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Gupta A, Laha JK. Growing Utilization of Radical Chemistry in the Synthesis of Pharmaceuticals. CHEM REC 2023; 23:e202300207. [PMID: 37565381 DOI: 10.1002/tcr.202300207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Indexed: 08/12/2023]
Abstract
Our current unhealthy lifestyle and the exponential surge in the population getting affected by a variety of diseases have made pharmaceuticals or drugs an imperative part of life, making the development of innovative strategies for drug discovery or the introduction of refined, cost-effective and modern technologies for the synthesis of clinically used drugs, a need of the hour. Ever since their discovery, free radicals and radical cations or anions as reactive intermediates have captivated the chemists, resulting in an exceptional utilization of these moieties throughout the field of chemical synthesis, owing to their unprecedented and widespread reactivity. Sticking with the idea of not judging the book by its cover, despite the conventional thought process of radicals being unstable and difficult to control entities, scientists and academicians around the globe have done an appreciable amount of work utilizing both persistent as well as transient radicals for a variety of organic transformations, exemplifying them with the synthesis of significant biologically active pharmaceutical ingredients. This review truly accounts for the organic radical transformations including radical addition, radical cascade cyclization, radical/radical cross-coupling, coupling with metal-complexes and radical cations coupling with nucleophiles, that offers fascinating and unconventional approaches towards the construction of intricate structural frameworks of marketed APIs with high atom- and step-economy; complementing the otherwise employed traditional methods. This tutorial review presents a comprehensive package of diverse methods utilized for radical generation, featuring their reactivity to form critical bonds in pharmaceutical total synthesis or in building key starting materials or intermediates of their synthetic journey, acknowledging their excellence, downsides and underlying mechanisms, which are otherwise poorly highlighted in the literature. Despite great achievements over the past few decades in this area, many challenges and obstacles are yet to be unraveled to shorten the distance between the academics and the industry, which are all discussed in summary and outlook.
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Affiliation(s)
- Anjali Gupta
- Department of Pharmaceutical Technology (Process Chemistry), National Institute of Pharmaceutical Education & Research (NIPER) S.A.S. Nagar, Sahibzada Ajit Singh Nagar, Mohali, 160062, India
| | - Joydev K Laha
- Department of Pharmaceutical Technology (Process Chemistry), National Institute of Pharmaceutical Education & Research (NIPER) S.A.S. Nagar, Sahibzada Ajit Singh Nagar, Mohali, 160062, India
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Mill D, Johnson JL, Corre L, Lee K, D'Lima D, Clifford R, Seubert L, Salter SM, Page AT. Use of a reference text by pharmacists, intern pharmacists and pharmacy students: a national cross-sectional survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:548-557. [PMID: 37454279 DOI: 10.1093/ijpp/riad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Reference texts assist pharmacists by addressing knowledge gaps and enabling evidence-based decisions when providing patient care. It is unknown whether reference text utilisation patterns differ between pharmacists, intern pharmacists and pharmacy students. To describe and compare the self-reported use and perceptions of a reference text, namely the national formulary, by pharmacists, intern pharmacists and pharmacy students. METHODS Registered pharmacists, intern pharmacists and pharmacy students living in Australia were surveyed in July 2020. The survey was electronic and self-administered. Questions considered self-reported use of a specific reference text in the preceding 12 months. KEY FINDINGS There were 554 eligible responses out of 774 who commenced the survey: 430 (78%) pharmacists, 45 (8%) intern pharmacists and 79 (14%) pharmacy students. Most participants (529/554, 96%) reported historical use of the text, though pharmacists were significantly less likely than intern pharmacists and students to use it frequently (52/422, 12% versus 16/43, 37% versus 23/76, 30%, P < 0.001). Pharmacists (44%, 177/404) reported using the text as a tool to resolve a situation when providing a service or patient care (177/404, 44%) or as a teaching resource (150/404, 38%). In contrast, intern pharmacists and students most commonly use these to familiarise themselves with the contents (30/43, 70%; 46/76, 61%) or update their knowledge (34/43, 79%; 53/76, 70%). CONCLUSIONS Access and use patterns varied significantly across career stages. A broader understanding of the use of reference texts may help develop interventions to optimise the content and usability. Varying usage patterns across the groups may inform the tailoring of texts for future use.
