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Daniel K, Bousfield J, Hocking L, Jackson L, Taylor B. Women's Health Hubs: a rapid mixed-methods evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-138. [PMID: 39268794 DOI: 10.3310/jyft5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Background Women's sexual and reproductive health needs are complex and vary across the life course. They are met by a range of providers, professionals and venues. Provision is not well integrated, with inequalities in access. In some areas of the United Kingdom Women's Health Hubs have been established to improve provision, experience and outcomes for women, and to address inequalities and reduce costs. These models were established prior to the national implementation of Women's Health Hubs announced in the English 2022 Women's Health Strategy. Objective To explore the 'current state of the art', mapping the United Kingdom landscape, and studying experiences of delivering and using Women's Health Hubs across England, defining key features and early markers of success to inform policy and practice. Design A mixed-methods evaluation, comprising three work packages: Mapping the Women's Health Hub landscape and context and developing a definition of Women's Health Hubs, informed by an online national survey of Women's Health Hub leaders, and interviews with regional stakeholders. In-depth evaluation in four hub sites, including interviews with staff and women, focus groups in local communities and documentary analysis. Interviews with national stakeholders and consolidation of findings from work packages 1 and 2. Fieldwork was undertaken from May 2022 to March 2023. The evaluation was initiated prior to the national scale-up of Women's Health Hubs announced in the 2022 Women's Health Strategy. Results Most areas of the United Kingdom did not have a Women's Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women's Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, commissioning, workforce issues, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging. Limitations It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented. It was not possible to develop a typology of Women's Health Hubs as planned due to heterogeneity in models. Conclusions Existing Women's Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development. Evidence of system-level impact and costs was still emerging. Women's Health Hubs may widen inequalities if models are more accessible to advantaged groups. The important role of committed leaders in existing 'bottom-up' models may limit scalability and sustainability. Findings suggest that national scale-up will take time and requires funding and that it is necessary to design models according to local needs and resources. In 2023, the Department of Health and Social Care announced funding to establish a Women's Health Hub in every Integrated Care System in England. Future work Future evaluation should consider system-level impact and costs, explore unintended consequences and test assumptions. Funding This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135589) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Kelly Daniel
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | | | | | - Louise Jackson
- Warwick Medical School, University of Warwick, Coventry, UK
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Beck Taylor
- Warwick Medical School, University of Warwick, Coventry, UK
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Saka SA, Osineye TR. Considerations, barriers and enablers of deprescribing among healthcare professionals in Ogun State, Southwest, Nigeria: a cross-sectional survey. BMC Health Serv Res 2024; 24:661. [PMID: 38789975 PMCID: PMC11127322 DOI: 10.1186/s12913-024-11101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Deprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults' health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria. METHODS A quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants' sociodemographics, HCPs' experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal-Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value < 0.05 was considered significant. RESULTS Overall, 453 copies of the questionnaire were analysed. Of the participants 204 (45.0%) were within the age group of 20-30 years; 173 (38.2%) claimed that older adults occasionally requested deprescribing of their medications. The majority (417; 92.1%) considered patients' quality of life to be very important in deprescribing; 423 (93.4%) opined that having a care goal known to members of the HCP team is an enabler for deprescribing while 308 (68.0%) disagreed or strongly disagreed that lack of incentives and remuneration for HCPs that de-prescribe is a barrier to deprescribing. There is a significant difference among the participants across professional groups on the assertion that pressure from pharmaceutical companies is a barrier to deprescribing in older adults (p = 0.037). CONCLUSIONS The participants in this study had various considerations for deprescribing medication in older adults including patients' quality of life. Having a care goal known to every HCP involved in managing a patient is an enabler for deprescribing while the lack of incentives and remuneration for HCPs that de-prescribe may not necessarily be a barrier to deprescribing. There is a need for regulations and policies to support the identified enablers among HCPs and reduce the barriers to effective deprescribing process.
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Affiliation(s)
- Sule Ajibola Saka
- Department of Clinical Pharmacy & Bio-Pharmacy, Olabisi Onabanjo University, Sagamu Campus, Nigeria.
| | - Tolulope Ruth Osineye
- Department of Clinical Pharmacy & Bio-Pharmacy, Olabisi Onabanjo University, Sagamu Campus, Nigeria
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Jonsdottir F, Blondal AB, Gudmundsson A, Bates I, Stevenson JM, Sigurdsson MI. The association of degree of polypharmacy before and after among hospitalised internal medicine patients and clinical outcomes: a retrospective, population-based cohort study. BMJ Open 2024; 14:e078890. [PMID: 38548367 PMCID: PMC10982714 DOI: 10.1136/bmjopen-2023-078890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES To determine the prevalence and incidence of polypharmacy/hyperpolypharmacy and which medications are most prescribed to patients with varying burden of polypharmacy. DESIGN Retrospective, population-based cohort study. SETTING Iceland. PARTICIPANTS Including patients (≥18 years) admitted to internal medicine services at Landspitali - The National University Hospital of Iceland, between 1 January 2010 with a follow-up of clinical outcomes through 17 March 2022. MAIN OUTCOMES MEASURES Participants were categorised into medication use categories of non-polypharmacy (<5), polypharmacy (5-10) and hyperpolypharmacy (>10) based on the number of medications filled in the year predischarge and postdischarge. The primary outcome was prevalence and incidence of new polypharmacy. Secondary outcomes were mortality, length of hospital stay and re-admission. RESULTS Among 85 942 admissions (51% male), the median (IQR) age was 73 (60-83) years. The prevalence of preadmission non-polypharmacy was 15.1% (95% CI 14.9 to 15.3), polypharmacy was 22.9% (95% CI 22.6 to 23.2) and hyperpolypharmacy was 62.5% (95% CI 62.2 to 62.9). The incidence of new postdischarge polypharmacy was 33.4% (95% CI 32.9 to 33.9), and for hyperpolypharmacy was 28.9% (95% CI 28.3 to 29.5) for patients with preadmission polypharmacy. Patients with a higher level of medication use were more likely to use multidose drug dispensing and have a diagnosis of adverse drug reaction. Other comorbidities, including responsible subspeciality and estimates of comorbidity and frailty burden, were identical between groups of varying polypharmacy. There was no difference in length of stay, re-admission rate and mortality. CONCLUSIONS Preadmission polypharmacy/hyperpolypharmacy and postdischarge new polypharmacy/hyperpolypharmacy is common amongst patients admitted to internal medicine. A higher level of medication use category was not found to be associated with demographic, comorbidity and clinical outcomes. Medications that are frequently inappropriately prescribed were among the most prescribed medications in the group. An increased focus on optimising medication usage is needed after hospital admission. TRIAL REGISTRATION NUMBER NCT05756400.
