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Ma Z, Xu M, Fu M, Huang T, Shi L, Zhang Y, Guan X. Association of potentially inappropriate medications with prognosis among older patients with non-small cell lung cancer. BMC Geriatr 2024; 24:550. [PMID: 38918727 PMCID: PMC11197362 DOI: 10.1186/s12877-024-05138-3] [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: 10/23/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) are common among older adults with cancer, but their association with overall survival (OS) among non-small cell lung cancer (NSCLC) patients remains unclear. This study aimed to investigate the association between the use of PIMs and OS in patients with NSCLC. METHODS In this cohort study, we included patients ≥ 65 years with newly diagnosed NSCLC from January 2014 to December 2020. Potentially inappropriate medication (PIM) is defined by the Beers criteria of 2019 at baseline and within six months following the initiation of systemic therapy. Multivariable Cox regression model was built to assess the association between PIMs and overall survival (OS). RESULTS We finally included 338 patients with a median follow-up for OS of 1777 days. The prevalence of patients receiving at least one PIM was 39.9% (135/338) and 61.2% (71/116) at baseline and after systemic therapy, respectively. The most important factor associated with PIM use was the number of prescribed medications (P < 0.001). Baseline PIM use and PIM after systemic therapy were significantly associated with inferior OS (476 days vs. 844 days, P = 0.044; and 633 days vs. 1600 days, P = 0.007; respectively). In multivariable analysis, both baseline PIM use and PIM after systemic therapy were independent predictors of poor prognosis (adjusted HR, 1.33; 95% CI, 1.01-1.75; P = 0.041; and adjusted HR, 1.86; 95% CI, 1.11-3.14; P = 0.020; respectively). CONCLUSIONS PIMs are prevalent among older patients with NSCLC and are independent predictors of NSCLC prognosis. There is an urgent need for clinicians to conduct medication reconciliation and appropriate deprescribing for this population, especially for patients with multiple PIMs.
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Affiliation(s)
- Zhuo Ma
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Man Xu
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100010, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
- International Research Center for Medicinal Administration, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Kovačević T, Savić Davidović M, Barišić V, Fazlić E, Miljković S, Djajić V, Miljković B, Kovačević P. The Role of a Clinical Pharmacist in the Identification of Potentially Inadequate Drugs Prescribed to the Geriatric Population in Low-Resource Settings Using the Beers Criteria: A Pilot Study. PHARMACY 2024; 12:84. [PMID: 38921960 PMCID: PMC11207722 DOI: 10.3390/pharmacy12030084] [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: 04/01/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
Population aging is a global phenomenon. Each country in the world faces an increased number of older persons in the total population. With aging, a high prevalence of multiple chronic diseases occurs, leading to the use of complex therapeutic regimens and often to polypharmacy. Potentially inappropriate medication (PIM) is a medicine prescribed to a patient for whom the risks outweigh the benefits. Today, several tools are used to evaluate the use of pharmacotherapy in older adults, one of them is the 2019 AGS Beers Criteria. In this prospective, pilot study, we aimed to investigate if the number of PIMs in elderly patients would be significantly reduced if a clinical pharmacist performed a pharmacotherapy review. The study included 66 patients over 65 years of age who were hospitalized at the 1200-bed university hospital. The intervention was conducted by a clinical pharmacist who reviewed the patients' pharmacotherapy and provided written suggestions to physicians. The pharmacotherapy was again reviewed at the patients' discharge from the hospital. A total number of 204 PIMs were identified in the pharmacotherapy of the study population. At discharge, the number of PIMs decreased to 67. A total of 67% of the pharmacist's suggestions were accepted by the physicians. The pharmacist's intervention led to significant decrease in the number of PIMs on patients' discharge letters.
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Affiliation(s)
- Tijana Kovačević
- University Clinical Centre of Republic of Srpska, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina; (V.B.); (S.M.); (V.D.); (P.K.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | | | - Vedrana Barišić
- University Clinical Centre of Republic of Srpska, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina; (V.B.); (S.M.); (V.D.); (P.K.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Emir Fazlić
- Faculty of Pharmacy, University of Sarajevo, 71000 Sarajevo, Republic of Srpska, Bosnia and Herzegovina;
| | - Siniša Miljković
- University Clinical Centre of Republic of Srpska, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina; (V.B.); (S.M.); (V.D.); (P.K.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Vlado Djajić
- University Clinical Centre of Republic of Srpska, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina; (V.B.); (S.M.); (V.D.); (P.K.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | | | - Peđa Kovačević
- University Clinical Centre of Republic of Srpska, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina; (V.B.); (S.M.); (V.D.); (P.K.)