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Affiliation(s)
- Deanna Mill
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta L Johnson
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lauren Corre
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Kenneth Lee
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Liza Seubert
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sandra M Salter
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Theresa Page
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
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3
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Hemmo SI, Naser AY, Taybeh EO. Hospital Admission Due to Hypotension in Australia and in England and Wales. Healthcare (Basel) 2023; 11:healthcare11091210. [PMID: 37174752 PMCID: PMC10178301 DOI: 10.3390/healthcare11091210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Hypotension is overlooked because it is often harmless, easily reversed, and can have few or even no symptoms. However, complications of untreated hypotension are dangerous and can result in death. The aim of this study was to examine the trend of hospital admission due to hypotension in Australia and in England and Wales between 1999 and 2020. METHOD This was a secular trend analysis study that examined the hospitalisation pattern for hypotension in Australia, England, and Wales between 1999 and 2020. Hospitalisation data were obtained from the National Hospital Morbidity Database in Australia, Hospital Episode Statistics database in England, and Patient Episode Database for Wales. We analysed the variation in hospitalisation rates using the Pearson chi-square test for independence. RESULTS Our study showed that hypotension hospital admission rates increased significantly between 1999 and 2020 by 168%, 398%, and 149% in Australia, England, and Wales, respectively. The most common hypotension hospital admissions reason was orthostatic hypotension. All types of hypotension-related hospital admissions in Australia, England, and Wales were directly related to age, more common among the age group 75 years and above. Bed-days hypotension hospital admission patients accounted for 84.6%, 99.5%, and 99.7% of the total number of hypotension hospital admissions in Australia, England, and Wales. CONCLUSION In the past two decades, orthostatic hypotension was the most prevalent type of hypotension that required hospitalization in Australia, England, and Wales. Age was identified as the primary risk factor for hypotension across all causes. Future research should focus on identifying modifiable risk factors for hypotension and developing strategies to reduce the burden of orthostatic hypotension.
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Affiliation(s)
- Sara Ibrahim Hemmo
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
| | - Esra' O Taybeh
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman 11622, Jordan
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Davidov EL, Yaskevich RA. Pharmacoepidemiological analysis of antihypertensive therapy in older age groups with senile asthenia syndrome. TERAPEVT ARKH 2023; 94:1381-1386. [PMID: 37167182 DOI: 10.26442/00403660.2022.12.201982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
Aim. To conduct a pharmacoepidemiological study to determine the characteristics of antihypertensive therapy in older patients with senile asthenia syndrome (SSA) and compliance of this therapy with modern clinical recommendations.
Materials and methods. The study included 146 patients diagnosed with stage IIII hypertension who underwent inpatient treatment in the therapeutic department of the Krasnoyarsk Regional Hospital for War Veterans, the subjects were divided into two groups. The first group included 55 elderly patients (WHO, 2012) with hypertension and SSA. The second group included 35 elderly patients (WHO, 2012) with hypertension and SSA. The comparison group consisted of 56 patients aged 60 to 84 years with hypertension without SSA. Evaluation of the pharmacotherapy was carried out based on extracts from the medical histories of inpatient patients.
Results. The most commonly taken groups of antihypertensive drugs in patients of older age groups with hypertension and SSA according to the study are diuretics and -blockers. Diuretics were taken by 88.6% of elderly patients and 83.6% of senile patients. The main combinations of antihypertensive drugs in patients with hypertension and SSA were: a two-component scheme of combination of an ACE inhibitor and a diuretic, a three-component scheme of combination of an ACE inhibitor, a -blocker and a diuretic, four-component schemes of combination of an ACE inhibitor, a -blocker, a calcium channel blocker and a diuretic, as well as a combination of an angiotensin II receptor blocker, a -blocker, calcium channel blocker and diuretic with combined medications.
Conclusion. The prescribed antihypertensive therapy in patients of older age groups with hypertension and SSA in most cases is represented by a combination of several drugs. Many patients take three-component antihypertensive therapy regimens. There were no statistically significant differences between patients of older age groups with hypertension and SSA, as well as patients of older age groups with hypertension without SSA. Therefore, it can be concluded that the presence of senile asthenia syndrome does not affect the tactics of treatment of hypertension and regardless of the presence or presence of SSA, patients receive the same hypotensive therapy, which contradicts existing clinical guidelines.