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Affiliation(s)
- Freyja Jonsdottir
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna B Blondal
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
- Development Centre for Primary Healthcare in Iceland, Reykjavik, Iceland
| | - Adalsteinn Gudmundsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Ian Bates
- University College London, London, UK
| | - Jennifer Mary Stevenson
- Institute of Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin I Sigurdsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
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Srivastava SB. Polypharmacy, Unintended Consequences, and Impact of Lifestyle Medicine. Am J Lifestyle Med 2024; 18:54-57. [PMID: 39184275 PMCID: PMC11339771 DOI: 10.1177/15598276231207302] [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: 08/27/2024] Open
Abstract
The coexistence of more than one chronic condition is called multimorbidity. Polypharmacy is defined as the use of multiple medicines with the typical definition stating 5 or more medications. There are several risk factors associated with polypharmacy and it may occur due to many reasons. Polypharmacy has been associated with multiple negative outcomes including nonadherence to treatment, side effects, drug-drug or disease interactions, falls, fractures, impairments-physical and cognitive, and medical errors. Strategies to assess and address polypharmacy are necessary, and lifestyle medicine is shown to play a role in improving health outcomes even when polypharmacy exists.
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Affiliation(s)
- Sneha Baxi Srivastava
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA (SBS)
- Lake County Health Department, Highland Park, IL, USA (SBS)
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Hedqvist AT, Praetorius G, Ekstedt M. Exploring interdependencies, vulnerabilities, gaps and bridges in care transitions of patients with complex care needs using the Functional Resonance Analysis Method. BMC Health Serv Res 2023; 23:851. [PMID: 37568114 PMCID: PMC10422836 DOI: 10.1186/s12913-023-09832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hospital discharge is a complex process encompassing multiple interactions and requiring coordination. To identify potential improvement measures in care transitions for people with complex care needs, intra- and inter-organisational everyday work needs to be properly understood, including its interdependencies, vulnerabilities and gaps. The aims of this study were to 1) map coordination and team collaboration across healthcare and social care organisations, 2) describe interdependencies and system variability in the discharge process for older people with complex care needs, and 3) evaluate the alignment between discharge planning and the needs in the home. METHODS Data were collected through participant observations, interviews, and document review in a region of southern Sweden. The Functional Resonance Analysis Method (FRAM) was used to model the discharge process and visualise and analyse coordination of care across healthcare and social care organisations. RESULTS Hospital discharge is a time-sensitive process with numerous couplings and interdependencies where healthcare professionals' performance is constrained by system design and organisational boundaries. The greatest vulnerability can be found when the patient arrives at home, as maladaptation earlier in the care chain can lead to an accumulation of issues for the municipal personnel in health and social care working closest to the patient. The possibilities for the personnel to adapt are limited, especially at certain times of day, pushing them to make trade-offs to ensure patient safety. Flexibility and appropriate resources enable for handling variability and responding to uncertainties in care after discharge. CONCLUSIONS Mapping hospital discharge using the FRAM reveals couplings and interdependencies between various individuals, teams, and organisations and the most vulnerable point, when the patient arrives at home. Resilient performance in responding to unexpected events and variations during the first days after the return home requires a system allowing flexibility and facilitating successful adaptation of discharge planning.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
- Ambulance Service, Region Kalmar County, Västervik, Sweden.
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Borre, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
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Verhaegen F, Butterworth KT, Chalmers AJ, Coppes RP, de Ruysscher D, Dobiasch S, Fenwick JD, Granton PV, Heijmans SHJ, Hill MA, Koumenis C, Lauber K, Marples B, Parodi K, Persoon LCGG, Staut N, Subiel A, Vaes RDW, van Hoof S, Verginadis IL, Wilkens JJ, Williams KJ, Wilson GD, Dubois LJ. Roadmap for precision preclinical x-ray radiation studies. Phys Med Biol 2023; 68:06RM01. [PMID: 36584393 DOI: 10.1088/1361-6560/acaf45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022]
Abstract
This Roadmap paper covers the field of precision preclinical x-ray radiation studies in animal models. It is mostly focused on models for cancer and normal tissue response to radiation, but also discusses other disease models. The recent technological evolution in imaging, irradiation, dosimetry and monitoring that have empowered these kinds of studies is discussed, and many developments in the near future are outlined. Finally, clinical translation and reverse translation are discussed.