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina
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Gonçalves JR, Sleath BL, Cerdeira M, Cavaco AM. Older people, medication usage and long-term care pharmacists: a retrospective cohort study. Eur J Hosp Pharm 2023:ejhpharm-2023-003908. [PMID: 37758319 DOI: 10.1136/ejhpharm-2023-003908] [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: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To investigate the impact of the presence of a pharmacist on medication usage in long-term care facilities. METHODS The study followed a retrospective cohort design, with a sample of patients aged ≥65 years admitted to three long-term care facilities over 30 months. Data on age, gender, type of stay, the presence or absence of a pharmacist and pharmacotherapeutic profile at admission and discharge were obtained for study patients. Variations in the number of medicines, anticholinergic burden and potentially inappropriate medications at admission and discharge were assessed as outcome variables. Anticholinergic burden and potentially inappropriate medications were assessed using the Anticholinergic Cognitive Burden scale and the EU(7)-PIM List, respectively. One-sample t-tests were used to compare the mean values of the outcome variables. A four-way ANOVA was used to test the association between background and outcome variables. Partial eta squared (η2) was used to measure the effect size. RESULTS A total of 1366 patients were studied. All outcome variables showed a statistically significant increase at discharge compared with admission. The presence of a pharmacist was statistically significant in improving the number of medicines (p<0.001) and the anticholinergic burden score (p<0.001), while no statistically significant value was reached on potentially inappropriate medications (p=0.642). Small effect size values were obtained for the impact of the pharmacist on the number of medicines and anticholinergic burden scores (η2=0.021 and η2=0.011, respectively). CONCLUSION These findings suggest that the presence of a long-term care pharmacist can positively impact the use of medication associated with poor health outcomes. An integrated interprofessional approach is needed to address potentially inappropriate medications, anticholinergic burden and polypharmacy in long-term care settings, particularly at the time of discharge.
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Affiliation(s)
| | - Betsy L Sleath
- UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Mariana Cerdeira
- Pharmacy Services, Residências Montepio - Serviços de Saúde S.A, Lisbon, Portugal
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Sichieri K, Trevisan DD, Barbosa RL, Secoli SR. Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study. SAO PAULO MED J 2023; 142:e2022666. [PMID: 37531493 PMCID: PMC10393373 DOI: 10.1590/1516-3180.2022.0666.r1.190523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.
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Affiliation(s)
- Karina Sichieri
- Nurse and Doctoral Student, Hospital Universitário (HU),
Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Danilo Donizetti Trevisan
- PhD. Nurse and Assistant Professor, Universidade Federal de São
João Del Rei (UFSJ), Divinópolis (MG), Brazil
| | - Ricardo Luís Barbosa
- PhD. Mathematics and Assistant Professor, Universidade Federal
de Uberlândia (UFU), Monte Carmelo (MG), Brazil
| | - Silvia Regina Secoli
- PhD. Nurse and Senior Professor, Graduate Program in Adult
Health Nursing, School of Nursing, Universidade de São Paulo (USP), São Paulo
(SP), Brazil
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Ladjouzi N, Romdhani A, Zouloumis G, Ould Ouali C, Jhouri A, Schlatter J. Reassessment of Treatments in a Long-Term Care Unit. Gerontol Geriatr Med 2023; 9:23337214231156030. [PMID: 36819230 PMCID: PMC9932759 DOI: 10.1177/23337214231156030] [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: 12/06/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 02/16/2023] Open
Abstract
The risks of iatrogenic medication related adverse events are high among older patients. Assessing prescriptions is critical to prevent overusing, underusing, or misusing medications. The aim of this study is to evaluate the prescription reassessment in older patients hospitalized in long-term care unit. Among the 30 patients (M age = 83 years, woman 66%), polymedication was present, patients taking 5 to 18 drugs (mean 11 drugs). The length of stay varied from 92 days to 4.5 years (mean 564 ± 430 days). The prescription reassessment of the patients hospitalized in our long-term care unit varied from 1 to 125 days with a mean of 16 days. Plan the prescription reassessment could reduce the iatrogenic medication in weakened patients.
