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Schwab C, Clementz A, Dechartres A, Fernandez C, Hindlet P. Are Lists of Potentially Inappropriate Medications Associated with Hospital Readmissions? A Systematic Review. Drugs Aging 2024; 41:209-218. [PMID: 38273186 DOI: 10.1007/s40266-024-01099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Suboptimal prescribing, including the prescription of potentially inappropriate medications (PIM), is frequent in patients aged 65 years and older. PIMs are associated with adverse drug events, which may lead to hospital admissions and readmissions for the most serious cases. Several tools, known as lists of PIMs, can detect suboptimal prescription. OBJECTIVE This systematic review aimed to identify which lists of PIMs are associated with hospital readmission of older patients. PATIENTS AND METHODS MEDLINE, the Cochrane Library, EMBASE, and clinicaltrials.gov were searched for the period from 1 January 1991 up to 12 May 2022 to identify original studies assessing the association between PIMs and hospital readmissions or emergency department (ED) revisits within 30 days of discharge in older patients. This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist, and the risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies (NOS) and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS A total of six studies presenting four different lists of PIMs were included. Readmission rates varied from 4.3 to 25.5% and the odds ratio (OR) between PIMs and hospital readmission varied from 0.92 [95% confidence interval (CI) 0.59; 1.42] to 6.48 [95% CI 3.00; 14.00]. Only two studies found a statistically significant association between a list of PIMs and hospital readmission. These two studies used different tools: the Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert Doctors to Right Treatment (START) and a combination of Beers Criteria® and STOPP and START. CONCLUSION This systematic review shows that the association between list of PIMs and 30-day unplanned readmissions remains unclear and seems dependent on the PIM detection tool. Further studies are needed to clarify this association. PROSPERO registration number CRD42021252107.
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Affiliation(s)
- Camille Schwab
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France.
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France.
| | - Alice Clementz
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Sainte-Périne, Pharmacie, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Christine Fernandez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France
| | - Patrick Hindlet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France
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Hsieh KP, Huang RY, Yang YH, Ho PS, Chen KP, Tung CL, Chu YL, Tsai JH. Using PIM-Taiwan, PRISCUS, and Beers criteria to assess potentially inappropriate medication use among older adults with 90-day rehospitalization: a population-based study in Taiwan. Front Pharmacol 2023; 14:1194537. [PMID: 37521484 PMCID: PMC10374845 DOI: 10.3389/fphar.2023.1194537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Background: Multimorbidity and polypharmacy increase the risk of hospitalization in older adults receiving potentially inappropriate medication (PIM). The current study compared the ability of PIM-Taiwan, PRISCUS, and Beers criteria to predict 90-day rehospitalization in older patients with and without PIM. Methods: The retrospective cohort study used Taiwan's Longitudinal Health Insurance Database to retrieve quarterly information about prescribed medication for adults aged ≥65 years hospitalized between 2001 and 2018. We analyzed the association of PIM with 90-day rehospitalization using logistic regression. Results: The study cohort included 206,058 older adults (mean age: 72.5 years). In the analysis, 133,201 (64.6%), 97,790 (47.5%), and 147,450 (71.6%), were identified as having PIM exposure in PIM-Taiwan, PRICUS, and Beers criteria, respectively. PIM-Taiwan criteria found exposure to PIM affecting the cardiovascular (adjusted OR [aOR] 1.37, 95% confidence interval [CI] = 1.32-1.41), gastrointestinal (aOR 1.26, 95% CI = 1.23-1.30), central nervous (aOR 1.11, 95% CI = 1.08-1.14), and respiratory (aOR 1.16, 95% CI = 1.12-1.20) systems significantly increased the risk of 90-day rehospitalization, after adjustment for covariates. In PRISCUS criteria, exposure to PIM affecting the respiratory (aOR 1.48, 95% CI = 1.41-1.56), central nervous (aOR 1.12, 95% CI = 1.09-1.15), and cardiovascular (aOR 1.20, 95% CI = 1.16-1.24) systems significantly increased the risk. In Beers criteria, exposure to PIM affecting the cardiovascular (aOR 1.37, 95% CI = 1.32-1.41), gastrointestinal (aOR 1.38, 95% CI = 1.35-1.42), central nervous (aOR 1.18, 95% CI = 1.15-1.21), endocrine (aOR 1.10, 95% CI = 1.06-1.15), and respiratory (aOR 1.09, 95% CI = 1.04-1.13) systems significantly increased the risk. Patients with 90-day rehospitalization had higher rates of the potentially harmful drug-drug interaction (DDI) pairs of serotonin syndrome (n = 19; 48.8%), QT prolongation (n = 4; 30.8%), extrapyramidal symptoms (EPS) (n = 102; 24.5%), and hypokalemia (n = 275; 20.1%). Conclusion: Beers criteria was more efficient in predicting 90-day rehospitalization among older adults experiencing PIM in Taiwan than either PIM-Taiwan or PRISCUS. The risk of 90-day rehospitalization was associated with the potentially harmful DDI classes of serotonin syndrome, QT prolongation, EPS, and hypokalemia.
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Affiliation(s)
- Kun-Pin Hsieh
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ru-Yu Huang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Pei-Shan Ho
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-Peng Chen
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chun-Liong Tung
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ya-Lan Chu
- Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Fidalgo-Neto AA, Lopes RM, Ribeiro RRM, de Souza CAM, de Souza Cavalcanti RL, da Silva Ferreira NC, Alves LA. Teaching and learning pharmacology in Brazil before COVID-19 pandemic: a case study in Rio de Janeiro. BMC MEDICAL EDUCATION 2023; 23:471. [PMID: 37353802 DOI: 10.1186/s12909-023-04437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Knowledge of pharmacology is crucial for physicians to perform rational and safe medicine. Medical professionals are responsible for prescribing drugs and a weak performace of those can result in medication errors leading to disability, hospitalization, and death, among other situations. It occurs worldwide, including in Brazil, so that learning pharmacology impacts on public health service. We aim to investigate the current pharmacology educational practices in medical schools in the state of Rio de Janeiro, Brazil. METHODS We surveyed 14 of 22 medical schools in Rio de Janeiro. Pharmacology teachers (n=16) and medical students (n=89) answered a semi-structured questionnaire that included questions about the staff characteristics, pharmacology content, teacher's concepts, and common practices and resources that were used in pharmacology classes. RESULTS Our results revealed that the medical schools had similar overall curriculums. Pharmacology teachers work more than 30hs a week (75%) and conducted both research and teaching (62.5%). We also found that the multimedia projector was the most common resource (71.9%), and passive pedagogical methodologies (e.g., expository classes) remain a current strategy in pharmacology classes (89.9%). In general, medical students are poorly motivated (55%), which may be related to their performance in assessments. In addition, students believe that pharmacology is a complex (52%) or very complex subject (46%) since for its full understanding the student needs concepts from other disciplines, which can have an impact on the performance and motivation of students. As a result, these medical students do not fully understand the integration between pharmacology's basic concepts and their clinical applications. CONCLUSION These data seem to demonstrate that the adopted teaching and learning pharmacology strategies and methodologies can be improved in Rio de Janeiro.
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Affiliation(s)
- Antonio Augusto Fidalgo-Neto
- Laboratory of Cellular Communication, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Renato Matos Lopes
- Laboratory of Cellular Communication, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil
| | | | | | | | | | - Luiz Anastacio Alves
- Laboratory of Cellular Communication, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Brazil.
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Patel TK, Patel PB, Bhalla HL, Dwivedi P, Bajpai V, Kishore S. Impact of suspected adverse drug reactions on mortality and length of hospital stay in the hospitalised patients: a meta-analysis. Eur J Clin Pharmacol 2023; 79:99-116. [PMID: 36399205 DOI: 10.1007/s00228-022-03419-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate the risk of mortality and length of stay in hospitalised patients who have experienced suspected adverse drug reactions (ADRs) as compared to patients who did not experience suspected ADRs. METHODS A systematic literature search was conducted on databases for observational and randomised controlled studies conducted in any inpatient setting that reported deaths and/or length of hospital stay in patients who had suspected ADRs and did not have suspected ADRs during hospitalisation. PRISMA guidelines were strictly followed during the review. The methodological quality of included studies was assessed using a tool designed by Smyth et al. for the studies of adverse drug reactions. The meta-analytic summary of all-cause mortality was estimated using odds ratio-OR (95% CI) and length of stay using mean difference-MD (95% CI). Both outcomes were pooled using a random effect model (DerSimonian and Laird method). Subgroup and meta-regression were performed based on study variables: study design, age group, study ward, study region, types of suspected ADRs (ADRAd-suspected ADRs that lead to hospitalisation and ADRIn-suspected ADRs that occur following hospitalisation), study duration, sample size and study period. The statistical analysis was conducted through the 'Review manager software version 5.4.1 and JASP (Version 0.14.1)'. RESULTS After screening 475 relevant articles, 55 studies were included in this meta-analysis. Patients having suspected ADRs had reported significantly higher odds of all-cause mortality [OR: 1.50 (95% CI: 1.21-1.86; I2 = 100%) than those patients who did not have suspected ADRs during hospitalisation. Study wards, types of suspected ADRs and sample size were observed as significant predictors of all-cause mortality (p < 0.05). Patients having suspected ADRs had reported significantly higher mean difference in hospital stay [MD: 3.98 (95% CI: 2.91, 5.05; I2 = 99%) than those patients who did not have suspected ADRs during hospitalisation. Types of suspected ADRs and study periods were observed as significant predictors of length of stay (p < 0.05). CONCLUSION Suspected ADRs significantly increase the risk of mortality and length of stay in hospitalised patients. SYSTEMATIC REVIEW REGISTRATION CRD42020176320.