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Affiliation(s)
- Frank Verhaegen
- MAASTRO Clinic, Radiotherapy Division, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
- SmART Scientific Solutions BV, Maastricht, The Netherlands
| | - Karl T Butterworth
- Patrick G. Johnston, Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Anthony J Chalmers
- School of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, United Kingdom
| | - Rob P Coppes
- Departments of Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology and Radiation Oncology, University Medical Center Groningen, University of Groningen, 9700 AD Groningen, The Netherlands
| | - Dirk de Ruysscher
- MAASTRO Clinic, Radiotherapy Division, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sophie Dobiasch
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine and Klinikum rechts der Isar, Germany
- Department of Medical Physics, Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Germany
| | - John D Fenwick
- Department of Medical Physics & Biomedical Engineering University College LondonMalet Place Engineering Building, London WC1E 6BT, United Kingdom
| | | | | | - Mark A Hill
- MRC Oxford Institute for Radiation Oncology, University of Oxford, ORCRB Roosevelt Drive, Oxford OX3 7DQ, United Kingdom
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, LMU München, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich, Germany
| | - Brian Marples
- Department of Radiation Oncology, University of Rochester, NY, United States of America
| | - Katia Parodi
- German Cancer Consortium (DKTK), Partner site Munich, Germany
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching b. Munich, Germany
| | | | - Nick Staut
- SmART Scientific Solutions BV, Maastricht, The Netherlands
| | - Anna Subiel
- National Physical Laboratory, Medical Radiation Science Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom
| | - Rianne D W Vaes
- MAASTRO Clinic, Radiotherapy Division, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Ioannis L Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine and Klinikum rechts der Isar, Germany
- Physics Department, Technical University of Munich (TUM), Germany
| | - Kaye J Williams
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - George D Wilson
- Department of Radiation Oncology, Beaumont Health, MI, United States of America
- Henry Ford Health, Detroit, MI, United States of America
| | - Ludwig J Dubois
- The M-Lab, Department of Precision Medicine, GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Guimarães DDM, Parro YM, Muller HS, Coelho EB, Martins VDP, Santana R, Lia ÉN. Xerostomia and dysgeusia in the elderly: prevalence of and association with polypharmacy. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023. [DOI: 10.20396/bjos.v22i00.8666637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Xerostomia is defined as the perception of dry mouth, and dysgeusia, as a change in taste. Both are common complaints in the elderly, especially among those making use of polypharmacy drug combinations. Aim: This study aimed to determine the prevalence of xerostomia and dysgeusia and to investigate their association with polypharmacy in the elderly. Methods: older people under follow-up at the Multidisciplinary Elderly Center of the University Hospital of Brasília were interviewed and asked about health problems, medications used, presence of xerostomia and dysgeusia. Descriptive statistics were used to determine the prevalence of the symptoms surveyed. The chi-square test was used to investigate the relationship between xerostomia and dysgeusia and polypharmacy. Secondary associations were performed using binomial logistic regression. Results: Ninety-six older people were evaluated and of these, 62.5% had xerostomia and 21.1%, had dysgeusia. The average number of medications used was 4±3 medications per individual. Polypharmacy was associated with xerostomia but not dysgeusia. It was possible to associate xerostomia with the use of antihypertensive drugs. Conclusion: Xerostomia was a frequent complaint among elderly people making use of polypharmacy, especially those using antihypertensives. Antihypertensives and antidepressants were used most drugs by the elderly and exhibited interactions with drugs most prescribed in Dentistry. Two contraindications were found between fluconazole and mirtazapine; and between erythromycin and simvastatin.
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Mavragani A, Dixe MDA, Gonçalves Pereira S, Meyer-Massetti C, Verloo H. An Intervention Program to Reduce Medication-Related Problems Among Polymedicated Home-Dwelling Older Adults (OptiMed): Protocol for a Pre-Post, Multisite, Pilot, and Feasibility Study. JMIR Res Protoc 2023; 12:e39130. [PMID: 36696165 PMCID: PMC9909524 DOI: 10.2196/39130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/20/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient's acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. OBJECTIVE This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. METHODS This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study's objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ≥65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. RESULTS Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers' multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. CONCLUSIONS Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population's medication management and recording the first effects of the intervention will make this pilot and feasibility study's findings very valuable as home care becomes an ever more common solution. TRIAL REGISTRATION Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4.
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Affiliation(s)
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | | | - Carla Meyer-Massetti
- Institute for Primary Health Care BIHAM, University of Bern, Bern, Switzerland.,Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences (HES-SO) Valais/Wallis, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Pereira F, Bieri M, del Rio Carral M, Martins MM, Verloo H. Collaborative medication management for older adults after hospital discharge: a qualitative descriptive study. BMC Nurs 2022; 21:284. [PMID: 36280875 PMCID: PMC9590396 DOI: 10.1186/s12912-022-01061-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Safe medication management for older adults after hospital discharge requires a well-coordinated, interprofessional, patient-centered approach. This study aimed to describe the perceived needs for collaborative medication management for older adults taking several different medications at home after hospital discharge. METHODS A qualitative descriptive study was conducted using semi-structured interviews with older adults (n = 28), informal (n = 17), and professional caregivers (n = 13). RESULTS Findings revealed four main needs: older adults and informal caregivers' perceived needs for greater involvement in discharge planning; older adults' perceived needs to be informed, listened to, and to be actively involved in decision-making; informal caregivers' perceived needs for help in supporting and coordinating medication management; and older adults' and informal and professional caregivers' perceived needs for better communication and coordination between professional caregivers. CONCLUSION This study revealed two underutilized pathways towards improving collaborative medication management: medication follow-up involving a community healthcare professional taking an overarching responsibility and empowering older adults and their informal caregivers in medication management after hospital discharge.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES- SO), CH-1950 Sion, Switzerland
| | - Marion Bieri
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES- SO), CH-1950 Sion, Switzerland
| | - Maria del Rio Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination, University of Lausanne, Lausanne, Switzerland
| | | | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES- SO), CH-1950 Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Korol LA, Egorova SN, Kudlay DA, Krasnyuk II, Sologova SS, Korol VA, Smolyarchuk EA, Mandrik MA. Problems associated with effective pharmacotherapy of the elderly patients (geriatrics): A review. TERAPEVT ARKH 2022; 94:914-919. [DOI: 10.26442/00403660.2022.07.201717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
The worlds older population is growing dramatically. At the same time, ensuring an appropriate high standard of living for the elderly by reducing of morbidity and disability of geriatric patients is one of the main objectives of the modern healthcare system. However, changes associated with body aging necessitate application of novel approaches to the correction of pharmacotherapy and usage of specialized dosage forms. Such medicinal products provide both an appropriate therapeutic effect and facilitate their use. Presented review considers several features of pharmacotherapy of geriatric patients.
