; and Senior Scientist at the Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
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22
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Laberge M, Sirois C, Lunghi C, Gaudreault M, Nakamura Y, Bolduc C, Laroche ML. Economic Evaluations of Interventions to Optimize Medication Use in Older Adults with Polypharmacy and Multimorbidity: A Systematic Review. Clin Interv Aging 2021; 16:767-779. [PMID: 33981140 PMCID: PMC8108125 DOI: 10.2147/cia.s304074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy. Methods We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs. Results Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability. Conclusion Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients.
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Affiliation(s)
- Maude Laberge
- Department of Operations & Decision Systems, Faculty of Administration, Université Laval, Quebec City, Quebec, Canada.,Vitam, Centre de recherche en santé durable-Université Laval, Quebec, Canada.,Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Caroline Sirois
- Vitam, Centre de recherche en santé durable-Université Laval, Quebec, Canada.,Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.,Institut National de santé publique du Québec, Quebec City, Quebec, Canada
| | - Carlotta Lunghi
- Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada.,Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Myriam Gaudreault
- Faculty of Administration, Université Laval, Quebec City, Quebec, Canada
| | - Yumiko Nakamura
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carolann Bolduc
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | - Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur les médicaments, Service de Pharmacologie, Toxicologie et Pharmacovigilance, CHU de Limoges, Limoges, France.,Laboratoire Vie-Santé, Faculté de Médecine, Université de Limoges, Limoges, France
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23
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Roux B, Sirois C, Simard M, Gagnon ME, Laroche ML. Reply to Potentially inappropriate medication use in older adults: a reply to Amorim et al. Fam Pract 2021; 38:191-192. [PMID: 32954423 DOI: 10.1093/fampra/cmaa098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, IPPRITT, Faculty of Medicine, University of Limoges, Limoges, France
| | - Caroline Sirois
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,Centre of Excellence on Aging of Quebec, Integrated University Health and Social Services Centres of the Capitale-Nationale, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Integrated University Health and Social Services Centres of the Capitale-Nationale, Québec, Canada
| | - Marc Simard
- Office of Information and Studies in Population Health, Quebec National Institute of Public Health, Quebec, Canada
| | - Marie-Eve Gagnon
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,Office of Information and Studies in Population Health, Quebec National Institute of Public Health, Quebec, Canada
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, IPPRITT, Faculty of Medicine, University of Limoges, Limoges, France
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24
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Gervais F, Dauphinot V, Mouchoux C, Krolak-Salmon P. Exposure to Anticholinergic and Sedative Drugs and Healthcare Costs in Older Patients with Neurocognitive Disorders. J Alzheimers Dis 2021; 80:1515-1524. [PMID: 33720884 DOI: 10.3233/jad-201127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Literature supports an increasing number of older patients living with neurocognitive disorders alongside with their annual worldwide costs. Therapeutic management of behavioral and psychological symptoms includes the use of anticholinergic and sedative drugs for which significant exposure is negatively associated with clinical outcomes. OBJECTIVE The aim of this study was to assess the healthcare costs differences related to an increase in the exposure to anticholinergic and sedative drugs in older patients with neurocognitive disorder. METHODS A longitudinal study was conducted during 3 years on 1,604 participants of the MEMORA cohort linked with both regional public health insurance and hospital discharge databases between 2012 and 2017. Direct medical and non-medical costs were included. Exposure to anticholinergic and sedative drugs was measured by the drug burden index (DBI). RESULTS Costs difference associated with a DBI≥0.5 were + 338€ (p < 0.001). After adjustment on comorbidities, NCD stage, cognitive impairment, functional limitation, polypharmacy, and sociodemographic characteristics, a DBI≥0.5 was found to be an independent predictor of an increase of total healthcare costs by 22%(p < 0.001). CONCLUSION Anticholinergic and sedative drugs have a substantial economic burden among older patients with neurocognitive disorder. More studies are required to assess the clinical and economic impact of an efficient strategy based on the reduction of the exposure to anticholinergic and sedative drugs and the promotion of non-pharmacological interventions.