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Hussain A, Ali K, Parekh N, Stevenson JM, Davies JG, Bremner S, Rajkumar C. Characterising older adults' risk of harm from blood-pressure lowering medications: a sub-analysis from the PRIME study. Age Ageing 2022; 51:6555261. [PMID: 35352796 PMCID: PMC8966023 DOI: 10.1093/ageing/afac045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
AIM Cardiovascular disease (CVD) is common amongst frail older people. The evidence base for CVD commonly excludes older adults with multimorbidity or chronic conditions. Most cardiovascular drugs have the potential to lower blood pressure (BP) and therefore cause medication-related harm (MRH). We aimed to identify key clinical and sociodemographic characteristics associated with MRH in older people taking BP-lowering drugs for whatever indication they were prescribed. METHODS The PRIME (prospective study to develop a model to stratify the risk of MRH in hospitalised elderly patients in the UK) study investigating the incidence and cost of MRH in older people across Southern England. Adults ≥65 years were recruited from five teaching hospitals at hospital discharge and followed up for 8 weeks. Telephone interviews with study participants, review of primary care records and hospital readmissions were undertaken to identify MRH. PRIME study participants taking BP-lowering drugs (as defined by National Institute for Health and Care Excellence hypertension guidelines) were included in this analysis. RESULTS One hundred and four (12%) study patients experienced a total of 153 MRH events associated with BP-lowering drugs. Patients on four BP-lowering drugs were five times more likely to experience MRH compared to those taking one medication (OR 4.96; 95%CI 1.63-15.13; P = 0.01). Most MRH events were classified 'serious' (80%, n = 123), requiring dose change or treatment cessation. Almost half of MRH were potentially preventable (49%, n = 75). CONCLUSION Polypharmacy from BP-lowering drugs in older people is associated with preventable harm. Decisions around cardiovascular risk reduction should be carefully considered in view of MRH arising from BP-lowering drugs.
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Affiliation(s)
- Ahmed Hussain
- Department of Elderly Medicine, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Khalid Ali
- Department of Elderly Medicine, University Hospitals Sussex NHS Foundation Trust, Sussex, UK.,Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK
| | - Nikesh Parekh
- Department of Elderly Medicine, University Hospitals Sussex NHS Foundation Trust, Sussex, UK.,Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK
| | - Jennifer M Stevenson
- Institute of Pharmaceutical Science, King's College London, London, UK.,Pharmacy Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Graham Davies
- Institute of Pharmaceutical Science, King's College London, London, UK.,School of Applied Sciences, University of Sussex, Brighton, East Sussex, UK
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK
| | - Chakravarthi Rajkumar
- Department of Elderly Medicine, University Hospitals Sussex NHS Foundation Trust, Sussex, UK.,Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK
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Marinović I, Bačić Vrca V, Samardžić I, Marušić S, Grgurević I, Papić I, Grgurević D, Brkić M, Jambrek N, Mesarić J. Impact of an integrated medication reconciliation model led by a hospital clinical pharmacist on the reduction of post-discharge unintentional discrepancies. J Clin Pharm Ther 2021; 46:1326-1333. [PMID: 33969511 DOI: 10.1111/jcpt.13431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE There is no optimal standardized model in the transfer of care between hospitals and primary healthcare facilities. Transfer of care is a critical point during which unintentional discrepancies, that can jeopardize pharmacotherapy outcomes, can occur. The objective was to determine the effect that an integrated medication reconciliation model has on the reduction of the number of post-discharge unintentional discrepancies. METHODS A randomized controlled study was conducted on an elderly patient population. The intervention group of patients received a medication reconciliation model, led entirely by a hospital clinical pharmacist (medication reconciliation at admission, review and optimization of pharmacotherapy during hospitalization, patient education and counselling, medication reconciliation at discharge, medication reconciliation as part of primary health care in collaboration with a primary care physician and a community pharmacist). Unintentional discrepancies were identified by comparing the medications listed on the discharge summary with the first list of medications prescribed and issued at primary care level, immediately after discharge. The main outcome measures were incidence, type and potential severity of post-discharge unintentional discrepancies. RESULTS AND DISCUSSION A total of 353 patients were analysed (182 in the intervention and 171 in the control group). The medication reconciliation model, led by a hospital clinical pharmacist, significantly reduced the number of patients with unintentional discrepancies by 57.1% (p < 0.001). The intervention reduced the number of patients with unintentional discrepancies associated with a potential moderate harm by 58.6% (p < 0.001) and those associated with a potential severe harm by 68.6% (p = 0.039). The most common discrepancies were incorrect dosage, drug omission and drug commission. Cardiovascular medications were most commonly involved in unintentional discrepancies. WHAT IS NEW AND CONCLUSION The integrated medication reconciliation model, led by a hospital clinical pharmacist in collaboration with all health professionals involved in the patient's pharmacotherapy and treatment, significantly reduced unintentional discrepancies in the transfer of care.