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12
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Aguiar JP, Gama Marques J, Leufkens HGM, Alves da Costa F. Healthcare Professionals' Views on the Management of Medication Complexities in the Elderly With Mental Health Disorders: A Cross-Sectional Study. Front Psychiatry 2022; 13:885216. [PMID: 35677869 PMCID: PMC9168079 DOI: 10.3389/fpsyt.2022.885216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many challenges in elderly pharmacotherapy are identified, including the use of Potentially Inappropriate Medications (PIMs) which may increase the odds of adverse events, especially in elderly patients with mental health disorders (e. g., behavioral, and psychological symptoms of dementia-BPSD, schizophrenia, bipolar disorder). However, information on the knowledge and practice of healthcare professionals (HCPs) about this topic is still scarce. Methods A cross-sectional study was undertaken from July-October 2019. An online questionnaire was specifically designed and validated for this study. We sought HCPs (physicians, pharmacists, and nurses) worldwide, using (a) social media, via Facebook, Twitter, and LinkedIn; and (b) email contacts of the research team (convenience sample). Either way participants were asked to share on their social media or via e-mail the questionnaires with other HCPs (snowballing sample). The survey assessed two main domains: knowledge and practice. Knowledge was evaluated by self-report (perceived knowledge by a 5-item Likert confidence scale) and using three clinical cases, scored between 0 and 30 points (each one rated from 0 to 10 points; real knowledge). Barriers in clinical practice were evaluated using a 5-item Likert scale judging practitioners' opinion. Results A total of 165 questionnaires were collected. HCPs were mainly female (n = 114; 69.1%), with a mean age of 35.3 ± 11.3 years old. Seventy-two percent (n = 118) were pharmacists, 21.1% (n = 35) were physicians, and 7.3% (n = 12) nurses. There was a weak correlation, albeit significant, between perceived and real knowledge (r = 0.199; p = 0.001). The mean score of the clinical vignettes regarding elderly patients with dementia and bipolar disorder were 4.59 ± 4.08 and 4.86 ± 2.97 points, respectively. Most HCPs were classified as having an intermediate knowledge (n = 100; 60.6%) about medication complexities in the elderly with mental disorders. Most HCPs agreed that lack of time (81.6%; n = 138), lack of education and training on elderly pharmacotherapy (72.2%; n = 122), and lack of tools adapted to daily practice (61.8%; n = 105) were the main barriers. Conclusions Most of the HCPs felt confident to manage medication complexities in elder patients with mental disorders, but only a minority obtained a good score in the knowledge assessment test. The main barriers identified included structural barriers (tools unfit for practice) and process barriers (time).
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Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
| | - João Gama Marques
- Serviço de Psiquiatria Geral e Transcultural, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisboa, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa (FMUL), Lisboa, Portugal
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
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Rodrigues DA, Plácido AI, Tavares AB, Azevedo D, Mateos-Campos R, Figueiras A, Herdeiro MT, Roque F. Potentially Inappropriate Medication Prescribing in Older Adults According to EU(7)-Potentially Inappropriate Medication List: A Nationwide Study in Portugal. Curr Ther Res Clin Exp 2022; 97:100681. [PMID: 35937773 PMCID: PMC9350873 DOI: 10.1016/j.curtheres.2022.100681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/04/2022] [Indexed: 10/25/2022] Open
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Lun P, Law F, Ho E, Tan KT, Ang W, Munro Y, Ding YY. Optimising prescribing practices in older adults with multimorbidity: a scoping review of guidelines. BMJ Open 2021; 11:e049072. [PMID: 34907045 PMCID: PMC8671917 DOI: 10.1136/bmjopen-2021-049072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Inappropriate polypharmacy occurs when multiple medications are prescribed without clear indications or where harms outweigh their benefits. The aims of this scoping review are to (1) identify prescribing guidelines that are available for older adults with multimorbidity and (2) to identify cross-cutting themes used in these guidelines. DESIGN Scoping review. DATA SOURCES PubMed, Embase, Web of Science, the Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, grey literature sources, six key geriatrics journals, and reference lists of identified review papers. The search was conducted in November 2018 and updated in September 2019. STUDY SELECTION General prescribing guidelines tailored to or for adults including older adults with multimorbidity. DATA EXTRACTION Data for publication description, guideline characteristics, information for users and criteria were extracted. The synthesis contains summarised qualitative descriptions of the studies and guideline characteristics as well as identified cross-cutting themes. RESULTS Our search strategy yielded 10 427 unique citations, of which 70 fulfilled the inclusion criteria for synthesis. Among these, there were 61 unique guidelines and tools which used implicit, explicit, mixed or other approaches in the prescriber decision-making process. There are 11 cross-cutting themes identified in the guidelines. Prescriber-related themes are: conduct a comprehensive assessment before prescribing, identify patients' needs, goals and priorities, adopt shared decision-making, consider evidence-based recommendations, use clinical prescribing tools, incorporate multidisciplinary inputs and embrace technology-enabled prescribing. Wider organisation-related and system-related themes related to education, training and the work environment are also identified. CONCLUSIONS From guidelines and tools identified, eleven cross-cutting themes provide a usable knowledge base when seeking to optimise prescribing among older adults with multimorbidity. Incorporating these themes in an approach that uses mixed criteria and implementation information could facilitate greater uptake of published prescribing recommendations.