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Affiliation(s)
- Frederic Gervais
- Pharmacie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Virginie Dauphinot
- Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Pharmacie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France.,Research Clinic Centre (CRC)eVCF (Aging Brain Frailty), Lyon Institute For Elderly, Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS, Research Centre of Neurosciences of Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France.,Research Clinic Centre (CRC)eVCF (Aging Brain Frailty), Lyon Institute For Elderly, Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS, Research Centre of Neurosciences of Lyon, Lyon, France
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25
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Mangoni AA, Jarmuzewska EA. Incorporating pharmacokinetic data into personalised prescribing for older people: challenges and opportunities. Eur Geriatr Med 2021; 12:435-442. [PMID: 33417165 DOI: 10.1007/s41999-020-00437-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE We discuss the known age-associated changes in drug metabolism and elimination, the potential use of this information when selecting specific therapeutic strategies in older patients, and the steps required to fill the knowledge gap in this field. METHODS We conducted a narrative review that encapsulates the current knowledge regarding the main age-associated changes in drug metabolism and elimination and discusses their possible inclusion in current and future personalised prescribing tools for the older patient population. RESULTS Despite some progress in this field, the lack of specific information regarding the impact of frailty, pharmacogenomics, and drug-drug, drug-disease, and organ-organ interactions, particularly in subjects > 80 years, currently prevents the routine incorporation of pharmacokinetic data, barring measures of renal function, into personalised prescribing tools. CONCLUSIONS The incorporation of pharmacokinetic data into personalised prescribing, an approach based on the consideration of a number of patient's characteristics when selecting the right drug(s) and dose regimen(s) to maximize effectiveness and limit toxicity, remains a hypothetical construct in geriatric care. Pending the inclusion of frail and complex older patients in pre- and post-marketing studies, a better understanding of the key pharmacokinetic alterations of common medications in "real-life" patients, together with the implementation of effective strategies tackling inappropriate prescribing, is likely to improve clinical outcomes and reduce healthcare utilization in the older population.
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Affiliation(s)
- Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia. .,Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Elzbieta A Jarmuzewska
- Department of Internal Medicine, Polyclinic IRCCS, Ospedale Maggiore, University of Milan, Milan, Italy
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26
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Jalal Z, Cheema E, Hadi MA, Sharma P, Stewart D, Al Hamid A, Haque MS, Moore PV, Paudyal V. Pharmacists providing prescribing advice and education to healthcare professionals in community, primary care and outpatient settings. Hippokratia 2020. [DOI: 10.1002/14651858.cd013793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Zahraa Jalal
- School of Pharmacy; University of Birmingham; Birmingham UK
| | - Ejaz Cheema
- Department of Pharmacy Practice; University of Birmingham; Birmingham UK
| | | | - Pawana Sharma
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Derek Stewart
- Qatar University Health College of Pharmacy; Qatar University; Doha Qatar
| | - Abdullah Al Hamid
- Pharmacy; General Directorate of Health Affairs; Najran Saudi Arabia
| | - Mohammed S Haque
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Patrick V Moore
- Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Vibhu Paudyal
- School of Pharmacy; University of Birmingham; Birmingham UK
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27
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Saastamoinen L, Verho J. Regional variation in potentially inappropriate medicine use in older adults. - A national register-based cross-sectional study on economic, health system-related and patient-related characteristics. Res Social Adm Pharm 2020; 17:1223-1227. [PMID: 33071213 DOI: 10.1016/j.sapharm.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Potentially inappropriate medicines (PIM), i.e. medicines in which the potential harms may outweigh the benefits, use may be associated with e.g. hospitalization, outpatient visits and health care costs. As regional institutions are often responsible for financing pharmaceuticals, understanding the regional variation of PIM use could help to tackle the associated problems and costs. OBJECTIVE To explore regional variation in PIM use among older adults and the association with regional health-system related, patient-related and economic characteristics and the frequency of PIM use. METHODS This is a nation-wide study based on the Finnish Prescription Register. PIM use was defined according to the Finnish Meds75+ database and regional characteristics derived from national statistics. RESULTS Variation at the hospital district level was large, with the largest difference between the most and least PIM prescribing being 45.2%. The factors associated with high PIM prescribing were a higher share of women and a higher number of private doctor visits per inhabitant in a municipality. The factor associated to lower PIM prescribing was a higher share of Swedish-speaking population. The studied factors explained 23% of the municipal-level variation in PIM. CONCLUSIONS Large regional differences may lead to regional inequality in prescribing and in the distribution of pharmaceutical costs. As only a small share of the variation was explained by economic, health system-related and patient-related factors, the key reasons may lie in unobserved prescribing practices.
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Affiliation(s)
- Leena Saastamoinen
- Research Unit, The Social Insurance Institution of Finland, PO Box 450, 00056, Kela, Helsinki, Finland.
| | - Jouko Verho
- VATT Institute for Economic Research, Arkadiankatu 7, Helsinki, 00100, Finland.