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Affiliation(s)
- Tejas K Patel
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, 273008, India.
| | - Parvati B Patel
- Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, 390021, India
| | - Hira Lal Bhalla
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, 273008, India
| | - Priyanka Dwivedi
- Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, 273008, India
| | - Vijeta Bajpai
- Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, 273008, India
| | - Surekha Kishore
- All India Institute of Medical Sciences, Gorakhpur, 273008, India
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Allela O. Explore Adverse Drug Reactions (ADRs) reporting by clinical and community pharmacists in Duhok, Kurdistan region- Iraq: hampered and perspective. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e95691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Pharmacovigilance systems are crucial for monitoring, ensuring the safe use of medications, and reducing the frequency of adverse drug reactions (ADRs). They also raise awareness of the importance of reporting ADRs to healthcare systems.
Aim: Explore the hampered and perspective held by Duhok pharmacists, particularly those employed in hospitals and private pharmacy sectors, about pharmacovigilance and ADR reporting.
Methods: A cross-sectional study was carried out from 20 February to 20 March 2019 using a self-administered questionnaire that had been previously created and modified. The data were examined using SPSS version 20, a statistical application for social software.
Results: The majority of respondents, pharmacists, stated that it is their responsibility to report adverse drug reactions (ADRs), and that drug safety monitoring is crucial (91%). More than 85% of pharmacists agreed that ADRs that result in life-threatening situations and those that result in congenital abnormalities should be reported immediately. The majority of them, however, were unaware of the Iraqi pharmacovigilance system, had never reported any adverse drug reactions, were unable to get reporting forms, and lacked the clinical knowledge required to recognize ADRs.
Conclusion: Underreporting was the main issue identified by the study because the majority of respondents were unable to define the term “pharmacovigilance” correctly, but they were aware of ADRs and displayed a positive attitude toward ADR reporting despite the fact that the majority of them had never reported any ADRs. To raise pharmacists’ knowledge and awareness of the ADR reporting procedure, however, required steps should be made to establish interventional programs.
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Choi E, Kim S, Suh HS. Exploring the prevalence and characteristics of adverse drug events among older adults in South Korea using a national health insurance database. Front Pharmacol 2022; 13:1047387. [DOI: 10.3389/fphar.2022.1047387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Adverse drug events (ADEs) in the elderly frequently occur because of their multiple chronic diseases and complexity of drug therapy. To better understand adverse drug events, the prevalence and characteristics of adverse drug events in elderly South Korean patients were assessed.Methods: The National Health Insurance databases for 2015 and 2016 were used for the analysis. We included patients aged ≥65 years that had at least one claim with the diagnosis codes ‘drug-induced,’ ‘poisoning by drug,’ and ‘vaccine-associated’ each year for the base-case analysis. To minimize the underestimation of adverse drug event prevalence, we also used an extended definition analysis by adding the ‘adverse drug event very likely’ codes. We estimated the prevalence of adverse drug events by sex, age group, and type of insurance and examined the frequent types of adverse drug events in 2015 and 2016.Results: In the base-case analysis, adverse drug event prevalence in individuals aged 65 years and older was 2.75% in 2015 and 2.77% in 2016. With advanced age, the prevalence of adverse drug event tended to increase, peaking in the age group of 75–79 years. In addition, the adverse drug event prevalence was higher in females and Medical Aid enrollees. The most frequently occurring adverse drug event was ‘allergy, unspecified,’ followed by ‘other drug-induced secondary parkinsonism,’ and ‘generalized skin eruption due to drugs and medicaments.’ When we examined the extended definition analysis, the prevalence of adverse drug events was 4.47% in 2015 and 4.52% in 2016, which significantly increased from those estimated in the base-case analysis.Conclusion: Among the older adults, the prevalence of adverse drug event was higher in advanced age, females, and Medical Aid enrollees. In particular, allergy and drug-induced secondary parkinsonism frequently occurred. This study provides evidence that health policies addressing the prevention and management of adverse drug events should be a priority for the most vulnerable elderly patients.
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Evaluation of Factors Associated with Adverse Drug Events in South Korea Using a Population-Based Database. J Clin Med 2022; 11:jcm11216248. [PMID: 36362475 PMCID: PMC9657773 DOI: 10.3390/jcm11216248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
This retrospective study aims to investigate the factors associated with the occurrence of ADEs using nationally representative claims data. All patients with at least one claim with diagnosis codes denoting potential ADE between 1 July 2015 and 31 December 2015 were included. Potential ADE was defined as ADE identified in the claims data, because it was not verified. The index date was defined as the date of the first claim with potential ADEs. Demographic data were collected at the index date, while data on comorbidities and number of medications used were collected six months before the index date. Multivariate logistic regression was used to explore the association between potential ADEs and several factors, including sex, age group, insurance type, comorbidities, and number of prescribed medications. Patients with potential ADEs were older, had more chronic diseases, and used more medications than those without potential ADEs. In the multivariate analysis, occurrence of potential ADEs was associated with age (≥65 years, odds ratio [OR] 1.15, 95% confidence interval [CI] 1.08–1.21), Medical Aid program (OR 1.37, 95% CI 1.27–1.47), Charlson Comorbidity Index scores (≥5, OR 2.87, 95% CI 2.56–3.20), and use of six or more medications (6–10 medications, OR 1.89, 95% CI 1.79–1.99). Age, Medical Aid program, comorbidities, and number of medications were associated with occurrence of potential ADEs.
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Gerard E, Quindroit P, Lemaitre M, Robert L, Gautier S, Decaudin B, Vambergue A, Beuscart JB. Defining explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A systematic review. PLoS One 2022; 17:e0274256. [PMID: 36094919 PMCID: PMC9467327 DOI: 10.1371/journal.pone.0274256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Potentially inappropriate prescriptions (PIPs) of antidiabetic drugs (ADs) (PIPADs) to patients with type 2 diabetes mellitus (T2DM) have been reported in some studies. The detection of PIPs in electronic databases requires the development of explicit definitions. This approach is widely used in geriatrics but has not been extended to PIPADs in diabetes mellitus. The objective of the present literature review was to identify all explicit definitions of PIPADs in patients with T2DM. Materials and methods We performed a systematic review of the literature listed on Medline (via PubMed), Scopus, Web of Science, and, Embase between 2010 and 2021. The query included a combination of three concepts ("T2DM" AND "PIPs" AND "ADs") and featured a total of 86 keywords. Two independent reviewers selected publications, extracted explicit definitions of PIPADs, and then classified the definitions by therapeutic class and organ class. Results Of the 4,093 screened publications, 39 were included. In all, 171 mentions of PIPADs (corresponding to 56 unique explicit definitions) were identified. More than 50% of the definitions were related to either metformin (34%) or sulfonylureas (29%). More than 75% of the definitions were related to either abnormal renal function (56%) or age (22%). In addition, 20% (n = 35) mentions stated that biguanides were inappropriate in patients with renal dysfunction and 17.5% (n = 30) stated that sulfonylureas were inappropriate above a certain age. The definitions of PIPADs were heterogeneous and had various degrees of precision. Conclusion Our results showed that researchers focused primarily on the at-risk situations related to biguanide prescriptions in patients with renal dysfunction and the prescription of sulfonylureas to older people. Our systematic review of the literature revealed a lack of consensus on explicit definitions of PIPADs, which were heterogeneous and limited (in most cases) to a small number of drugs and clinical situations.
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Affiliation(s)
- Erwin Gerard
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
- * E-mail:
| | - Paul Quindroit
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- University of Lille, Lille, France
| | - Laurine Robert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
| | - Sophie Gautier
- CHU de Lille, Centre Régional de Pharmacovigilance, Lille, France
| | - Bertrand Decaudin
- CHU Lille, Institut de Pharmacie, Lille, France
- Univ. Lille, CHU Lille, ULR 7365 - GRITA: Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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Ali S, Curtain CM, Bereznicki LR, Salahudeen MS. Actual drug-related harms in residential aged care facilities: a narrative review. Expert Opin Drug Saf 2022; 21:1047-1060. [PMID: 35634890 DOI: 10.1080/14740338.2022.2084071] [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: 11/04/2022]
Abstract
INTRODUCTION Older people in residential aged care facilities (RACFs) have a high risk of safety issues and concerns about the potential quality of care received. This narrative review investigates the types of actual drug-related harms, their prevalence, reporting of any standard definitions for these harms, and their identification methods. AREAS COVERED The authors conducted a systematic search on Ovid Embase, Ovid Medline, and PubMed from March 2001 to March 2021. This narrative review included all types of studies targeting aged care residents aged 65 years and above with actual drug-related harms. EXPERT OPINION The prevalence of actual drug-related harms in residents ranged from 0.07% to 63.0%. Falls, drug-drug interactions, neuropsychiatric symptoms, anaphylaxis, urinary tract infection, hypoglycemia, hypokalaemia, and acute kidney injury are the most common drug-related harms in older residents. Psychotropic drugs are the most common drug class implicated in these harms. Evidence related to the association between individual psychotropic drugs and injury, or harm is also lacking. Due to the variation in study duration, reported prevalence, identification methods, and absence of a definition for actual drug-related harms in most studies, further research is mandated to understand the prevalence and clinical implications of drug-related harms in older residents.
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Affiliation(s)
- Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Luke Re Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Nimee F, Steier J, Papandreou G, Skouroliakou M. A comprehensive medication review of a polypharmacy patient population: A cross-sectional observational study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022. [DOI: 10.1016/j.rcsop.2022.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Rosmasari R, Esha P, Figueras A. Identification of Potential of Drug-Drug Interaction and Its Affecting Factors: A cross-sectional study among hospitalized coronary heart disease patients. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220404155622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Coronary Heart Disease (CHD) patients are at risk of suffering from drug interactions, leading to a higher risk of mortality and morbidity among these patients. This study aims to identify the potential drug-drug interactions (PDDIs) and CHD patients' related factors.