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Affiliation(s)
- Ivana Marinović
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Vesna Bačić Vrca
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivana Samardžić
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Srećko Marušić
- Department of Endocrinology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivica Grgurević
- Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Papić
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Dijana Grgurević
- Department of Clinical Pharmacy, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Brkić
- Community Health Center Zagreb-East, Zagreb, Croatia
| | | | - Jasna Mesarić
- Faculty of Health Sciences, Libertas International University, Zagreb, Croatia
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Abstract
Deprescribing is the process of discontinuing drugs that are either potentially harmful or no longer required.
It can be achieved in older people and may be associated with improved health outcomes without long-term adverse effects.
The risk of drug withdrawal effects can often be mitigated by carefully monitoring and gradually tapering the dose.
Deprescribing should ideally be a shared decision-making process between the patient and the prescriber.
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Affiliation(s)
- Michelle Liacos
- Pharmacy Department, Alfred Health, Melbourne.,WA Centre for Health and Ageing, University of Western Australia, Crawley, WA.,Centre for Medicine Use and Safety, Monash University, Melbourne.,Royal Perth Hospital, Perth
| | - Amy Theresa Page
- Pharmacy Department, Alfred Health, Melbourne.,WA Centre for Health and Ageing, University of Western Australia, Crawley, WA.,Centre for Medicine Use and Safety, Monash University, Melbourne.,Royal Perth Hospital, Perth
| | - Christopher Etherton-Beer
- Pharmacy Department, Alfred Health, Melbourne.,WA Centre for Health and Ageing, University of Western Australia, Crawley, WA.,Centre for Medicine Use and Safety, Monash University, Melbourne.,Royal Perth Hospital, Perth
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Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D. Withdrawal of antihypertensive drugs in older people. Cochrane Database Syst Rev 2020; 6:CD012572. [PMID: 32519776 PMCID: PMC7387859 DOI: 10.1002/14651858.cd012572.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hypertension is an important risk factor for subsequent cardiovascular events, including ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Overall, the use of antihypertensive medications has led to reduction in cardiovascular disease, morbidity rates and mortality rates. However, the use of antihypertensive medications is also associated with harms, especially in older people, including the development of adverse drug reactions, drug-drug interactions and can contribute to increasing medication-related burden. As such, discontinuation of antihypertensives may be considered and appropriate in some older people. OBJECTIVES To investigate whether withdrawal of antihypertensive medications is feasible, and evaluate the effects of withdrawal of antihypertensive medications on mortality, cardiovascular outcomes, hypertension and quality of life in older people. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2019: the Cochrane Hypertension Specialised Register, CENTRAL (2019, Issue 3), Ovid MEDLINE, Ovid Embase, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also conducted reference checking, citation searches and, when appropriate, contacted study authors to identify any additional studies. The searches had no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) of withdrawal versus continuation of antihypertensive medications used for hypertension or primary prevention of cardiovascular disease in older adults (defined as 50 years and over). Participants were eligible if they lived in the community, residential aged care facilities, or were based in hospital settings. We sought to include trials looking at the complete withdrawal of the antihypertensive medication, and those focusing on a dose reduction of the antihypertensive medicine. DATA COLLECTION AND ANALYSIS We compared the intervention of discontinuing or reducing antihypertensive medication to usual treatment using mean differences (MD) and 95% confidence intervals (95% CIs) for continuous variables and we used Peto odds ratios (ORs) and 95% CI for binary variables. Our primary outcomes included: mortality, myocardial infarction, development of adverse drug reactions or adverse drug withdrawal reactions. Secondary outcomes included: blood pressure, hospitalisation, stroke, success of withdrawing from antihypertensives, quality of life, and falls. Two authors independently, and in duplicate, conducted all stages of study selection, data extraction and quality assessment. MAIN RESULTS Six RCTs met the inclusion criteria and were included in the review (1073 participants). Study duration and follow-up ranged from 4 weeks to 56 weeks. Meta-analysis of studies showed that, in the discontinuation group compared to continuation, the odds for all-cause mortality were 2.08 (95% CI 0.79 to 5.46; low certainty of evidence), for myocardial infarction 1.86 (95% CI 0.19 to 17.98; very low certainty of evidence) and for stroke 1.44 (95% CI 0.25 to 8.35; low certainty of evidence). Blood pressure was higher in the discontinuation group than the continuation group (systolic blood pressure: MD = 9.75 mmHg, 95% CI 7.33 to 12.18; and diastolic blood pressure: MD = 3.5 mmHg, 95% CI 1.82 to 5.18; low certainty of evidence). For the development of adverse events, meta-analysis was not possible; antihypertensive discontinuation did not appear to increase the risk of adverse events and may lead to resolution of adverse drug reactions, although eligible studies had limited reporting of adverse effects of drug withdrawal (very low certainty of evidence). One study reported hospitalisation with an odds ratio of 0.83 for discontinuation compared to continuation (95% CI 0.33 to 2.10; low certainty of evidence). No studies were identified which reported falls. Between 10.5% and 33.3% of participants in the discontinuation group compared to 9% to 15% in the continuation group experienced raised blood pressure or other clinical criteria (as pre-defined by the studies) that would require restarting of therapy/removal from the study. The sources of bias included selective reporting (reporting bias), lack of blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), and lack of blinding of participants and personnel (performance bias). AUTHORS' CONCLUSIONS There is no evidence of an effect of discontinuing compared with continuing antihypertensives used for hypertension or primary prevention of cardiovascular disease in older adults on all-cause mortality and myocardial infarction. The evidence was low to very low certainty mainly due to small studies and low event rates. These limitations mean that we cannot make any firm conclusions about the effect of deprescribing antihypertensives on these outcomes. Future research should focus on populations with the greatest uncertainty of the benefit:risk ratio for use of antihypertensive medications, such as those with frailty, older age groups and those taking polypharmacy, and measure clinically important outcomes such as falls, quality of life and adverse drug events.