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28
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Turner JP, Sanyal C, Martin P, Tannenbaum C. Economic Evaluation of Sedative Deprescribing in Older Adults by Community Pharmacists. J Gerontol A Biol Sci Med Sci 2020; 76:1061-1067. [DOI: 10.1093/gerona/glaa180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Sedative use in older adults increases the risk of falls, fractures, and hospitalizations. The D-PRESCRIBE (Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly), pragmatic randomized clinical trial demonstrated that community-based, pharmacist-led education delivered simultaneously to older adults and their primary care providers reduce the use of sedatives by 43% over 6 months. However, the associated health benefits and cost savings have yet to be described. This study evaluates the cost-effectiveness of the D-PRESCRIBE intervention compared to usual care for reducing the use of potentially inappropriate sedatives among older adults.
Methods
A cost-utility analysis from the public health care perspective of Canada estimated the costs and quality-adjusted life-years (QALYs) associated with the D-PRESCRIBE intervention compared to usual care over a 1-year time horizon. Transition probabilities, intervention effectiveness, utility, and costs were derived from the literature. Probabilistic analyses were performed using a decision tree and Markov model to estimate the incremental cost-effectiveness ratio.
Results
Compared to usual care, pharmacist-led deprescribing is less costly (−$1392.05 CAD) and more effective (0.0769 QALYs). Using common willingness-to-pay (WTP) thresholds of $50 000 and $100 000, D-PRESCRIBE was the optimal strategy. Scenario analysis indicated the cost-effectiveness of D-PRESCRIBE is sensitive to the rate of deprescribing.
Conclusions
Community pharmacist-led deprescribing of sedatives is cost-effective, leading to greater quality-of-life and harm reduction among older adults. As the pharmacist’s scope of practice expands, consideration should be given to interprofessional models of remuneration for quality prescribing and deprescribing services.
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Affiliation(s)
- Justin P Turner
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | | | - Philippe Martin
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | - Cara Tannenbaum
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Québec, Canada
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29
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Sanyal C, Turner JP, Martin P, Tannenbaum C. Cost‐Effectiveness of Pharmacist‐Led Deprescribing of
NSAIDs
in Community‐Dwelling Older Adults. J Am Geriatr Soc 2020; 68:1090-1097. [DOI: 10.1111/jgs.16388] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Justin P. Turner
- Faculty of PharmacyUniversité de Montréal Montréal Québec Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal Montréal Québec Canada
| | - Philippe Martin
- Faculty of PharmacyUniversité de Montréal Montréal Québec Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal Montréal Québec Canada
| | - Cara Tannenbaum
- Faculty of PharmacyUniversité de Montréal Montréal Québec Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal Montréal Québec Canada
- Faculty of MedicineUniversité de Montréal Montréal Québec Canada
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Jankyova S, Rubintova D, Foltanova T. The analysis of the use of potentially inappropriate medications in elderly in the Slovak Republic. Int J Clin Pharm 2019; 42:100-109. [PMID: 31820202 DOI: 10.1007/s11096-019-00944-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022]
Abstract
Background The prevalence of potentially inappropriate medications (PIM) using explicit criteria has been well documented in European countries, however, there is a lack of evidence in the Slovak Republic. There are no specific guidelines and there is a lack of geriatricians in Slovakia. Higher use of PIM leads to greater healthcare services use as well as increases healthcare costs. Objective The aim of this study was to perform an evaluation of the availability and the actual use of PIM by geriatric patients in the nursing homes in Slovakia. Setting Together 459 residents ≥ 65 years living in nursing homes in the Slovak Republic were included for analysis of their drug therapy. Methods Retrospective analysis of medical records of patients' therapy for evaluation of PIM use. Identification of PIM was based on the Renom-Guiteras EU7 PIM list published in 2015. Main outcome measure Potentially inappropriate medications use. The presence of polypharmacy in patients. Results Inappropriate drug use according to EU7 PIM list was identified in 90.60% (416) patients. The mean number of PIM was 2.34 ± 0.07 PIM/patient/day. Polypharmacy (use of ≥ 5 drugs by patient daily) was found in 83% of all patients. The mean number of prescribed drugs was 8.32 ± 0.17 drugs/patient/day. Out of all 282 PIM listed in EU7 PIM list, there are 150 (53.19%) available on the Slovak market and 86 (30.50%) were used in patients. Patients using at least one PIM took two times more drugs compared to patients without PIM (8.77 ± 0.17 vs. 3.98 ± 0.39 drugs/patient/day, p < 0.001). The most common PIM were PPI (36% of patients), piracetam (17.2%) and alprazolam (16.80%). Conclusions The risk of PIM was almost 9.5 times higher if polypharmacy was present in geriatric patients (OR 9.51, 95% CI, 4.86 - 18.61, p < 0.001). There was a strong, positive correlation (ρ = 0.65) between the number of drugs and the number of PIM (p < 0.01). There was neither association between age/gender of patient and polypharmacy; nor age/gender of patient and presence of PIM. The lack of geriatricians and national guidelines for inappropriate prescribing results in alarmingly high use of PIM in the Slovak Republic.