Methods:
A cross-sectional study was performed among the CHD patients to identify the PDDIs from 2014 to 2017 at Secondary Hospital. The PDDIs were categorized according to the interaction mechanism, onset, severity, and documentation.
Results:
Among 91 CHD patients, 151 PDDIs were identified consisting of pharmacodynamics mechanism and delayed onset, 50.33% and 83.44%, respectively. Furthermore, there was a correlation between the number of PDDIs and the number of drugs (r = 0.496; p < 0,001).
Conclusion:
: This study revealed that the more the drugs were prescribed to CHD patients, the more the PDDIs risk would occur. The regular monitoring of the CHD patient’s prescriptions is noteworthy to avoid the PDDIs.
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Affiliation(s)
- Reny Rosmasari
- Department of Pharmacy Profession, Universitas Muhammadiyah Yogyakarta, Indonesia
| | - Pramitha Esha
- Department of Pharmacy Profession, Universitas Muhammadiyah Yogyakarta, Indonesia
- Department of Pharmacy Profession, Universitas Muhammadiyah Yogyakarta, Indonesia
| | - Albert Figueras
- Department of Pharmacology. Universitat Autònoma de Barcelona, , E-08035-Barcelona, Spain
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Lee JW, Li M, Boyd CM, Green AR, Szanton SL. Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review. J Am Med Dir Assoc 2022; 23:528-536.e2. [PMID: 34861224 PMCID: PMC8983441 DOI: 10.1016/j.jamda.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To summarize the evidence for preoperative deprescribing and its effect on postoperative outcomes in older adults undergoing surgery. DESIGN Systematic review. SETTING AND PARTICIPANTS All available studies. METHODS We searched EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), and PubMed from inception to January 12, 2021. Settings included outpatient settings during the waiting period for surgery (ie, preoperative clinic) through to the preoperative period in the hospital. Participants who were older adults, aged ≥65 years, undergoing planned or emergency surgery with deprescribing or medication-related interventions were included for review. RESULTS We identified 3 different methods of deprescribing intervention delivery during the preoperative period: geriatrician-led (n = 2), interdisciplinary team-led (n = 8), and pharmacist-led (n = 6). Outcomes were related to health care utilization, patient outcomes, and medication changes; however, results were difficult to compare because of heterogeneous outcomes within the topics. Overall, results were either positive or neutral. CONCLUSIONS AND IMPLICATIONS The evidence for deprescribing during the preoperative period for older adults undergoing surgery is weak because of the heterogeneity of intervention delivery and outcomes, inclusion of nonoperative cases in some studies, and low power. This review highlights the need for future research, which may consider the following: (1) interdisciplinary approach, (2) coordination of deprescribing efforts with primary care provider from the waiting period for surgery up to after hospital discharge, and (3) validated deprescribing criteria such as STOPP/START that is easy to implement. It is important to note that results yielded positive and neutral results, not negative ones, which should reassure clinicians to implement deprescribing for older adults during the surgical period. Additionally, policy initiatives such as integrated electronic medical records or increased reimbursement of deprescribing efforts for primary care providers and/or hospitals should be pursued to prevent adverse postoperative events for this population.
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Affiliation(s)
- Ji Won Lee
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Mengchi Li
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Ariel R Green
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Teixeira JJM, Provin MP, Freitas MPD, Santana FR, Pedatella MTA, Rocha LEDA. Impediments to deprescription in Brazil: overview from a panel of geriatrics experts. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: To identify impediments to deprescription among older adults from the perspective of a panel of Brazilian geriatricians. Methods: The Delphi method was used to obtain a consensus among Brazilian geriatricians about the factors that influence the lack of deprescription for older adults in clinical practice. The study was developed in two stages: (i) a survey and description of potential factors involved in deprescription; and (ii) applying the results of the survey to a panel of experts to obtain a consensus. Results: The deprescription process is influenced by the interaction of three pillars of older adult health care: the prescriber, the patient-family, and the health care system. In the professional and health care systems, professional training and communication skills, prolonged clinical follow-up, access to the multidisciplinary team, medical consultations of an adequate time, and unified electronic health records were identified as facilitators of deprescription. In the patient-family pillar, clear facilitators included health literacy, no sensory or cognitive deficits, and a clinical situation of transitional or palliative care. Conclusions: Deprescription is a complex, multifactorial process that requires attention, time, and specific skills and competencies from the attending physician, but it also requires shared decision-making and a health system compatible with a culture of deprescription.
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Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait. Clin Interv Aging 2022; 17:1025-1036. [PMID: 35822127 PMCID: PMC9271279 DOI: 10.2147/cia.s328693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Potentially inappropriate medications are major health concerns for patients aged ≥65 years. To investigate the prevalence of potentially inappropriate medications, Beer's criteria can be used. We estimated the prevalence of potentially inappropriate medications prescription among patients aged ≥65 years admitted to Kuwait's largest hospital and identified the predictors of prescribing a potentially inappropriate medication. METHODS A cross-sectional study was conducted retrospectively using inpatient records from the medical department at the Hospital in Kuwait from 1 January 2019 to 31 December 2019. The latest version of Beer's criteria was used to identify potentially inappropriate medications in patients' medical records. Data were analyzed descriptively to estimate the prevalence of potentially inappropriate medications and to describe participant characteristics. The predictors of potentially inappropriate medications prescribing were determined using binary logistic regression. RESULTS A total of 423 medical records of patients were collected. The mean age of the patients admitted was 76 ± 7 years, and 222 of them (52.5%) were women. Upon hospital admission, potentially inappropriate medication was prevalent in 58.4% of patients. The most prevalent potentially inappropriate medications identified were proton pump inhibitors (27.3%), diuretics (21.5%), antipsychotic agents (9%), selective serotonin reuptake inhibitors (5%), and methyldopa (4%). Polypharmacy, Alzheimer's disease, depression, irritable bowel syndrome, hypothyroidism, chronic kidney disease were predictors of potentially inappropriate medications prescription. CONCLUSION A high prevalence of potentially inappropriate medication prescription was observed among patients aged ≥65 years admitted to a hospital in Kuwait. The most likely predictor of potentially inappropriate medication prescription was polypharmacy.
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Affiliation(s)
- Hesah Alshammari
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Correspondence: Hesah Alshammari, Department of Clinical and Pharmaceutical sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK, Email
| | - Eman Al-Saeed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zamzam Ahmed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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15
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Schapira M, Calabró P, Montero-Odasso M, Osman A, Guajardo ME, Martínez B, Pollán J, Cámera L, Sassano M, Perman G. A multifactorial intervention to lower potentially inappropriate medication use in older adults in Argentina. Aging Clin Exp Res 2021; 33:3313-3320. [PMID: 32388838 DOI: 10.1007/s40520-020-01582-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults. AIMS To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults. METHODS We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65 years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient's electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6 months prior to the intervention) and final (12 months after) prevalence of PIM use using a test of proportions. RESULTS There was a significant reduction (p < 0.05) in all drug classes evaluated. Non-Steroidal Anti-Inflammatory Drugs (basal prevalence 5.92%; final 1.59%); benzodiazepines (10.13%; 6.94%); histamine antagonists (7.74%; 3.07%); opioids (2.16%; 1.25%); tricyclic antidepressants (8.08%; 4.10%); muscle relaxants (7.74%; 3.41%), anti-hypertensives (3.53%; 1.82%) and oxybutynin (2.96%; 1.82%). The absolute reduction in the overall prevalence was 8.5 percentage points (relative reduction of 51.4%). CONCLUSION This multifactorial intervention is feasible and effective in reducing the use of potentially inappropriate medication in all drug classes evaluated.
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Affiliation(s)
- Marcelo Schapira
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
| | - Pablo Calabró
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
| | - Manuel Montero-Odasso
- Geriatric Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Abdelhady Osman
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - María Elena Guajardo
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
| | - Bernardo Martínez
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
| | - Javier Pollán
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
- Department of Public Health, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Luis Cámera
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
| | - Miguel Sassano
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina
| | - Gastón Perman
- Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina.
- Department of Public Health, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.
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16
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Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol. Healthcare (Basel) 2021; 9:healthcare9111539. [PMID: 34828585 PMCID: PMC8622925 DOI: 10.3390/healthcare9111539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/21/2022] Open
Abstract
In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs.
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17
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Laatikainen O, Sneck S, Turpeinen M. Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge. Eur J Clin Pharmacol 2021; 78:159-170. [PMID: 34611721 PMCID: PMC8748358 DOI: 10.1007/s00228-021-03213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022]
Abstract
Purpose Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.