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Affiliation(s)
- Penny Lun
- Geriatric Education and Research Institute, Singapore
| | - Felicia Law
- Geriatric Medicine, National Healthcare Group Woodlands Health Campus, Singapore
| | - Esther Ho
- Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Wendy Ang
- Pharmacy, Changi General Hospital, Singapore
| | - Yasmin Munro
- Medical Library, Lee Kong Chian School of Medicine, Singapore
| | - Yew Yoong Ding
- Geriatric Education and Research Institute, Singapore
- Geriatric Medicine, Tan Tock Seng Hospital, Singapore
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15
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Haruta J, Tsugawa S. What Types of Networks Do Professionals Build, and How Are They Affected by the Results of Network Evaluation? Front Public Health 2021; 9:758809. [PMID: 34888285 PMCID: PMC8650603 DOI: 10.3389/fpubh.2021.758809] [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: 08/15/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to explore what kind of social networks characterizable as "consult/be consulted" are built among healthcare professionals in a community and the impact of providing the professionals with these findings. Methods: We adopted mixed methods exploratory study using social network analysis (SNA) and content analysis. SNA can visualize social network structures such as relationships between individuals. The healthcare professionals were asked about the key persons they consulted and were consulted by concerning these healthcare issues: (1) daily work; (2) a person with acute back pain; (3) a garbage-filled house reported by a neighbor; (4) a person with dementia; and (5) a study meeting. We identified the key roles depending on the issues using SNA. After analysis, the analytical findings were shared with the participants. To explore their cognitive responses, an open-ended questionnaire was delivered and a content analysis was implemented. Results: Of 54 healthcare professional participants, the data of 52 were available for analysis. The findings (in the respective order of the five topics above) were as follows: the number of nodes was 165, 95, 85, 82, and 68; clustering coefficient was 0.19, 0.03, 0.02, 0.11, and 0.23; assortativity was -0.043, -0.11, -0.23, -0.17, and -0.23; reciprocity was 0.35, 0.31, 0.39, 0.29, and 0.48. The top three centralities included nurses. Eighty-seven free comments were received, of which 39 were categorized as descriptive, 10 as analytical, and 38 as critical. Discussion: The structure of "consult/be consulted" networks differed by topic. SNA is available to detect the healthcare resources network and it may have helped them to reflect on their own networks.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan.,Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sho Tsugawa
- Division of Information Engineering, Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
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Criddle DT, Devine B, Murray K, Budgeon CA, Sanfilippo FM, Gupta S, Davidson A, Etherton-Beer C, Clifford R. Developing PHarmacie-R: A bedside risk prediction tool with a medicines management focus to identify risk of hospital readmission. Res Social Adm Pharm 2021; 18:3137-3148. [PMID: 34556434 DOI: 10.1016/j.sapharm.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The imperative to identify patients at risk of medication-related harm has never been greater. Hospital clinicians cannot easily predict risk of readmission or harm. Candidate variables associated with medication-related harm derived from the literature or significantly represented in a complex patient cohort have been previously described by PHarmacie-4. With a focus on polypharmacy and high-risk medicines in vulnerable patient cohorts, PHarmacie-4 was easy to use and highlighted risks. However it over-estimated risk, reducing its usefulness in stratifying risk of readmission. OBJECTIVE Develop a risk prediction tool built into a smart phone app, enabling clinicians to identify and refer high-risk patients for an early post-discharge medicines review. Demonstrate usability, real world application and validity in an independent dataset. METHODS A retrospective, observational study was conducted with 1201 randomly selected patients admitted to Sir Charles Gairdner Hospital between June 1, 2016 to December 31, 2016. Patient characteristics and outcomes of interest were reported, including unplanned hospital utilisation at 30, 60 and 90 days post-discharge. Using multivariable logistic regression modelling, an algorithm was developed, built into a smart phone app and used and validated in an independent dataset. RESULTS 738 patients (61%) were included in the derivation sample. The best predictive performance was achieved by PHarmacie-R (C-statistic 0.72, 95% CI 0.68-0.75) which included PHarmacie-4 risk variables, a non-linear effect of age, unplanned hospital utilisation in the preceding six months and gender. The independent validation dataset had a C-statistic of 0.64 (95% CI 0.56-0.72). CONCLUSION PHarmacie-R is the first readmission risk prediction tool, built into a smart phone app, focussing on polypharmacy and high-risk medicines in vulnerable patients. It can assist clinical pharmacists to identify medical inpatients who may benefit from early post-discharge medication management services. External validation is needed to enable application in other clinical settings.
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Affiliation(s)
- Deirdre T Criddle
- Pharmacy Department, Sir Charles Gairdner Hospital, Perth, 6009, Australia; Complex Needs Coordination Team, South Metropolitan Health Service, Murdoch Drive, Perth, 6150, Australia; Medicines Solutions, Dianella, 6059, Australia.
| | - Benjamin Devine
- Complex Needs Coordination Team, South Metropolitan Health Service, Murdoch Drive, Perth, 6150, Australia
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, 6009, Australia
| | - Charley A Budgeon
- School of Population and Global Health, University of Western Australia, Perth, 6009, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, 6009, Australia
| | - Shetaal Gupta
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, 6009, Australia
| | | | | | - Rhonda Clifford
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, 6009, Australia
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17
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Rasu RS, Shrestha N, Karpes Matusevich AR, Zalmai R, Large S, Johnson L, O'Bryant SE. Polypharmacy and Cognition Function Among Rural Adults. J Alzheimers Dis 2021; 82:607-619. [PMID: 34057144 DOI: 10.3233/jad-200951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Polypharmacy (using≥5 medications) is associated with poor health outcomes. Mixed results from past studies surrounding chronic medication use, control of chronic conditions, and their effects on cognitive performance warrant further attention. OBJECTIVE Investigate a link between polypharmacy and cognition function in rural-dwelling adults in Texas, USA. METHODS Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a cross-sectional epidemiological study using community-based participatory research in three counties of Texas. Residents age > 40 were eligible for inclusion. The primary outcome is cognitive impairment, and exposures of interest are polypharmacy; comorbidities; and diabetes, hypertension, and depression medication. Logistic regression was used to assess association. RESULTS Six hundred eighty-nine individuals participated; the mean age was 61, and the majority were female (68.7%).The median number of medications taken by participants was 3.3 (IQR: 0-5); the rate of polypharmacy was 29.6%. Anti-hypertensive agents were the most common medications (15%) used. Polypharmacy users were 2.84 times more likely to have cognitive impairment [OR: 2.84, 95%CI (1.32-6.09)] than those using < 5 medications. Participants on hypertensive medications had 1.85 times higher odds [OR: 1.85, 95%CI (1.14-3.01)] of having cognitive impairment than those who did not have cognitive impairment. CONCLUSION Polypharmacy increases the odds of cognitive impairment. The odds of presenting with cognitive impairment increased as the number of medications increased. Additionally, we identified a large, concerning number of participants with pharmacotherapy and poor chronic disease management. A larger study should examine medication adherence among rural elders to manage chronic disease and any healthcare barriers to adherence.