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Affiliation(s)
- Stanislava Jankyova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, Bratislava, 832 32, Slovak Republic
| | - Dominika Rubintova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, Bratislava, 832 32, Slovak Republic
| | - Tatiana Foltanova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, Bratislava, 832 32, Slovak Republic.
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Moriarty F, Bennett K, Kenny RA, Fahey T, Cahir C. Comparing Potentially Inappropriate Prescribing Tools and Their Association With Patient Outcomes. J Am Geriatr Soc 2019; 68:526-534. [PMID: 31675114 DOI: 10.1111/jgs.16239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the agreement of several different measures of potentially inappropriate prescribing (PIP) in older people and compare their relationship with patient-reported outcomes. DESIGN Prospective cohort study including participants in The Irish Longitudinal Study on Ageing (TILDA). SETTING Waves 1 and 2 of TILDA, a nationally representative aging cohort study. PARTICIPANTS A total of 1753 community-dwelling TILDA participants with linked administrative pharmacy claims data on medications. MEASUREMENTS Potentially inappropriate medications were assessed using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) v1, American Geriatrics Society (AGS) Beers Criteria® 2012, and relevant Assessing Care of Vulnerable Elders (ACOVE) v3 indicators. Potential prescribing omissions were assessed using the Screening Tool to Alert Doctors to the Right Treatment (START) v1 and ACOVE v3 indicators. Their agreement was assessed via κ statistics, and multivariate regression was used to assess relationships with emergency department visits, general practitioner (GP) visits, quality of life, and functional decline (increased assistance needed for activities of daily living). RESULTS There was slight agreement between STOPP and AGS Beers Criteria® (κ = 0.20) and ACOVE indicators (κ = 0.15), while agreement between AGS Beers Criteria® and ACOVE indicators was fair (κ = 0.31). Agreement was fair between START and ACOVE indicators (κ = 0.34). All measures of inappropriate medications were significantly associated with increased GP visits. Only exposure to two or more START indicators was associated with reduced quality of life (adjusted mean difference = -1.12; 95% confidence interval [CI] = -1.92 to -0.33), and only two or more AGS Beers Criteria® were associated with functional decline (adjusted odds ratio = 2.11; 95% CI = 1.37-3.28). For omissions, both measures were associated with functional decline, but only ACOVE indicators were associated with increased GP visits. CONCLUSION Prevalence of PIP and relationships with outcomes can differ substantially between tools with little agreement. Choice of PIP measure for research or practice should be considered in light of the circumstances and requirements in each case. J Am Geriatr Soc 68:526-534, 2020.
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Affiliation(s)
- Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
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Franchi C, Rossio R, Ardoino I, Mannucci PM, Nobili A. Inappropriate prescription of benzodiazepines in acutely hospitalized older patients. Eur Neuropsychopharmacol 2019; 29:871-879. [PMID: 31221501 DOI: 10.1016/j.euroneuro.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
Benzodiazepines (BDZs) are widely prescribed in older people. The aims of the study are to assess the prevalence of inappropriate prescription of BZDs and the associated factors in acutely hospitalized older patients. Patients aged 65 years or more hospitalized from 2010 to 2017 in more than 100 Italian internal medicine and geriatric wards in the frame of the REPOSI register were included if prescribed with BDZs at hospital admission or discharge. Appropriateness of prescription was assessed according to the 2015 Beers criteria and their modified French and German versions. Among 4681 patients discharged from hospital, 15% (N = 710) were discharged with BDZs, and 62% of them (N = 441, 95% CI: 58.5%-65.6%) were inappropriately prescribed, being prescribed with BDZ to be always avoided in the elderly (45%), at higher doses than recommended (31%) or with no appropriate clinical conditions (19%). From admission to discharge the prevalence of inappropriate BDZ prescription decreased by 4%, but 62% of patients inappropriately prescribed at admission were still inappropriately prescribed at discharge. Among the 179 patients first prescribed at the time of discharge, half were inappropriately prescribed. Being female (OR 1.32, 95%CI 0.95-1.85), enrolled in REPOSI during the years 2016 and 2017 (OR 1.94, 95%CI 1.10-3.39; OR 1.57, 95%CI 0.95-2.58) and living in nursing homes (OR 2.04, 95%CI 0.95-4.37) were associated with an increased risk to be inappropriately prescribed. This study shows a high prevalence of inappropriate use of BDZ in acutely hospitalized older patients both at hospital admission and discharge.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - R Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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