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Affiliation(s)
- O Laatikainen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland. .,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.
| | - S Sneck
- Oulu University Hospital, Oulu, Finland
| | - M Turpeinen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland.,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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18
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Dumain M, Jaglin P, Wood C, Rainville P, Pageaux B, Perrochon A, Lavallière M, Vendeuvre T, Romain D, Langlois P, Cardinaud N, Tchalla A, Rigoard P, Billot M. Long-Term Efficacy of a Home-Care Hypnosis Program in Elderly Persons Suffering From Chronic Pain: A 12-Month Follow-Up. Pain Manag Nurs 2021; 23:330-337. [PMID: 34344593 DOI: 10.1016/j.pmn.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pain is a major public health concern in the aging population. However, medication brings about negative effects that compel healthcare professionals to seek alternative management techniques to alleviate pain. Hypnosis has been recognized as an effective technique to manage pain, but its long-term efficacy has yet to be examined in older adults. AIMS The aim was to assess the effectiveness, over a 12-month period, of home-care hypnosis in elderly participants suffering from chronic pain. DESIGN Real-life retrospective one-arm study with a 12-month follow-up. SETTINGS Elderly Persons Suffering From Chronic Pain enrolled in a clinical health care program that offered home medical follow-up. PARTICIPANTS/SUBJECTS Fourteen elderly women (mean age 81 years) with chronic pain participated in the home-care hypnosis program. All participants presented chronic pain (≥6 months) with average pain score >4/10. METHODS Participants took part in seven 15-minute hypnosis sessions within 12 months. The Brief Pain Inventory questionnaire was used to evaluate pain perception and pain interference at baseline and at 3-, 6-, and 12-month follow-up period. RESULTS Hypnosis home-care program significantly decreased pain perception and pain interference compared to baseline after 3 months (-29% and -40%, p < .001), and remained lower at 6 (-31% and -54%, p < .001) and 12 (-31% and -47%, p < .001) months. CONCLUSIONS Seven sessions of 15 minutes allocated throughout a 12-month period produced clinically significant decreases in pain perception and pain interference. Hypnosis could be considered as an optimal additional way for health practitioners to manage chronic pain in an elderly population with long-term efficacy. This study offers a new long-term option to improve chronic pain management at home in elderly populations through a low-cost nonpharmacological intervention.
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Affiliation(s)
- Marion Dumain
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Pauline Jaglin
- Rehabilitation Centre André Lalande - Fondation Partage et Vie, Noth, France
| | - Chantal Wood
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Pierre Rainville
- Department of Stomatology, University of Montreal, Montreal, Quebec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Benjamin Pageaux
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada; École de kinésiologie et des sciences de l'activité physique (EKSAP), Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Anaick Perrochon
- HAVAE EA 6310 Laboratory, University of Limoges, Limoges, France
| | - Martin Lavallière
- Laboratoire de Recherche Biomécanique & Neurophysiologique en Réadaptation Neuro-Musculo-Squelettique-Lab BioNR, Department of Health Sciences, Centre Intersectoriel en Santé Durable (CISD), Module de Kinésiologie, Université du Québec à Chicoutimi, Saguenay, QC, Canada
| | - Tanguy Vendeuvre
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France; Pprime Institute UPR 3346, CNRS - University of Poitiers - ISAE-ENSMA, Poitiers, France; Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
| | - David Romain
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Pascaline Langlois
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Noelle Cardinaud
- Department of Clinical Geriatric, University Hospital Center, Limoges, France; UPSAV, Department of Clinical Geriatric, University Hospital Center, Limoges, France
| | - Achille Tchalla
- Department of Clinical Geriatric, University Hospital Center, Limoges, France
| | - Philippe Rigoard
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Pprime Institute UPR 3346, CNRS - University of Poitiers - ISAE-ENSMA, Poitiers, France; Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
| | - Maxime Billot
- From the PRISMATICS Lab (Predictive Research In Spine/Neurostimulation Management And Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France.
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Paradissis C, Cottrell N, Coombes I, Scott I, Wang W, Barras M. Patient harm from cardiovascular medications. Ther Adv Drug Saf 2021; 12:20420986211027451. [PMID: 34367546 PMCID: PMC8317255 DOI: 10.1177/20420986211027451] [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: 10/23/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary
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Affiliation(s)
- Chariclia Paradissis
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Wang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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Ayalew MB, Dieberg G, Quirk F, Spark MJ. Development and validation of explicit criteria to identify potentially inappropriate prescribing for adults with type 2 diabetes mellitus. Res Social Adm Pharm 2021; 18:2989-2996. [PMID: 34330635 DOI: 10.1016/j.sapharm.2021.07.014] [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: 12/14/2020] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early detection and timely resolution of potentially inappropriate prescribing (PIP) prevents adverse outcomes and improves patient care. An explicit tool specifically designed to detect PIP among people with Type 2 Diabetes Mellitus (T2DM) has not been published. OBJECTIVES This study aims to develop and validate the Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus (IMPACT2DM); an explicit tool that can be used to identify PIP for adults with T2DM. METHODS Current national and international guidelines for the management of T2DM and drug information software programs were used to generate potential items. The content of the IMPACT2DM was validated by 2 consecutive rounds of Delphi method. Physicians and clinical pharmacists experienced in providing care for people with diabetes and authors of selected diabetes guidelines were invited to participate in the Delphi panel. Consensus was assumed if 90% (first round) and 85% (second round) of expert panelists showed agreement to include or exclude an item. RESULTS A total of 95 potential items were generated from selected diabetes guidelines and drug information software programs. After the first Delphi round 27 items had ≥90% agreement and were included in the tool; 19 items were considered not PIP and were excluded from the tool. The second round contained 49 items; of these 43 were included and 6 were excluded from the tool. The final IMPACT2DM contains 70 items categorized by type of PIP and arranged in terms of medical conditions and medication classes. IMPACT2DM can be applied using information on medical charts and requires minimal or no clinical knowledge to assess quality of diabetes care and improve medication selection. CONCLUSIONS IMPACT2DM has been developed from current quality evidence and undergone content validation. It is the first explicit tool specifically designed to identify PIP for adults with T2DM.
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Affiliation(s)
- Mohammed Biset Ayalew
- Pharmacy, School of Rural Medicine, University of New England, Armidale, 2351, Australia; Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Gudrun Dieberg
- Biomedical Science, School of Science and Technology, University of New England, Armidale, 2351, Australia
| | - Frances Quirk
- Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - M Joy Spark
- Pharmacy, School of Rural Medicine, University of New England, Armidale, 2351, Australia.
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Grubbs C, Morris L. This is not the time to modify a HTN regimen. THE JOURNAL OF FAMILY PRACTICE 2021; 70:293-295. [PMID: 34431775 PMCID: PMC8407227 DOI: 10.12788/jfp.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intensifying hypertension regimens at discharge increases risk in older patients.
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22
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Mekonnen AB, Redley B, de Courten B, Manias E. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4150-4172. [PMID: 34008195 PMCID: PMC8597090 DOI: 10.1111/bcp.14870] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/17/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS To synthesise associations of potentially inappropriate prescribing (PIP) with health-related and system-related outcomes in inpatient hospital settings. METHODS Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health-related and system-related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates. RESULTS Overall, 63 studies were included. Pooled risk estimates did not show a significant association with all-cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90-1.36; adjusted hazard ratio 1.02, 83% CI 0.90-1.16), and hospital readmission (AOR 1.11, 95% CI 0.76-1.63; adjusted hazard ratio 1.02, 95% CI 0.89-1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event-related hospital admissions (AOR 1.91, 95% CI 1.21-3.01), functional decline (AOR 1.60, 95% CI 1.28-2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11-1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health-related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods. CONCLUSIONS PIP was significantly associated with a range of health-related and system-related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.
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Affiliation(s)
- Alemayehu B Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
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Adamczak M, Chudek J, Zejda J, Bartmańska M, Grodzicki T, Zdrojewski T, Wiecek A. Prevalence of hypokalemia in older persons: results from the PolSenior national survey. Eur Geriatr Med 2021; 12:981-987. [PMID: 33830482 PMCID: PMC8463376 DOI: 10.1007/s41999-021-00484-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Hypokalemia is one of the most common electrolyte disturbances in clinical practice. There are only a few epidemiological studies analyzing the occurrence of hypokalemia in older persons. The aim of the study was to determine the prevalence of hypokalemia in the Polish older population. METHODS Serum potassium concentration was estimated in 4654 participants (2270 females and 2384 males, mean age 76.5 [11.0] years), who participated in the PolSenior study. Hypokalemia was defined as serum potassium concentration below 3.5 mmol/L. Hypokalemia was found in 39 participants (0.84%) and was significantly more frequent among females (28 females = 1.23% and 11 males = 0.46%; p = 0.003). The prevalence of hypokalemia was not related to age. Among 3303 participants suffering from arterial hypertension, 1093 were treated with potassium-losing diuretics. RESULTS Hypokalemia was significantly more frequent among hypertensive than normotensive older participants (1.06 vs. 0.30% respectively; p = 0.007) and among hypertensive participants treated with potassium losing diuretics than ones untreated with these drugs (1.96 vs. 0.46% respectively; p < 0.001). In hypertensive participants, the prevalence of hypokalemia did not depend significantly on oral supplementation of potassium (1.92 and 0.98% respectively, NS). None of 81 participants using laxative agents presented hypokalemia. CONCLUSIONS This study demonstrates that: older age seems not to appear to be a significant risk factor of hypokalemia. Hypokalemia is more often found in the older hypertensive patients treated with potassium losing diuretics, and prevention of diuretic-induced hypokalemia with oral supplementation of potassium seems to be insufficient.
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Affiliation(s)
- Marcin Adamczak
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Francuska Str. 20/24, 40-027, Katowice, Poland
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jan Zejda
- Department of Epidemiology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Magdalena Bartmańska
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Francuska Str. 20/24, 40-027, Katowice, Poland.