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Affiliation(s)
- Rafia S Rasu
- College of Pharmacy, Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA.,School of Public Health, Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Nistha Shrestha
- School of Public Health, Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Aliza R Karpes Matusevich
- College of Pharmacy, Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rana Zalmai
- College of Pharmacy, Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Stephanie Large
- Graduate School of Biomedical Sciences, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Leigh Johnson
- Graduate School of Biomedical Sciences, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sid E O'Bryant
- Graduate School of Biomedical Sciences, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
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18
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Taghy N, Cambon L, Boulliat C, Aromatario O, Dussart C. Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviours in Primary Care for the Elderly-Protocol for a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147656. [PMID: 34300106 PMCID: PMC8303935 DOI: 10.3390/ijerph18147656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
Polypharmacy is becoming increasingly common, especially among the elderly. It often has a negative connotation, but is sometimes necessary or even desirable, and needed to categorize polypharmacy as appropriate or inappropriate. The challenge is in ensuring that this is considered appropriate when necessary. We aimed to develop an evidence-based intervention to reduce the risks associated with using a systematic approach, involving key stakeholders in prescribing and dispensing drugs to the elderly in primary care. The purpose of this study is to identify the key components which are perceived as influencing these behaviours. It is a qualitative study of general practitioners (GPS) and community pharmacists involved in the care of the elderly. The main inclusion criterion is the geographic location. Qualitative data will be generated from one-on-one, semi-structured interviews and processed for thematic content analysis. Our approach integrates the patient pathway in primary care. It considers the fact that GP and pharmacist behaviours are far from being independent. This study represents the first step in the process of developing an intervention theory which involves a crossover between data from the literature and the knowledge of experts, allowing us to interrogate hypotheses about the influences and mechanisms associated with prescribing and dispensing drugs to the elderly in primary care.
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Affiliation(s)
- Najwa Taghy
- Laboratory P2S (Systemic Health Process), University Claude Bernard of Lyon 1, University of Lyon, EA4129 Lyon, France
- Correspondence:
| | - Linda Cambon
- ISPED, U1219 Inserm Center, Bordeaux Population Health, University of Bordeaux, CHU Bordeaux, 33000 Bordeaux, France; (L.C.); (O.A.)
| | | | - Olivier Aromatario
- ISPED, U1219 Inserm Center, Bordeaux Population Health, University of Bordeaux, CHU Bordeaux, 33000 Bordeaux, France; (L.C.); (O.A.)
| | - Claude Dussart
- Lyon Public Hospices, Central Pharmacy, Laboratory P2S (Systemic Health Process), University Claude Bernard Lyon 1, University of Lyon, EA4129 Lyon, France;
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Ailabouni NJ, Marcum ZA, Schmader KE, Gray SL. Medication Use Quality and Safety in Older Adults: 2019 Update. J Am Geriatr Soc 2021; 69:336-341. [PMID: 33438206 PMCID: PMC11057223 DOI: 10.1111/jgs.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
Improving the quality of medication use and medication safety are important priorities for prescribers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2019. We selected high-quality studies that moved the field of research forward and were not merely replication studies. The chosen articles cover domains related to aspects of suboptimal prescribing and medication safety. The first study used a nationally representative sample of Medicare beneficiaries to examine the continuation of medications with limited benefit in patients admitted for cancer and non-cancer diagnoses in hospice (domain: potentially inappropriate medications). The second study, a retrospective cohort study of older adults in Ontario, Canada, assessed the association between prescribing oral anticoagulants in an emergency department relative to not prescribing anticoagulants in the emergency department and their persistence at 6 months (domain: underuse of medications). The third study, a cluster randomized trial in Quebec, Canada, evaluated the effect of conducting electronic medication reconciliation on several outcomes including adverse drug events and medication discrepancies (domain: medication safety). Lastly, the fourth study, a retrospective study using national inpatient and outpatient Veteran Health Administration combined with clinical and Medicare Claims data, examined the effects of intensification of antihypertensive medications on older adults' likelihood for hospital re-admission and other important clinical outcomes (domain: medication safety). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.
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Affiliation(s)
- Nagham J. Ailabouni
- Quality Use of Medicine and Pharmacy Research Centre, UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Zachary A. Marcum
- Quality Use of Medicine and Pharmacy Research Centre, UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Department of Pharmacy, University of Washington, Seattle, Washington
| | - Kenneth E. Schmader
- Department of Medicine (Geriatrics), School of Medicine, Duke University Medical Center, Durham, North Carolina
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Shelly L. Gray
- Department of Pharmacy, University of Washington, Seattle, Washington
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García-Agua Soler N, Gómez-Bermúdez E, Baixauli-Fernández VJ, Bellver-Beltrán S, Velasco-Martínez J, García Ruiz AJ, Jódar-Sánchez F. Medicines use review service in community pharmacies in Spain: REVISA project. Int J Clin Pharm 2020; 43:524-531. [PMID: 32996076 PMCID: PMC8214585 DOI: 10.1007/s11096-020-01158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022]
Abstract
Background Community pharmacy services play an important role in controlling some factors related to medicine use and patients can benefit from these services to improve the adherence and knowledge of their medications, besides to reduce medicine-related problems. Objective The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review service in Spanish community pharmacies. Setting Sixty-four community pharmacies from all regions of Spain. Method A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies. A structured interview enabled to pharmacists to obtain a better understanding of patient's medicines use. Main outcome measure Medicines use review-related time and cost, satisfaction and willingness to pay. Results A total of 495 patients were enrolled. The mean age of the patients was 66.1 years, with the majority females (56.4%) and a mean consumption of 5.7 medicines. A total of 2811 medicines were evaluated and 550 referral recommendations were made (29.8% to Primary Care). The mean time employed by the pharmacists in the medicines use review service was 52.8 min (medicines use review-related cost of €17.27). Most patients expressed a high level of satisfaction with this service (98.5%) and a willingness to pay for it (84%). Conclusion Medicines use review service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. This service may offer an opportunity to promote inter-professional collaboration between pharmacists and general practitioners.
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Affiliation(s)
- Nuria García-Agua Soler
- Chair of Health Economics and Rational Use of Drugs, Department of Pharmacology. University of Málaga, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain.
- Pharmacoeconomics: Clinical and Economic Evaluation of Pharmaceutical Drugs and Palliative Care, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain.
- Illustrious in the Official College of Pharmacists of Málaga, Málaga, Spain.