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Affiliation(s)
- Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- College of Pharmacy, Dalhousie University, Halifax, Canada
- Geriatric Medicine Research, Nova Scotia Health Authority and Dalhousie University, Halifax, Canada
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Wade Thompson
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Mouna Sawan
- Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney University, Camperdown, Sydney, Australia
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ingrid Hopper
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - Sarah N Hilmer
- Kolling Institute, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre, University of Sydney, Sydney, Australia
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The association of antihypertensive use and depressive symptoms in a large older population with hypertension living in Australia and the United States: a cross-sectional study. J Hum Hypertens 2020; 34:787-794. [PMID: 32001828 DOI: 10.1038/s41371-020-0303-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/23/2019] [Accepted: 01/16/2020] [Indexed: 12/19/2022]
Abstract
Cardiovascular drugs impact many pathways involved in depression pathophysiology and treatment. However, their distinct impact on mood is underrecognized and the literature is conflicting. Therefore, using a very large and well-characterised sample of older adults with hypertension, we aimed to investigate the prevalence of depressive symptoms in users of different antihypertensive classes. We analysed baseline data from 14,195 older individuals with hypertension enroled in a large clinical trial. Median age was 75 years. The association of antihypertensive use by class and depression prevalence, as measured by a validated depression scale, was determined using logistic regression models. Multivariable logistic models were implemented to account for important confounding factors. Our analyses showed a positive association between depressive symptoms and the use of beta blockers (BB) (OR: 1.37; 95% CI: 1.17-1.60, p < 0.01), compared with users of other antihypertensive classes. All other classes of antihypertensives (including angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers) were not significantly associated with depressive symptoms. In secondary analysis, this relationship was stronger for lipophilic (39%) and nonselective BB (52%) compared with hydrophilic (26%) and selective medications (31%), respectively. This study adds further evidence for a probable association between BB and depression in a large sample of older adults with hypertension and no history of cardiovascular disease or heart failure. These findings should regenerate interest and increase awareness of clinicians about the possible adverse effects of these medications in an otherwise healthy older population.
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Seppala LJ, van der Velde N, Masud T, Blain H, Petrovic M, van der Cammen TJ, Szczerbińska K, Hartikainen S, Kenny RA, Ryg J, Eklund P, Topinková E, Mair A, Laflamme L, Thaler H, Bahat G, Gutiérrez-Valencia M, Caballero-Mora MA, Landi F, Emmelot-Vonk MH, Cherubini A, Baeyens JP, Correa-Pérez A, Gudmundsson A, Marengoni A, O'Mahony D, Parekh N, Pisa FE, Rajkumar C, Wehling M, Ziere G. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Eur Geriatr Med 2019; 10:275-283. [PMID: 34652762 DOI: 10.1007/s41999-019-00162-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.