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Zdrojewski
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Francuska Str. 20/24, 40-027, Katowice, Poland
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24
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Seifert J, Fay B, Strueven NT, Schiekofer S, Wenzel-Seifert K, Haen E. [Adverse Drug Reactions in Geriatric Psychiatric Patients - Influence of Potentially Inappropriate Drugs]. PSYCHIATRISCHE PRAXIS 2021; 49:37-45. [PMID: 33773503 DOI: 10.1055/a-1394-2412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the extent to which "potentially inappropriate drugs" (PID) are associated with an increased risk for adverse drug reactions (ADR). METHODS Data from 304 geriatric psychiatric inpatients was collected. Medical documentation was used to find indications of ADRs. Causal relationship between the ADR and the prescribed drugs was assessed by experts. RESULTS Almost 30 % of patients received ≥ 1 PID before admission to hospital, in comparison to 22 % at discharge. Increasing number of total prescriptions and the diagnosis of schizophrenia resulted in an increased risk for receiving ≥ 1 PID. Higher age and dementia were protective factors. Patients receiving ≥ 1 PID had a 5-fold increased risk of experiencing ≥ 1 ADR. Risk for an ADR increased with number of PID prescriptions. Patients treated with ≥ 1 PID had a 4-fold increased risk of experiencing severe ADRs. Risk for severe ADRs was 10-fold higher in patients treated with ≥ 2 PIDs. CONCLUSION The PRISCUS list predicts significant risk factors for the occurrence of ADRs in the geriatric psychiatric setting.
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Affiliation(s)
- Johanna Seifert
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Sozialpsychiatrie, Medizinische Hochschule Hannover, Deutschland
| | - Bianca Fay
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland
| | - Nina Theresa Strueven
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, kbo-Inn-Salzach-Klinikum GmbH, Wasserburg am Inn, Deutschland
| | - Stephan Schiekofer
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland
| | | | - Ekkehard Haen
- Klinik für Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Deutschland
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25
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Hospital admissions to geriatric ward related to adverse drug events: a cross-sectional study from the Czech Republic. Int J Clin Pharm 2021; 43:1218-1226. [PMID: 33763812 DOI: 10.1007/s11096-021-01237-y] [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: 09/25/2020] [Accepted: 01/13/2021] [Indexed: 10/21/2022]
Abstract
Background Geriatric patients represent a vulnerable population in terms of adverse drug events (ADEs). Objective The aims of this study were to determine the prevalence and preventability of hospital admissions to a geriatric ward related to ADEs, to identify medications involved in these ADEs and to describe potential preventability aspects of ADE-related admissions. Setting University Hospital Hradec Králové, Czech Republic. Methods This cross-sectional study evaluated acute hospital admissions to the geriatric ward of University Hospital Hradec Králové over a period of nine months (April-December 2017). Medication reviews were performed in order to identify ADE-related hospital admissions. Causality was assessed using the World Health Organization-Uppsala Monitoring Centre criteria. Modified Schumock-Thornton algorithm was used to assess the preventability of ADEs. Main outcome measure 9-month-prevalence of ADE-related hospital admissions. Results A total of 366 hospital admissions were included. The 9-month-prevalence of ADE-related hospital admissions was 11.75% [95% confidence interval 8.45-15.05]. Antithrombotic agents and diuretics represented the most common medication classes associated with ADEs (30.2% each). Electrolyte disturbances and gastrointestinal haemorrhages and ulcerations were the most frequently observed ADEs associated with hospital admission. Out of 43 ADE-related hospitalisations, 23 (53.5%) were considered potentially preventable. Conclusion The contribution of ADEs to hospital admission to the geriatric ward was not negligible. Our results also suggest that 53.5% of identified ADE-related admissions could be potentially prevented. This finding demonstrates just how important the research on the preventability of medication-related hospitalisations is. Further studies and implementations are still needed aiming to minimize the risk of medication-related harm.
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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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Xue Y, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Lang BH, Kelley-Baker T, Li G. Potentially Inappropriate Medication Use and Hard Braking Events in Older Drivers. Geriatrics (Basel) 2021; 6:20. [PMID: 33672575 PMCID: PMC8005989 DOI: 10.3390/geriatrics6010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study came from the Longitudinal Research on Aging Drivers study, a multisite naturalistic driving study of older adults. Multivariable negative binominal modeling was used to estimate incidence rate ratios and 95% confidence intervals of hard braking events (proxies for unsafe driving behavior defined as events with a deceleration rate ≥0.4 g) associated with PIM use among older drivers. The study sample consisted of 2932 drivers aged 65-79 years at baseline, including 542 (18.5%) who used at least one PIM. These drivers were followed through an in-vehicle recording device for up to 44 months. The overall incidence of hard braking events was 1.16 per 1000 miles. Use of PIMs was associated with a 10% increased risk of hard braking events. Compared to drivers who were not using PIMs, the risk of hard braking events increased 6% for those using one PIM, and 24% for those using two or more PIMs. Use of PIMs by older adult drivers is associated in a dose-response fashion with elevated risks of hard braking events. Reducing PIM use in older adults might help improve driving safety as well as health outcomes.
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Affiliation(s)
- Yuqing Xue
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (Y.X.); (T.J.M.)
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; (S.C.); (B.H.L.)
| | - Howard F. Andrews
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO 80045, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - David W. Eby
- University of Michigan Transportation Research Institute, Ann Arbor, MI 48109, USA; (D.W.E.); (L.J.M.)
- Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI 48109, USA
| | - Linda L. Hill
- School of Public Health, University of California San Diego, La Jolla, CA 92093, USA;
| | - Vanya Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Thelma J. Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (Y.X.); (T.J.M.)
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Lisa J. Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, MI 48109, USA; (D.W.E.); (L.J.M.)
- Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI 48109, USA
| | | | - Barbara H. Lang
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; (S.C.); (B.H.L.)
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (Y.X.); (T.J.M.)
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; (S.C.); (B.H.L.)
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Sharma R, Bansal P, Arora M. Pitfalls in AGS Beers Criteria® Reflect Communication Gap Between Top Healthcare Organizations: Beware or Be Aware. J Am Geriatr Soc 2020; 68:2969-2971. [PMID: 33000469 DOI: 10.1111/jgs.16859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Rishabh Sharma
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, India
| | - Parveen Bansal
- University Centre of Excellence in Research, Baba Farid University of Health Sciences, Faridkot, India
| | - Malika Arora
- Multidisciplinary Research Unit, Department of Health Research, Ministry of Family and Welfare, Government of India, Guru Gobind Singh Medical College and Hospital, Faridkot, India
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Farrell B, Grad R, Howell P, Quast T, Reeve E. Deprescribing Guidelines: Value of an Interactive Mobile Application. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2020; 4:26. [PMID: 33111053 DOI: 10.22454/primer.2020.349237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction We developed a new channel on a mobile app as a continuing education tool to augment the use of deprescribing guideline content in clinical practice. In this research brief, we describe the reach and adoption of channel content, as well as user feedback. Methods Using Google Analytics, we counted page views of the website (deprescribing.org) where the app was promoted. We calculated total app downloads, monthly active users, and guideline-specific page views. Users were invited to complete the embedded Information Assessment Method (IAM) Questionnaire to obtain feedback on the value of information presented on the Deprescribing Channel. Results Between March 2, 2019 and November 30, 2019, we documented 9,454 page views of the promotional web page across 40 countries. The Deprescribing Channel was downloaded 3,256 times with an average of 464 monthly users. In total, the guidelines on this channel were accessed 14,377 times with 49,721 views across all guideline pages. Thirty-seven IAM questionnaires were completed. Thirty-two responses indicated this deprescribing information was relevant for at least one of their patients. Regarding educational outcomes, 22 responses were of learning something new and/or being motivated to learn more. Conclusion We documented international interest in a mobile app providing continuing education on deprescribing. App users generated sustained page views over the study period. Feedback from a small number of users was positive with the majority finding the content relevant, educational, and applicable to patient care. Further work is needed to improve the usability of the embedded feedback questionnaire and to evaluate its value in supporting learning.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute and Department of Family Medicine, University of Ottawa, Ottawa, Canada
- and School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Roland Grad
- McGill University Department of Family Medicine, Montreal, Quebec, Canada
| | - Pam Howell
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Tammie Quast
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
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ÇADIRCI D, OĞUZ E, KOÇAKOĞLU Ş, YAVUZ E, ALAŞEHİRLİ B. Knowledge and Attitudes of Resident Physicians About Adverse Drug Reactions. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.755655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Riaz M, Brown JD. Association of Adverse Drug Events with Hospitalization Outcomes and Costs in Older Adults in the USA using the Nationwide Readmissions Database. Pharmaceut Med 2020; 33:321-329. [PMID: 31933184 DOI: 10.1007/s40290-019-00286-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adverse drug events (ADEs) are a primary cause of significant morbidity, mortality, and healthcare utilization in older adults. OBJECTIVE The objective of this study was to evaluate the clinical outcomes and cost of ADEs during hospitalization in older adults. METHODS Discharges for patients aged 65 years or older were identified in the 2014 Nationwide Readmissions Database. ADEs were selected based on a previously developed algorithm of 442 unique diagnoses and external causes of injury codes. Patients were categorized into ADE or non-ADE groups. Regression models were used for a multivariable analysis for each outcome metric, which included all-cause readmission, in-hospital mortality, length of stay, and costs. RESULTS The study included 3,832,322 patients. Among these patients, 203,432 (5.3%) had at least one ADE during hospitalization. The majority of ADEs were related to broad categories of "medications affecting blood constituents" (22%) and "adverse effects of biological and medicinal substances in therapeutic use" (23%). In adjusted models, older adults with ADEs during hospitalization had a 25% (p < 0.0001) and 9% (p < 0.0001) higher odds of readmission and in-hospital mortality, respectively, as compared with those without ADEs. A 17% (p < 0.0001) increase in the length of stay was estimated in the ADE group and 1% point estimate (p > 0.05) rise in cost was observed in the ADE group when compared with the non-ADE group. CONCLUSIONS ADEs have a substantial burden on in-patient care of older adults both clinically (increased readmission, in-hospital mortality, and length of stay) and financially. Targeted interventions can help to prevent ADEs and, consequently, the associated clinical and economic burden.