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain.
| | - Eugenia Gómez-Bermúdez
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Vicente J Baixauli-Fernández
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Sara Bellver-Beltrán
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Javier Velasco-Martínez
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Antonio J García Ruiz
- Chair of Health Economics and Rational Use of Drugs, Department of Pharmacology. University of Málaga, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain
- Pharmacoeconomics: Clinical and Economic Evaluation of Pharmaceutical Drugs and Palliative Care, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
| | - Francisco Jódar-Sánchez
- Group in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS/Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
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21
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El Haddad K, de Souto Barreto P, de Mazieres CL, Rolland Y. Effect of a geriatric intervention aiming to improve polypharmacy in nursing homes. Eur Geriatr Med 2020; 11:863-868. [PMID: 32462509 DOI: 10.1007/s41999-019-00279-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To examine the effect of an intervention comprising professional support by a geriatrician engaged in a quality care indicators' audit for nursing home (NH) staff on reducing polypharmacy. METHODS Of a total of 3709 NH residents, 90 NHs (2026 residents) were allocated to a light intervention and 85 NHs (1683 residents) to a strong intervention group. RESULTS Mixed-effect linear model found no significant variation in the total number of medications over time (β-coefficient for interaction 0.007, 95% CI - 0.15, 0.16). Within-group-adjusted mean differences showed a statistical decline in the psychotropic medication class (- 0.04 SE 0.02 p 0.03 for the strong intervention group and - 0.06 SE 0.02 p 0.001 for the light intervention group) and a statistically significant increase in the analgesics use. CONCLUSION The possibility that a simple audit intervention might reduce psychotropic prescriptions deserves further investigation.
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Affiliation(s)
- Kamal El Haddad
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France.
- Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France.
| | - Philipe de Souto Barreto
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France
- INSERM U1027, University of Toulouse III, Toulouse, France
| | - Clarisse Laffon de Mazieres
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France
- INSERM U1027, University of Toulouse III, Toulouse, France
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Kalisch Ellett LM, Pratt NL, Nguyen TA, Roughead EE. Use of health and support services by people living with dementia in the community setting. Australas J Ageing 2020; 39:341-349. [DOI: 10.1111/ajag.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| | - Tuan A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences University of South Australia Adelaide SA Australia
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Raus K, Mortier E, Eeckloo K. Challenges in turning a great idea into great health policy: the case of integrated care. BMC Health Serv Res 2020; 20:130. [PMID: 32085770 PMCID: PMC7035709 DOI: 10.1186/s12913-020-4950-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 01/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the organization of health care and health care systems, there is an increasing trend towards integrated care. Policy-makers from different countries are creating policies intended to promote cooperation and collaboration between health care providers, while facilitating the integration of different health care services. Hopes are high, as such collaboration and integration of care are believed to save resources and improve quality. However, policy-makers are likely to encounter various challenges and limitations when attempting to turn these great ideas into effective policies. In this paper, we look into these challenges. MAIN BODY We argue that the organization of health care and integrated care is of public concern, and should thus be of crucial interest to policy-makers. We highlight three challenges or limitations likely to be encountered by policy-makers in integrated care. These are: (1) conceptual challenges; (2) empirical/methodological challenges; and (3) resource challenges. We will argue that it is still unclear what integrated care means and how we should measure it. 'Integrated care' is a single label that can refer to a great number of different processes. It can describe the integration of care for individual patients, the integration of services aimed at particular patient groups or particular conditions, or it can refer to institution-wide collaborations between different health care providers. We subsequently argue that health reform inevitably possesses a political context that should be taken into account. We also show how evidence supporting integrated care may not guarantee success in every context. Finally, we will discuss how promoting collaboration and integration might actually demand more resources. In the final section, we look at three different paradigmatic examples of integrated care policy: Norway, the UK's NHS, and Belgium. CONCLUSIONS There seems widespread agreement that collaboration and integration are the way forward for health care and health care systems. Nevertheless, we argue that policy-makers should remain careful; they should carefully consider what they hope to achieve, the amount of resources they are willing to invest, and how they will evaluate the success of their policy.
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Affiliation(s)
- Kasper Raus
- Ghent University Hospital and Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Eric Mortier
- Ghent University Hospital and Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Kristof Eeckloo
- Ghent University Hospital and Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Boye LK, Mogensen CB, Mechlenborg T, Waldorff FB, Andersen PT. Older multimorbid patients' experiences on integration of services: a systematic review. BMC Health Serv Res 2019; 19:795. [PMID: 31690308 PMCID: PMC6833141 DOI: 10.1186/s12913-019-4644-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.
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Affiliation(s)
- Lilian Keene Boye
- University Hospital of Southern Jutland, Kresten Philipsens vej 15, indgang F, 6200, Aabenraa, Denmark. .,Focused Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Emergency Department, University Hospital of Southern Jutland, Jutland, Denmark.
| | - Christian Backer Mogensen
- University Hospital of Southern Jutland, Kresten Philipsens vej 15, indgang F, 6200, Aabenraa, Denmark.,Focused Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Emergency Department, University Hospital of Southern Jutland, Jutland, Denmark
| | - Tine Mechlenborg
- Kong Christian X's Gigthospital, Toldbodgade 3, 6300, Gråsten, Denmark.,Focused Research Unit in Rheumatic, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, 5000, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Research Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700, Esbjerg, Denmark
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Pereira F, Roux P, Santiago-Delefosse M, von Gunten A, Wernli B, Martins MM, Verloo H. Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol. BMJ Open 2019; 9:e030030. [PMID: 31662367 PMCID: PMC6830655 DOI: 10.1136/bmjopen-2019-030030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Optimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes. METHODS AND ANALYSIS A mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles-made up of patient-related, medication-related and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky's quadruple aim. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers' and patients' associations.
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Affiliation(s)
- Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Pauline Roux
- Research Center for Psychology of Health, Aging and Sport Examination, University of Lausanne, Lausanne, Switzerland
| | - Marie Santiago-Delefosse
- Research Center for Psychology of Health, Aging and Sport Examination, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences, University of Lausanne, FORS, Lausanne, Switzerland
| | - Maria Manuela Martins
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Higher School of Nursing of Porto, Porto, Portugal
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018; 35:43-60. [PMID: 29350335 DOI: 10.1007/s40266-018-0516-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice. OBJECTIVES The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity). METHODS A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting. RESULTS After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%). CONCLUSION The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia.