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Affiliation(s)
- L J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - N van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - T Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H Blain
- Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier University, Euromov, France
| | - M Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
| | - T J van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - S Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland.,Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - E Topinková
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - A Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | - L Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska huset, 17177, Stockholm, Sweden
| | - H Thaler
- Trauma Center Wien-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - G Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - M Gutiérrez-Valencia
- Department of Health Sciences, Public University of Navarra (UPNA), Avda, Barañain s/n, 31008, Pamplona, Spain
| | - M A Caballero-Mora
- Servicio de Geriatría, Hospital Universitario de Getafe and CIBER de Fragilidad y Envejecimiento Saludable, Getafe, Madrid, Spain
| | - F Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - M H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - A Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'Invecchiamento, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - J P Baeyens
- University of Luxembourg, Ezch-sur-Alzette, Luxembourg.,AZ Alma, Eeklo, Belgium
| | - A Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - A Gudmundsson
- Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - D O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - N Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK
| | - F E Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - C Rajkumar
- Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - M Wehling
- Institute of Clinical Pharmacology Mannheim, University of Heidelberg, Heidelberg, Germany
| | - G Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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11
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Seppala LJ, van der Velde N, Masud T, Blain H, Petrovic M, van der Cammen TJ, Szczerbińska K, Hartikainen S, Kenny RA, Ryg J, Eklund P, Topinková E, Mair A, Laflamme L, Thaler H, Bahat G, Gutiérrez-Valencia M, Caballero-Mora MA, Landi F, Emmelot-Vonk MH, Cherubini A, Baeyens JP, Correa-Pérez A, Gudmundsson A, Marengoni A, O'Mahony D, Parekh N, Pisa FE, Rajkumar C, Wehling M, Ziere G. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Drugs Aging 2019; 36:299-307. [PMID: 30741371 PMCID: PMC6435622 DOI: 10.1007/s40266-018-0622-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.
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Affiliation(s)
- L J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - N van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - T Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H Blain
- Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier University, Euromov, France
| | - M Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
| | - T J van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - S Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - E Topinková
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - A Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | - L Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska huset, 17177, Stockholm, Sweden
| | - H Thaler
- Trauma Center Wien-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - G Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - M Gutiérrez-Valencia
- Department of Health Sciences, Public University of Navarra (UPNA), Avda, Barañain s/n, 31008, Pamplona, Spain
| | - M A Caballero-Mora
- Servicio de Geriatría, Hospital Universitario de Getafe and CIBER de Fragilidad y Envejecimiento Saludable, Getafe, Madrid, Spain
| | - F Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - M H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'Invecchiamento, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - J P Baeyens
- University of Luxembourg, Ezch-sur-Alzette, Luxembourg
- AZ Alma, Eeklo, Belgium
| | - A Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - A Gudmundsson
- Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - D O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - N Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK
| | - F E Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - C Rajkumar
- Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - M Wehling
- Institute of Clinical Pharmacology Mannheim, University of Heidelberg, Heidelberg, Germany
| | - G Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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12
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Tegegn HG, Erku DA, Sebsibe G, Gizaw B, Seifu D, Tigabe M, Belachew SA, Ayele AA. Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital. PLoS One 2019; 14:e0214191. [PMID: 30921379 PMCID: PMC6438590 DOI: 10.1371/journal.pone.0214191] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 03/09/2019] [Indexed: 11/18/2022] Open
Abstract
Polypharmacy among older patients has been associated with a decline in their quality of life. We aimed to assess the medication-related quality of life (MRQOL) among older patients with polypharmacy at Gondar University Hospital, Gondar, Ethiopia. A prospective cross-sectional study was carried out among 150 elder patients who had visited the internal medicine ward and ambulatory ward of Gondar referral hospital from March 25 to May 15, 2017, using a validated scale, Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0). A total of 150 older patients with polypharmacy participated in the study with a mean age of 70.06±5.12, andtwo-thirds of the participants (67.3%) were female. The overall prevalence of poor quality of life due to polypharmacy in the current study was found to be three fourth (75.3%) of the participants. Regarding the severity of impairment in MRQoL, Univariate analysis revealed that frequency of hospital visits (COR = 1.34, 95% CI, 1.02–1.77) and medication number (COR = 1.94, 95% CI, 1.33, 2.8) had a statistically significant positive association with the likelihood of having a severe impairment.The multivariate analysis also showed that one unit increase in the number of hospital visits (AOR = 1.45, 95% CI, 1.040–2.024) and medications greater than 5 (AOR = 1.91, 95% CI, 1.29, 2.84) increases 1.45 and 1.91 times the likely hood of posing severe impairment of MRQoL, respectively. As far as poor MRQoL quality of life is concerned, multivariate analysis did not show any significant association between the poor MRQoL;and Sociodemographic and clinical data of patients. The poor QoL associated with medication was very high in this study. Deprescribing should be sought by the health care providers to optimize drug therapy and minimize the polypharmacy related poor quality of life.