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Affiliation(s)
- Munaza Riaz
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA. .,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
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Adverse drug reactions that arise from the use of medicinal products outside the terms of the marketing authorisation. Res Social Adm Pharm 2020; 16:928-934. [DOI: 10.1016/j.sapharm.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
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Conhecimento de estudantes de medicina sobre medicamentos inapropriados para idosos. PAJAR - PAN AMERICAN JOURNAL OF AGING RESEARCH 2020. [DOI: 10.15448/2357-9641.2020.1.34163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivos: verificar e descrever o conhecimento de alunos de medicina sobre medicamentos inapropriados para idosos conforme os Critérios de Beers.Métodos: estudo transversal com a aplicação de questionários a 102 alunos matriculados do 9.º ao 11.º semestre do curso de Medicina da Universidade Luterana do Brasil – Canoas. Levantaram-se informações referentes ao conhecimento dos acadêmicos sobre medicamentos inapropriados para idosos frágeis ou com mais de 80 anos, com base na classificação do Critério de Beers.Resultados: 84,3% dos alunos pesquisados afirmaram ter conhecimento sobre medicamentos inapropriados para idosos, porém o percentual total de acertos foi de 20,2%. O maior número de acertos foi relacionado quanto à segurança do Diazepam (49%) e o menor percentual de acertos foi quanto ao medicamento Fluoxetina, com apenas 4,9% das respostas corretas. O maior percentual de respostas “Não Sei” foram relacionados em Oxibutinina (48%) e Ciclobenzaprina (37,3%). Os entrevistados que afirmaram não conhecer o tema e os indivíduos do sexo masculino apresentaram conhecimento significativamente maior com p=0,001.Conclusões: a maioria dos entrevistados afirmaram possuir conhecimento sobre o tema, porém a frequência de acertos foi baixa. O aprimoramento do ensino visando maior qualidade na prescrição e o uso racional de medicamentos é necessário para minimizar a iatrogenia em idosos
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Ross MSc Candidate SB, Wu PE, Atique Md Candidate A, Papillon-Ferland L, Tamblyn R, Lee TC, McDonald EG. Adverse Drug Events in Older Adults: Review of Adjudication Methods in Deprescribing Studies. J Am Geriatr Soc 2020; 68:1594-1602. [PMID: 32142161 DOI: 10.1111/jgs.16382] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Polypharmacy is common in older adults and associated with adverse drug events (ADEs). Several methods have been described in studies to help correlate ADE causation. We performed a narrative review to identify methods for ADE adjudication. We compared their strengths and limitations to assess their applicability to deprescribing studies (of which clinical trials are a subset) and to encourage the use of a standardized method in future studies. DESIGN We performed a review of original articles (1946-2019) using the Medline (Ovid) and Cochrane databases. We also conducted a manual reference search of review articles. Abstracts were screened for relevance. MEASUREMENTS Adjudication methods were compared for advantages and limitations including validity, ease of use, and applicability to clinical trials with deprescribing as the primary intervention. RESULTS The search yielded 1881 articles of which 175 articles were included for full-text review. Following in-depth review, 135 were excluded: 79 had no ADE outcome data, 35 were not specific to older adults, 9 were not relevant, 6 were review articles, 5 contained duplicate data, and 1 was not written in French or English. Forty articles remained for analysis, from which we identified 10 unique ADE adjudication methods. No method was developed originally for use in a deprescribing setting. CONCLUSION A standard method to identify ADEs is important to capture the outcome reliably in deprescribing studies. All methods we identified had limitations in terms of capturing adverse events from the withdrawal of medications. Future work should focus on refining adjudication methods for capturing ADEs related not only to medication continuation and new drug starts but also to deprescribing and drug discontinuation. J Am Geriatr Soc 68:1594-1602, 2020.
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Affiliation(s)
| | - Peter E Wu
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Louise Papillon-Ferland
- Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada.,Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Robyn Tamblyn
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Emily G McDonald
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Quebec, Canada
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35
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Sharma R, Arora M, Garg R, Bansal P. A closer look at the 2019 Beers criteria. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-019-00704-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Shrestha S, Poudel A, Steadman K, Nissen L. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: A systematic review. Br J Clin Pharmacol 2019; 86:1931-1945. [PMID: 31483057 DOI: 10.1111/bcp.14113] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Older patients with life-limiting illness (LLI) and limited life expectancy (LLE) continue to receive potentially inappropriate medicines, consequently deprescribing is often necessary. However, deprescribing in this population can be complex and challenging. Therefore, we aimed to investigate the evidence for outcomes of deprescribing interventions in older patients with LLI and LLE. METHODS Studies on deprescribing intervention and their outcomes in age ≥65 years with LLI and LLE were searched using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar. Medication appropriateness was primary outcome, while clinical and cost-related outcomes were secondary. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. RESULTS Of 9 studies (1375 participants), 3 reported on primary outcome. One study showed a significant reduction in medication inappropriateness by 34.9% (P < .001) from admission to close-out, the second achieved 29.4% (P < .001) and 15.1% (P = .003) reduction at 12 and 24 months, respectively. The third reported that their intervention stopped (17.2%) and altered the dose (2.6%) of high-risk medications. Commonly reported clinical outcomes were mortality (n = 3), quality of life (n = 2) and falls (n = 2). Outcomes in terms of cost were reported as overall cost (n = 2), medication cost (n = 1) and health care expenditure (n = 1). CONCLUSION Our findings suggest that deprescribing in older patients with LLI and LLE can improve medication appropriateness, and has potential for enhancement of several clinical outcomes and cost savings, but the evidence needs to be better established.
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Affiliation(s)
- Shakti Shrestha
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kathryn Steadman
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Rawat BPS, Li F, Yu H. Naranjo Question Answering using End-to-End Multi-task Learning Model. KDD : PROCEEDINGS. INTERNATIONAL CONFERENCE ON KNOWLEDGE DISCOVERY & DATA MINING 2019; 2019:2547-2555. [PMID: 31799022 DOI: 10.1145/3292500.3330770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the clinical domain, it is important to understand whether an adverse drug reaction (ADR) is caused by a particular medication. Clinical judgement studies help judge the causal relation between a medication and its ADRs. In this study, we present the first attempt to automatically infer the causality between a drug and an ADR from electronic health records (EHRs) by answering the Naranjo questionnaire, the validated clinical question answering set used by domain experts for ADR causality assessment. Using physicians' annotation as the gold standard, our proposed joint model, which uses multi-task learning to predict the answers of a subset of the Naranjo questionnaire, significantly outperforms the baseline pipeline model with a good margin, achieving a macro-weighted f-score between 0.3652 - 0.5271 and micro-weighted f-score between 0.9523 - 0.9918.
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Affiliation(s)
| | - Fei Li
- UMass Lowell, Lowell, USA
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38
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Li G, Andrews HF, Chihuri S, Lang BH, Leu CS, Merle DP, Gordon A, Mielenz TJ, Strogatz D, Eby DW, Betz ME, DiGuiseppi C, Jones VC, Molnar LJ, Hill LL. Prevalence of Potentially Inappropriate Medication use in older drivers. BMC Geriatr 2019; 19:260. [PMID: 31601189 PMCID: PMC6785868 DOI: 10.1186/s12877-019-1287-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 09/20/2019] [Indexed: 01/03/2023] Open
Abstract
Background Potentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers. Methods We applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the “brown-bag” review of medications for participants of the Longitudinal Research on Aging Drivers (LongROAD) study to examine the prevalence and correlates of PIM use in a geographically diverse, community-dwelling sample of older drivers (n = 2949). Proportions of participants who used one or more PIMs according to the American Geriatrics Society 2015 Beers Criteria, and estimated odds ratios (ORs) and 95% confidence intervals (CIs) of PIM use associated with participant characteristics were calculated. Results Overall, 18.5% of the older drivers studied used one or more PIM. The most commonly used therapeutic category of PIM was benzodiazepines (accounting for 16.6% of the total PIMs identified), followed by nonbenzodiazepine hypnotics (15.2%), antidepressants (15.2%), and first-generation antihistamines (10.5%). Compared to older drivers on four or fewer medications, the adjusted ORs of PIM use were 2.43 (95% CI 1.68–3.51) for those on 5–7 medications, 4.19 (95% CI 2.95–5.93) for those on 8–11 medications, and 8.01 (95% CI 5.71–11.23) for those on ≥12 medications. Older drivers who were female, white, or living in urban areas were at significantly heightened risk of PIM use. Conclusion About one in five older drivers uses PIMs. Commonly used PIMs are medications known to impair driving ability and increase crash risk. Implementation of evidence-based interventions to reduce PIM use in older drivers may confer both health and safety benefits. Trial registration Not applicable.