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Affiliation(s)
- Nadia Ladjouzi
- Hôpital Paul Doumer, Assistance
Publique des Hôpitaux de Paris, Labruyère, France
| | - Ahmed Romdhani
- Hôpital Paul Doumer, Assistance
Publique des Hôpitaux de Paris, Labruyère, France
| | - Georges Zouloumis
- Hôpital Paul Doumer, Assistance
Publique des Hôpitaux de Paris, Labruyère, France
| | - Cid Ould Ouali
- Hôpital Paul Doumer, Assistance
Publique des Hôpitaux de Paris, Labruyère, France
| | - Aziza Jhouri
- Hôpital Paul Doumer, Assistance
Publique des Hôpitaux de Paris, Labruyère, France
| | - Joël Schlatter
- Hôpital Paul Doumer, Assistance
Publique des Hôpitaux de Paris, Labruyère, France,Joël Schlatter, Hôpital Paul Doumer,
Assistance Publique des Hôpitaux de Paris, 1 route de l’hôpital, Labruyère
60140, France.
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Hanna V, Chahine B, Al Souheil F. Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon. Health Sci Rep 2022; 5:e759. [PMID: 35949679 PMCID: PMC9358532 DOI: 10.1002/hsr2.759] [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: 03/15/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Under-prescription is defined as the exclusion of medications indicated for the treatment of certain conditions without any rationale for not prescribing them. The under-prescription of medications is highly prevalent among older adults (≥65 years) receiving polypharmacy. This study aimed to assess the prevalence of the under-prescription of medications using the Screening Tool to Alert to Right Treatment (START) criteria version 2 and to identify the predictors of having potential prescribing omissions (PPOs). Methods This cross-sectional, face-to-face interview study was carried out between September 2021 and February 2022. The study comprised community-dwelling older adults taking at least one medication on a regular basis. The study questionnaire included the patients' demographics, clinical data, and comorbidities. PPOs were identified using the START criteria. The χ 2 test was used to assess the association between under-prescription of medication and the demographic/clinical variables. Multivariable logistic regression was performed to explore factors associated with under-prescription of medications as the dependent variable and taking all variables that showed a p < 0.05 in the bivariate analysis as independent. Results A total of 444 older adults agreed to participate in this study. The mean age of participants was 71 ± 8.6; the majority of them, 305 (68.7%), were men. Polypharmacy was present in 261 patients (58.8%) and underprescribing of medications in 260 patients (58.6%). The highest percentage of under-prescribing of medications was reported with statins in 115 patients (44.2%) followed by aspirin in 93 (35.7%), and angiotensin-converting enzyme inhibitors in 61 (23.4%). The results of the multivariable analysis showed that patients with underprescribed medications had higher odds of polypharmacy (odds ratio [OR]: 2.015, confidence interval [CI] 95% 1.362-2.980, p < 0.001) and higher Charlson Comorbidity Index (OR 2.807, CI 95% 1.463-5.85, p = 0.02). Conclusion The present findings highlight that PPOs are highly prevalent among community-dwelling older adults in Lebanon. Multimorbidity and polypharmacy were the identified predictors for under-prescription of medications in this population.
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Affiliation(s)
- Venise Hanna
- PharmD Program, School of PharmacyLebanese International UniversityBeirutLebanon
| | - Bahia Chahine
- PharmD Program, School of PharmacyLebanese International UniversityBeirutLebanon
| | - Farah Al Souheil
- PharmD Program, School of PharmacyLebanese International UniversityBeirutLebanon
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Inappropriate Prescriptions in Older People-Translation and Adaptation to Portuguese of the STOPP/START Screening Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116896. [PMID: 35682479 PMCID: PMC9180165 DOI: 10.3390/ijerph19116896] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
Inappropriate prescribing, which encompasses the prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), is a common problem for older people. The STOPP/START tool enables general practitioners, who are the main prescribers, to identify and reduce the incidence of PIMs and PPOs and appraise an older patient’s prescribed drugs during the diagnosis process to improve the clinical care quality. This study aimed to translate and validate the STOPP/START screening tool to enable its use by Portuguese physicians. A translation-back translation method including the validation of the obtained Portuguese version was used. Intra- and inter-rater reliability and agreement analyses were used in the validation process. A dataset containing the information of 334 patients was analyzed by one GP twice within a 2-week interval, while a dataset containing the information of 205 patients was independently analyzed by three GPs. Intra-rater reliability assessment led to a Kappa coefficient (κ) of 0.70 (0.65−0.74) for the STOPP criteria and 0.60 (0.52−0.68) for the START criteria, considered to be substantial and moderate values, respectively. The results of the inter-rater reliability rating were almost perfect for all combinations of raters (κ > 0.93). The version of the STOPP/START criteria translated into Portuguese represents an improvement in managing the medications prescribed to the elderly. It provides clinicians with a screening tool for detecting potentially inappropriate prescribing in patients older than 65 years old that is reliable and easy to use.
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