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
| | - Gillian E Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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28
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17:230. [PMID: 29017448 PMCID: PMC5635569 DOI: 10.1186/s12877-017-0621-2] [Citation(s) in RCA: 1578] [Impact Index Per Article: 225.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. METHODS The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). RESULTS A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. CONCLUSIONS Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
| | - Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia Australia
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Struckmann V, Leijten FRM, van Ginneken E, Kraus M, Reiss M, Spranger A, Boland MRS, Czypionka T, Busse R, Rutten-van Mölken M. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy 2017; 122:23-35. [PMID: 29031933 DOI: 10.1016/j.healthpol.2017.08.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. METHODS A scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological Abstracts, Social Services Abstracts, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. RESULTS In the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n=11) and US (n=5). Wagner's Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n=31; GCM n=6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to 'service delivery'. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n=10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). CONCLUSION Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.
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Affiliation(s)
- Verena Struckmann
- Berlin University of Technology, Department of Health Care Management, Germany.
| | - Fenna R M Leijten
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Ewout van Ginneken
- WHO Observatory on Health Systems and Policies, Berlin University of Technology, Department of Health Care Management, Germany
| | | | | | - Anne Spranger
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Melinde R S Boland
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | | | - Reinhard Busse
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Maureen Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands
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Improving medication safety. INT J EVID-BASED HEA 2016; 14:102-3. [DOI: 10.1097/xeb.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Petrillo LA, Ritchie CS. The challenges of symptom management for patients with multimorbidity in research and practice: a thematic review. PROGRESS IN PALLIATIVE CARE 2016; 24:262-267. [PMID: 28959091 DOI: 10.1080/09699260.2016.1192320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multimorbidity, the presence of multiple coexisting diseases or conditions, afflicts the majority of older adults, and is associated with increased mortality and healthcare utilization. In addition, multimorbidity negatively impacts quality of life and increases symptom burden. Yet, there is a dearth of evidence on how to best manage symptoms in patients with multimorbidity. Research in this area has been hampered by inconsistent definitions of multimorbidity and challenges in outcome measurement. Investigations of symptom management strategies in specific disease states, like cancer, typically exclude medically complex patients. In the absence of evidence, the American Geriatrics Society's recommendations for the care of adults with multimorbidity provide a useful starting point for clinicians. We present a case to demonstrate how the AGS recommendations can be tailored to the situation of symptom management in patients with multimorbidity. We also present suggestions for future research directions.
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Affiliation(s)
- Laura A Petrillo
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Division of Geriatrics, University of California at San Francisco, San Francisco, California
| | - Christine S Ritchie
- Division of Geriatrics, University of California at San Francisco, San Francisco, California
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Okumura Y, Shimizu S, Matsumoto T. Prevalence, prescribed quantities, and trajectory of multiple prescriber episodes for benzodiazepines: A 2-year cohort study. Drug Alcohol Depend 2016; 158:118-25. [PMID: 26652896 DOI: 10.1016/j.drugalcdep.2015.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Little is known about the use of multiple prescribers for benzodiazepines, which might reflect fragmented patient care and increases the risk of hospital admission for drug dependence or poisoning. Therefore, we aimed to identify the prevalence, prescribed quantities, and trajectory of multiple prescriber episodes for benzodiazepines. METHODS We conducted a 2-year cohort study of 1178,361 recipients aged 0-74 years using a large health insurance claims database in Japan. We quantified multiple prescriber episodes for benzodiazepines occurring in ambulatory care settings in a baseline and subsequent year by (1) counting the number of unique providers within a 12-month period, (2) calculating the maximum number of unique providers within a single month, and (3) identifying consecutive overlapping prescriptions of over 30 days duration. RESULTS Among 58,314 patients with a benzodiazepine prescription during the baseline year, 282 (0.5%) filled prescriptions from four or more providers within a 12-month period, 439 (0.8%) filled prescriptions from three or more providers within a single month, and 757 (1.3%) filled consecutive overlapping prescriptions. The odds for multiple prescriber episodes were significantly higher among patients with multiple chronic conditions. Consecutive overlapping prescriptions had the best accuracy to detect patients with potentially questionable prescribed quantities as well as to predict those with multiple prescriber episodes in the subsequent year. CONCLUSIONS These results highlight the need for pharmacists to increase their involvement in prescription oversight and for health insurance agencies to implement a prescription monitoring program to screen for patients with multiple prescriber episodes for benzodiazepines.
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Affiliation(s)
- Yasuyuki Okumura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 11 Toyo Kaiji Bldg. 2F, 1-5-11 Nishishimbashi, Minato-ku, Tokyo 105-0003, Japan.
| | - Sayuri Shimizu
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 11 Toyo Kaiji Bldg. 2F, 1-5-11 Nishishimbashi, Minato-ku, Tokyo 105-0003, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research/Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi cho, Kodaira, Tokyo 187-8553, Japan
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Williams O, Mutch A, Douglas PS, Boyle FM, Hill PS. Proposed changes to Medicare: undermining equity and outcomes in Australian primary health care? Aust N Z J Public Health 2015; 39:106-8. [PMID: 25716751 DOI: 10.1111/1753-6405.12348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, Bunton R, Gillespie J, Banfield M, Jones L, Kljakovic M, Yen L. Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey. PLoS One 2013; 8:e59379. [PMID: 23560046 PMCID: PMC3613388 DOI: 10.1371/journal.pone.0059379] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 02/14/2013] [Indexed: 11/18/2022] Open
Abstract
Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.
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Affiliation(s)
- Tanisha Jowsey
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia.
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Multimorbidity research challenges: where to go from here? JOURNAL OF COMORBIDITY 2011; 1:8-10. [PMID: 29090131 PMCID: PMC5556416 DOI: 10.15256/joc.2011.1.9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 11/24/2011] [Indexed: 11/05/2022]
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