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Affiliation(s)
- Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA. .,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. .,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA.
| | - Howard F Andrews
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA
| | - Barbara H Lang
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA
| | - Cheng Shiun Leu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - David P Merle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Abigail Gordon
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, 622 West 168th St, PH5-505, New York, NY, 10032, USA
| | | | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA.,The Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vanya C Jones
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, MI, USA.,The Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Linda L Hill
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
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Xing XX, Zhu C, Liang HY, Wang K, Chu YQ, Zhao LB, Jiang DC, Wang YQ, Yan SY. Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis. Ann Pharmacother 2019; 53:1005-1019. [PMID: 31129978 DOI: 10.1177/1060028019853069] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Adverse drug outcomes in the elderly have led to the development of lists of potentially inappropriate medications (PIMs), such as the Beers criteria, and these PIMs have been studied widely; however, it is still unclear whether PIM use is predictive of adverse outcomes in older people. Objective: To qualitatively examine the associations between exposure to PIMs from the general Beers criteria and the Screening Tool of Older Persons' Prescriptions list and adverse outcomes, such as adverse drug reactions (ADRs)/adverse drug events (ADEs), hospitalization, and mortality. Methods: Specified databases were searched from inception to February 1, 2018. Two reviewers independently selected studies that met the inclusion criteria, assessed study quality, and extracted data. Data were pooled using Stata 12.0. The outcomes were ADRs/ADEs, hospitalization, and mortality. Results: A total of 33 studies met the inclusion criteria. The combined analysis revealed a statistically significant association between ADRs/hospitalizations and PIMs (odds ratio [OR] = 1.44, 95% CI = 1.33-1.56; OR = 1.27, 95% CI = 1.20-1.35), but no statistically significant association was found between mortality and PIMs (OR = 1.04; 95% CI = 0.75-1.45). It is interesting to note that the results changed when different continents/criteria were used for the analysis. Compared with the elderly individuals exposed to 1 PIM, the risk of adverse health outcomes was much higher for those who took ≥2 PIMs. Conclusion and Relevance: We recommend that clinicians avoid prescribing PIMs for older adults whenever feasible. In addition, the observed associations should be generalized to other countries with different PIM criteria with caution.
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Affiliation(s)
- Xiao Xuan Xing
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Chen Zhu
- 3 Zhejiang University, Hangzhou, P R China
| | - Hua Yu Liang
- 4 The Seventh Medical Center of PLA General Hospital, Beijing, P R China
| | - Ke Wang
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Yan Qi Chu
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Li Bo Zhao
- 5 Capital Medical University, Beijing, P R China
| | - De Chun Jiang
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Yu Qin Wang
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
| | - Su Ying Yan
- 1 Xuanwu Hospital of Capital Medical University, Beijing, P R China.,2 National Clinical Research Center for Geriatric Disorders, Beijing, P R China
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Liao PJ, Mao CT, Chen TL, Deng ST, Hsu KH. Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case-control study. BMJ Open 2019; 9:e026771. [PMID: 31079084 PMCID: PMC6530431 DOI: 10.1136/bmjopen-2018-026771] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients. DESIGN A nested case-control study. SETTING A medical centre located in north Taiwan. PARTICIPANTS 539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected. EXPOSURE Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses. PRIMARY AND SECONDARY OUTCOME MEASURES ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes. RESULTS The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively. CONCLUSIONS The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient's safety improvement in geriatric care.
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Affiliation(s)
- Pei-Ju Liao
- Department of Health Care Administration, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Chien-Tai Mao
- Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tun-Liang Chen
- Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Tarng Deng
- Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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Petit-Monéger A, Jouhet V, Thiessard F, Berdaï D, Noize P, Gilleron V, Caridade G, Salmi LR, Saillour-Glénisson F. Appropriateness of psychotropic drug prescriptions in the elderly: structuring tools based on data extracted from the hospital information system to understand physician practices. BMC Health Serv Res 2019; 19:272. [PMID: 31039784 PMCID: PMC6492442 DOI: 10.1186/s12913-019-4064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/05/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The appropriateness of psychotropic prescriptions in the elderly is a major quality-of-care challenge at hospital. Quality indicators have been developed to prevent inappropriate psychotropic prescriptions. We aimed to select and automatically calculate such indicators, from the Bordeaux University Hospital information system, and to analyze the appropriateness of psychotropic prescription practices, in an observational study. METHODS Experts selected indicators of the appropriateness of psychotropic prescriptions in hospitalized elderly patients, according to guidelines from the French High Authority for Health. The indicators were reformulated to focus on psychotropic administrations. The automated calculation of indicators was analyzed by comparing their measure to data collected from a clinical audit. In elderly patients hospitalized between 2014 and 2015, we then analyzed the evolution of the appropriateness of psychotropic prescription practices during hospital stay, using methods of visualization, and described practices by considering patients' characteristics. RESULTS Two indicators were automated to detect overuse and misuse of psychotropic drugs. Indicators identified frequent inappropriate drug administrations, but practices tended to become more appropriate after quality-of-care improvement actions. In the majority of patients (85%), there was no inappropriate administration of psychotropic drugs during hospital stay; for the remaining 15% with at least one inappropriate administration, physicians tended to limit overuse or misuse during hospital stay. Inappropriate administrations were more frequent in patients suffering from psychiatric disorders, dependence and associated complications or morbidities. CONCLUSIONS The automated indicators are structuring tools for the development of a drug prescription monitoring system. Inappropriate psychotropic administrations were limited by physicians during hospital stay; some inappropriate prescriptions might be explained by clinical characteristics of patients.
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Affiliation(s)
- Aurélie Petit-Monéger
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France. .,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - Vianney Jouhet
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - Frantz Thiessard
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Pernelle Noize
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Véronique Gilleron
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Guillaume Caridade
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Louis-Rachid Salmi
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - Florence Saillour-Glénisson
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.,Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
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Monteiro Mantovani V, Moorhead S, de Abreu Almeida M, Rabelo-Silva ER. Adverse Reactions to Medications: Concept Analysis and Development of a New Risk Nursing Diagnosis. Int J Nurs Knowl 2019; 31:87-93. [PMID: 30900386 DOI: 10.1111/2047-3095.12237] [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: 02/14/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the concept of adverse reaction to medications and to develop the new nursing diagnosis Risk for Adverse Reactions to Medications. METHODS Concept analysis using Walker and Avant's eight step method. FINDINGS Thirty-three articles indexed in four databases were included. The components of the new nursing diagnosis were determined, including possible nursing outcomes and interventions. CONCLUSIONS The concept analysis supported the development of the new nursing diagnosis Risk for Adverse Reactions to Medications, which may help nurses to evaluate and identify patients susceptible to adverse reactions. IMPLICATIONS FOR NURSING PRACTICE The establishment of this nursing diagnosis will provide nurses an opportunity to implement interventions to anticipate and effectively intervene with patients at risk for this condition.
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Affiliation(s)
- Vanessa Monteiro Mantovani
- Vanessa Monteiro Mantovani, RN, MSc, is a PhD Student at the Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Brazil, is a Visiting Scholar at the College of Nursing, University of Iowa, Iowa, is a Member of the Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Sue Moorhead
- Sue Moorhead, RN, PhD, FAAN, is an Associate Professor at the College of Nursing, University of Iowa, Iowa, is the Director of the Center for Nursing Classification and Clinical Effectiveness, Iowa
| | - Miriam de Abreu Almeida
- Miriam de Abreu Almeida, RN, PhD, is an Associate Professor at the School of Nursing, is the Coordinator of the Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Brazil, is a Researcher at the GEPECADI, Porto Alegre, Rio Grande do Sul, Brazil, is a Researcher of CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida Rejane Rabelo-Silva
- Eneida Rejane Rabelo-Silva, RN, MSc, ScD, is an Associate Professor at the School of Nursing, Universidade Federal do Rio Grande do Sul, Nurse Coordinator of the PICC TEAM, Hospital de Clínicas de Porto Alegre, Brazil, is a Researcher at the GEPECADI, Porto Alegre, Rio Grande do Sul, Brazil, is a Researcher at CNPq, Porto Alegre, Rio Grande do Sul, Brazil
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Oktora MP, Denig P, Bos JHJ, Schuiling-Veninga CCM, Hak E. Trends in polypharmacy and dispensed drugs among adults in the Netherlands as compared to the United States. PLoS One 2019; 14:e0214240. [PMID: 30901377 PMCID: PMC6430511 DOI: 10.1371/journal.pone.0214240] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Polypharmacy is becoming increasingly common owing to the ageing population, which can pose problems for patients and society. We investigated the trends in polypharmacy and underlying drug groups among adults in the Netherlands from 1999 to 2014 stratified by age, and compared these with findings from the United States (US). METHODS We conducted a repeated cross-sectional study using the Dutch IADB.nl prescription database. All patients aged 20 years and older in the period 1999 to 2014 were included. Polypharmacy was defined as the dispensing of five or more chronic drugs at the pharmacological subgroup level. Chi-square tests were applied to calculate the p-value for trends. Changes in prevalences were compared between the Netherlands and the US. RESULTS The prevalence of polypharmacy increased from 3.1% to 8.0% (p-value for trend <0.001) over 15 years, and increased in all age groups. The highest rates were observed in patients aged ≥65 years, but the relative increase over time was higher in the younger age groups. Overall, large increases were observed for angiotensin-II inhibitors, statins and proton-pump inhibitors. The relative increase in polypharmacy was larger in the Netherlands than in the US (ratio of polypharmacy prevalence 2.4 versus 1.8). The Netherlands showed larger relative increases for angiotensin-II inhibitors, statins, proton-pump inhibitors, biguanides and smaller relative increases for antidepressants, benzodiazepines and insulins. CONCLUSIONS Polypharmacy more than doubled from 1999 to 2014, and this increase was not limited to the elderly. The relative increase was larger in the Netherlands compared to the US, which was partly due to larger increases in several guideline-recommended preventive drugs.