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Affiliation(s)
- Henok Getachew Tegegn
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
- * E-mail:
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Girum Sebsibe
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Biruktawit Gizaw
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Dawit Seifu
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | - Masho Tigabe
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
| | | | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, University of Gondar, Gondar, Amhara, Ethiopia
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13
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Page A, Etherton-Beer C. Undiagnosing to prevent overprescribing. Maturitas 2019; 123:67-72. [PMID: 31027680 DOI: 10.1016/j.maturitas.2019.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Health care focuses on controlling symptoms and managing risk factors to improve survival by avoiding future complications. Diagnoses describe a group of signs and symptoms, often implying specific aetiologies and underlying pathophysiological disease processes. The diagnosis provides a tool for the health professional to conceptualise and classify a presentation, and thus manage the condition, and can provide the patient with an explanation or validation of their experience. Not every diagnosis holds significant clinical implications. There are diagnosed conditions that do not require treatment and, moreover, where treatment has the potential for harm without the potential for benefit. Promoting investigations and diagnoses can lead to overdiagnosis related to vested interests in increased services, use of devices or therapeutics. Multiple factors drive this issue, including broadening disease definitions and cultural factors that encourage tests and treatments, as well as medicolegal factors. While the traditional medicine review process typically involved cross-referencing medicines used with current diagnoses, a more sophisticated version of this process critically reviews the medicines and associated diagnosis, giving less emphasis to diagnoses that are no longer relevant. Known as undiagnosis, this process facilitates the withdrawal of corresponding medicines used to manage those conditions. Systematically reviewing diagnoses regularly and the associated medicine management strategies could reduce prescribing. The novel ERASE process can help clinicians Evaluate diagnoses to consider Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and their corresponding medicines.
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Affiliation(s)
- Amy Page
- Alfred Health, 55 Commercial Rd, Australia; Monash University, Centre for Medicine Use and Safety, Melbourne, Australia; University of Western Australia, School of Allied Health, Centre for Medicines Optimisation, Perth, Australia.
| | - Christopher Etherton-Beer
- University of Western Australia, Western Australian Centre for Health and Ageing, Australia; Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
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14
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How May Coexisting Frailty Influence Adherence to Treatment in Elderly Hypertensive Patients? Int J Hypertens 2019; 2019:5245184. [PMID: 30723553 PMCID: PMC6339701 DOI: 10.1155/2019/5245184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/18/2018] [Accepted: 12/26/2018] [Indexed: 02/08/2023] Open
Abstract
Background Hypertension is considered to be the most common condition in the general population. It is the most important risk factor for premature deaths in the world. Treatment compliance at every stage is a condition for successful antihypertensive therapy, and improving the effectiveness of treatment is a major goal in preventing cardiovascular incidents. Treatment noncompliance and lack of cooperation stem from numerous problems of older age, including frailty syndrome. Objective To evaluate the effect of frailty syndrome on treatment compliance in older patients with hypertension. Methods The study sample consisted of 160 patients (91 women, 69 men) with hypertension aged 65 to 78 (mean = 72.09, SD = 7.98 years), hospitalized at the University Clinical Hospital due to exacerbation of disease symptoms. Standardised research tools were used: the Tilburg Frailty Indicator questionnaire and the questionnaire for the assessment of treatment compliance in patients with hypertension, the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Results Frailty syndrome was diagnosed in 65.62% of patients: 35.62% with mild, 29.38% with moderate, and 0.62% with severe frailty. The treatment compliance was 36.14%. The prevalence of the FS and its three components (physical, psychological, social) significantly affected (p <0.05) the global score of the Hill-Bone Compliance to High Blood Pressure Therapy Scale and all subscales: “reduced sodium intake”, “appointment keeping”, and “antihypertensive medication taking”. Conclusions The coexistence of frailty syndrome has a negative impact on the compliance of older patients with hypertension. Diagnosis of frailty and of the associated difficulties in adhering to treatment may allow for targeting the older patients with a poorer prognosis and at risk of complications from untreated or undertreated hypertension and for planning interventions to improve hypertension control.