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Affiliation(s)
- Monika P. Oktora
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- * E-mail:
| | - Petra Denig
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Jens H. J. Bos
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Catharina C. M. Schuiling-Veninga
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen, The Netherlands
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Peeters LEJ, Kester MP, Feyz L, Van Den Bemt PMLA, Koch BCP, Van Gelder T, Versmissen J. Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opin Drug Metab Toxicol 2019; 15:287-297. [PMID: 30880496 DOI: 10.1080/17425255.2019.1588249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hypertension is an important risk factor for developing cardiovascular diseases. It is more prevalent in the elderly population. Recently updated American and European guidelines recommend treating every elderly patient with hypertension independent of age, starting with a low dose of antihypertensive drugs. However, little information is available on the optimal dosages of antihypertensive drugs to treat the elderly safely. Areas covered: Comorbidities, co-medication and frailty status can alter the clinical outcome of drug treatment and can cause adverse events in the elderly. Also, due to pharmacokinetic and pharmacodynamic changes the interpatient variability when using antihypertensive drugs is considerable. In this review, an overview is given on the extent to which the previously mentioned parameters are changed in elderly patients and what this means for the exposure to antihypertensive medication. Also, recommendations on the starting dose of the most frequently used antihypertensive drugs are given based on literature data. Expert opinion: We believe that recommendations on starting dosages followed by a stepwise increase of dosages will lead to improved blood pressure control and less adverse drug reactions in the elderly patient. This may improve adherence to antihypertensive therapy.
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Affiliation(s)
- L E J Peeters
- a Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.,b Department of Internal Medicine , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - M P Kester
- b Department of Internal Medicine , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - L Feyz
- c Department of Cardiology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - P M L A Van Den Bemt
- a Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - B C P Koch
- a Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - T Van Gelder
- a Department of Hospital Pharmacy , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands.,b Department of Internal Medicine , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - J Versmissen
- b Department of Internal Medicine , Erasmus MC, University Medical Center Rotterdam , Rotterdam , The Netherlands
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Nabhanizadeh A, Oppewal A, Boot FH, Maes-Festen D. Effectiveness of medication reviews in identifying and reducing medication-related problems among people with intellectual disabilities: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:750-761. [PMID: 30793852 PMCID: PMC6850346 DOI: 10.1111/jar.12580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 12/21/2018] [Accepted: 01/30/2019] [Indexed: 01/11/2023]
Abstract
Background Polypharmacy is common in people with intellectual disabilities. Using multiple medication may lead to unintended medication‐related problems (MRPs). Medication review may serve as a tool to reduce MRPs. This systematic review assessed the scientific evidence for the effectiveness of medication reviews in identifying and reducing MRPs in people with intellectual disabilities. Method Literature databases were searched up to August 2017. Studies were selected that included the effect of medication reviews on identifying and/or reducing MRPs in people with intellectual disabilities with no restriction of type of medication, age and level of intellectual disabilities. Results The eight studies that fulfilled the inclusion criteria report that systematic medication reviews appear to assist in the identification and reduction of MRPs. Conclusion There is a lack of studies about the effect of medication reviews on identification and reduction of MRPs, especially health outcomes for people with intellectual disabilities. Further studies with long‐term follow‐up are needed.
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Affiliation(s)
- Amal Nabhanizadeh
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alyt Oppewal
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Dederieke Maes-Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Prescriber Implementation of STOPP/START Recommendations for Hospitalised Older Adults: A Comparison of a Pharmacist Approach and a Physician Approach. Drugs Aging 2019; 36:279-288. [DOI: 10.1007/s40266-018-0627-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Hoisnard L, Santos-Eggimann B, Chauvin P, Hiance-Delahaye A, Herr M. Do older adults know the purpose of their medications? A survey among community-dwelling people. Eur J Clin Pharmacol 2018; 75:255-263. [PMID: 30334201 DOI: 10.1007/s00228-018-2575-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE This study assessed the level of knowledge among community-dwelling older individuals about the purpose of medications and the characteristics that influenced that knowledge. We focused on drugs frequently used and/or often involved in iatrogenic events. METHODS This cross-sectional survey included 2690 community-dwelling older adults, aged 68 years and above, who reported using at least one drug of interest, in the canton of Vaud, Switzerland. Participants reported drugs that they currently used and described their purpose. A good knowledge level was defined as knowledge of the exact purpose or identification of the anatomical system or organ targeted by the drug. We performed a multivariate logistic regression analysis to identify factors associated with a good knowledge level for all drugs of interest. Sampling weights were employed to provide representative estimates. RESULTS On average, patients had good knowledge of 80.6% of the drugs reported. The highest knowledge levels were demonstrated for non-steroidal antiinflammatory drugs, antidiabetics, analgesics, and endocrinological drugs and the lowest for platelet aggregation inhibitors, minerals, anticoagulants, and other narrow therapeutic index drugs. Overall, 66% of participants had good knowledge of the purpose of all the drugs of interest. Polypharmacy and receiving help with drug management were negatively associated with good knowledge (adjusted OR4-5 drugs 0.45; 95% CI 0.29-0.71, adjusted OR≥ 6 drugs 0.20; 95% CI 0.13-0.31, and adjusted ORhelp 0.42; 95% CI 0.18-0.99). CONCLUSION This study showed that education about drugs was lacking among patients that received multiple drugs, particularly patients that used anticoagulants and antiplatelet inhibitors.
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Affiliation(s)
- Léa Hoisnard
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université de Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Anne Hiance-Delahaye
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université de Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,Service des consultations externes, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Sainte Périne, AP-HP, Paris, France
| | - Marie Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France. .,Université de Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France. .,Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Sainte Périne, AP-HP, Paris, France.
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48
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Fermini B, Coyne KP, Coyne ST. Challenges in designing and executing clinical trials in a dish studies. J Pharmacol Toxicol Methods 2018; 94:73-82. [PMID: 30267757 DOI: 10.1016/j.vascn.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022]
Abstract
The ever-increasing cost of drug discovery and development represents a significant challenge for the pharmaceutical industry and new strategies to bridge studies between preclinical testing and clinical trials are needed to reduce the knowledge gap prior to first human exposures, and to allow earlier decisions to be made on the further development of drugs. A number of studies have demonstrated that various cell types differentiated from human induced pluripotent stem cells (iPSCs) do not just respond similarly to human tissues in general, but rather recapitulate the drug response of their specific donor's, when exposed to the same drug in vivo. This recapitulation opens the doors to Clinical Trials in a Dish (CTiD), a platform which involves testing, in vitro, medical therapies for safety on cells collected from a sample of human patients, before moving into clinical trials. However, the science behind CTiD is complex, and every element of the process from tissue acquisition to data generation must be assessed and designed to meet quality metrics and standards. Without such rigorous assessment and design, the basic scientific integrity of CTiD constructs is likely compromised, and the results questionable. Given the lack of standard process and/or quality metrics in place for the use of stem cell-based products for in vitro testing per se, we discuss here the key elements that one needs to consider when designing, implementing and executing CTiD studies, in order to ensure an approach that will reliably mimic clinical trials, and allow obtaining reproducible and reliable experimental data.
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Affiliation(s)
- Bernard Fermini
- Coyne Scientific, 1899 Powers Ferry Road SE, Atlanta, GA 30339, USA.
| | - Kevin P Coyne
- Coyne Scientific, 1899 Powers Ferry Road SE, Atlanta, GA 30339, USA
| | - Shawn T Coyne
- Coyne Scientific, 1899 Powers Ferry Road SE, Atlanta, GA 30339, USA
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49
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Poleksic A, Turner C, Dalal R, Gray P, Xie L. Mining FDA resources to compute population-specific frequencies of adverse drug reactions. PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE 2018; 2017:1809-1814. [PMID: 30197820 DOI: 10.1109/bibm.2017.8217935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adverse drug reactions (ADRs) represent one of the main health and economic problems in the world. With increasing data on ADRs, there is an increased need for software tools capable of organizing and storing the information on drug-ADR associations in a form that is easy to use and understand. Here we present a step by step computational procedure capable of extracting drug-ADR frequency data from the large collection of patient safety reports stored in the Federal Drug Administration database. Our procedure is the first of its type capable of generating population specific drug-ADR frequencies. The drug-ADR data generated by our method can be made specific to a single patient population group (such as gender or age) or a single therapy characteristic (such as drug dosage, duration of therapy) or any combination of such.
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Affiliation(s)
- Aleksandar Poleksic
- Department of Computer Science, University of Northern Iowa, Cedar Falls, USA
| | - Carson Turner
- Department of Computer Science, University of Northern Iowa, Cedar Falls, USA
| | - Rishabh Dalal
- Department of Computer Science, University of Northern Iowa, Cedar Falls, USA
| | - Paul Gray
- Department of Computer Science, University of Northern Iowa, Cedar Falls, USA
| | - Lei Xie
- Department of Computer Science, Hunter College and CUNY Graduate Center, New York, USA
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50
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Wilchesky M, Mueller G, Morin M, Marcotte M, Voyer P, Aubin M, Carmichael PH, Champoux N, Monette J, Giguère A, Durand P, Verreault R, Arcand M, Kröger E. The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study. BMC Geriatr 2018; 18:204. [PMID: 30180821 PMCID: PMC6123948 DOI: 10.1186/s12877-018-0895-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either "generally", "sometimes" or "exceptionally" appropriate for NH residents with severe dementia. METHODS A quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents' families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran's-Q tests. RESULTS The KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a "sometimes appropriate" medication post-intervention were 0.81 (95% CI: 0.71-0.92) and 0.83 (95% CI: 0.74-0.94), respectively. CONCLUSION A simple KE intervention using a medication review guidance tool categorizing medications as being either "generally", "sometimes" or "exceptionally" appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.
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Affiliation(s)
- Machelle Wilchesky
- Department of Family Medicine and Division of Geriatric Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, Montreal, Quebec, H3S 1Z1, Canada.,Donald Berman Maimonides Centre for Research in Aging, 5795 Caldwell Avenue, Montreal, Quebec, H4W 1W3, Canada
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, UMIT-The Health & Life Sciences University, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall in Tyrol, Tyrol, Austria
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Michèle Aubin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Nathalie Champoux
- Faculté de médecine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada
| | - Anik Giguère
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - René Verreault
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Marcel Arcand
- Centre de recherche sur le vieillissement, affilié à l'Université de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada. .,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada.
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