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15
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Parekh N, Ali K, Stevenson JM, Davies JG, Schiff R, Van der Cammen T, Harchowal J, Raftery J, Rajkumar C. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. Br J Clin Pharmacol 2018; 84:1789-1797. [PMID: 29790202 PMCID: PMC6046489 DOI: 10.1111/bcp.13613] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/03/2018] [Accepted: 04/08/2018] [Indexed: 12/21/2022] Open
Abstract
Aims Polypharmacy is increasingly common in older adults, placing them at risk of medication‐related harm (MRH). Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. The aim of the present study was to investigate the incidence, severity, preventability and cost of MRH in older adults in England postdischarge. Methods An observational, multicentre, prospective cohort study recruited 1280 older adults (median age 82 years) from five teaching hospitals in Southern England, UK. Participants were followed up for 8 weeks by senior pharmacists, using three data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilization. Results Overall, 413 participants (37%) experienced MRH (556 MRH events per 1000 discharges), of which 336 (81%) cases were serious and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n = 158, 25%) or neurological (n = 111, 18%). The medicine classes associated with the highest risk of MRH were opiates, antibiotics and benzodiazepines. A total of 328 (79%) participants with MRH sought healthcare over the 8‐week follow‐up. The incidence of MRH‐associated hospital readmission was 78 per 1000 discharges. Postdischarge MRH in older adults is estimated to cost the National Health Service £396 million annually, of which £243 million is potentially preventable. Conclusions MRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.
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Affiliation(s)
- Nikesh Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - Khalid Ali
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | | | - J Graham Davies
- Institute of Pharmaceutical Science, Kings College London, London, UK
| | - Rebekah Schiff
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tischa Van der Cammen
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - James Raftery
- Department of Medicine, University of Southampton, Southampton, UK
| | - Chakravarthi Rajkumar
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK.,Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
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16
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Parekh N, Ali K, Davies K, Rajkumar C. Can supporting health literacy reduce medication-related harm in older adults? Ther Adv Drug Saf 2018; 9:167-170. [PMID: 29492245 DOI: 10.1177/2042098618754482] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nikesh Parekh
- Division of Medicine, Brighton and Sussex Medical School, Audrey Emerton Building, Eastern Road, Brighton, BN2 1EL, UK
| | - Khalid Ali
- Division of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Kevin Davies
- Division of Medicine, Brighton and Sussex Medical School, Brighton, UK
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17
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Abstract
Due to the increasing age of the population, neurohospitalists are more frequently caring for old and very old people. Fundamental definitions and topics related to geriatric medicine are therefore of particular importance. In this review, common issues encountered in geriatric patients hospitalized on the neurology service are discussed. Focus is put on the geriatric assessment, multiprofessional diagnostic and therapeutic procedures, geriatric syndromes, pharmacotherapy of the aged, delirium, pain, and palliative management as they are relevant for the neurohospitalist. In addition, ethical questions are addressed.
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Affiliation(s)
- Josef G Heckmann
- Department of Neurology, Municipal Hospital Landshut, Landshut, Germany
| | - Jörg Kraus
- Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Christoph J G Lang
- Department of Neurology, Medical Faculty, University Hospital Erlangen, Erlangen, Germany
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18
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Page AT, Clifford RM, Potter K, Seubert L, McLachlan AJ, Hill X, King S, Clark V, Ryan C, Parekh N, Etherton-Beer CD. Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study. BMJ Open 2017; 7:e017906. [PMID: 28838905 PMCID: PMC5724063 DOI: 10.1136/bmjopen-2017-017906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D) criteria provide expert consensus guidance about medication use for people with dementia. This study aimed to identify enablers and barriers to implementing the criteria in practice. SETTING Participants came from both rural and metropolitan communities in two Australian states. PARTICIPANTS Focus groups were held with consumers, general practitioners, nurses and pharmacists. OUTCOMES data were analysed thematically. RESULTS Nine focus groups were conducted. Fifty-five participants validated the content of MATCH-D, appraising them as providing patient-centred principles of care. Participants identified potential applications (including the use of MATCH-D as a discussion aid or educational tool for consumers about medicines) and suggested supporting resources. CONCLUSION Participants provided insights into applying MATCH-D in practice and suggested resources to be included in an accompanying toolkit. These data provide external validation of MATCH-D and an empiric basis for their translation to practice. Following resource development, we plan to evaluate the feasibility and efficacy of implementation in practice.
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Affiliation(s)
- Amy Theresa Page
- Western Australian Centre for Health and Ageing, School of Medicine, University of Western Australia, Perth, Australia
- School of Allied Health, University of Western Australia, Perth, Australia
| | | | - Kathleen Potter
- Western Australian Centre for Health and Ageing, School of Medicine, University of Western Australia, Perth, Australia
| | - Liza Seubert
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy and Centre for Education and Research on Ageing, University of Sydney, Sydney, New South Wales, Australia
- Concord Hospital, Sydney, New South Wales, Australia
| | - Xaysja Hill
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Stephanie King
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Vaughan Clark
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Cristin Ryan
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Christopher D Etherton-Beer
- Western Australian Centre for Health and Ageing, School of Medicine, University of Western Australia, Perth, Australia
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