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Iwamoto Y, Fujino N, Furuno T, Fujimoto Y, Kamada Y. Applicability of the Self-Evaluation Scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills to general nurses. J Rural Med 2024; 19:92-104. [PMID: 38655229 PMCID: PMC11033672 DOI: 10.2185/jrm.2023-046] [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: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 04/26/2024] Open
Abstract
Objective Many patients with dementia experience sleep-related problems. However, there is a lack of clarity regarding nursing practices that can address these issues. Thus, we developed a self-assessment scale for nursing practices to improve sleep quality among patients with dementia taking sleep medication and confirmed its validity and reliability. This study aimed to test the validity and reliability of this scale for adaptability to general nurses and test its applicability. Participants and Methods The survey included basic attributes and questionnaire items related to nursing practices to improve sleep quality in patients with dementia taking sleeping pills. Data from 477 participants with no missing values in the survey items were used in the analysis. The self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills was based on a three-factor model, and confirmatory factor analysis was performed using structural equation modeling. Results Goodness-of-fit indices were satisfactory, supporting the construct validity of the scale. Cronbach's α coefficients for the total score and the three factors of the self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills exceeded 0.7. Conclusion The development of this scale can improve the quality of nursing practice for patients with dementia who take sleeping pills. Moreover, it can serve as evidence for general nurses to participate in drug treatment and can be considered as basic research for appropriate drug treatment in nursing practice.
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Affiliation(s)
- Yuichi Iwamoto
- School of Nursing, Faculty of Medicine, Oita University,
Japan
| | - Narumi Fujino
- Department of Nursing, Faculty of Medicine, Saga University,
Japan
| | - Takaomi Furuno
- Department of Nursing, Faculty of Medicine, Saga University,
Japan
| | - Yuji Fujimoto
- Department of Nursing, Faculty of Medicine, Saga University,
Japan
| | - Yuki Kamada
- The Japanese Red Cross Kyushu International College of
Nursing, Japan
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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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Stauffer SJ, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Potentially inappropriate medication use among older adults with lower-limb loss. Geriatr Nurs 2024; 56:218-224. [PMID: 38367544 DOI: 10.1016/j.gerinurse.2024.02.018] [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: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of, and explore factors related to, prescription of potentially inappropriate medications (PIMs) among older adults with lower-limb loss (LLL). METHODS This was a secondary analysis of a cross-sectional dataset collected through an interdisciplinary limb loss clinic between September 2013 and November 2022. Self-report medication lists were reviewed during in-clinic face-to-face interviews and compared to the American Geriatrics Society Beers Criteria corresponding to the patient's evaluation year. RESULTS Of 82 participants (72.9 ± 6.6 years-old; 78.0 % male), n = 41 (50.0 %) reported using one or more PIM. PIM prescription was significantly associated with presence of phantom limb pain, history of upper gastrointestinal issues, and a greater number of medications. DISCUSSION Polypharmacy and PIM use are common among older adults with LLL. Greater attention should be paid to medications post-amputation, especially pain management medications, to minimize potential adverse side-effects.
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Affiliation(s)
- Samantha Jeanne Stauffer
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA; Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 100 Discovery Blvd, Newark, DE, 19713 USA; University of Delaware, Epidemiology Program, STAR Tower, Suite 614, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA.
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Shimazaki Y, Kishimoto K, Ishikawa J, Iwakiri R, Araki A, Imai S. Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital. Geriatrics (Basel) 2024; 9:15. [PMID: 38392102 PMCID: PMC10887641 DOI: 10.3390/geriatrics9010015] [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: 10/04/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29-8.57) and moderate (OR: 2.46, 95% CI: 1.06-5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51-2.95, p < 0.001], 2.42 [95% CI: 1.79-3.27, p < 0.001], and 2.01 [95% CI: 1.46-2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.
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Affiliation(s)
- Yoshitomo Shimazaki
- Division of Pharmacy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Depertment of Pharmacoepidemiology, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
| | - Keiko Kishimoto
- Department of Social Pharmacy, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
| | - Joji Ishikawa
- Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Rika Iwakiri
- Division of Elderly Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Atsushi Araki
- Frail Prevention Center, Training Center, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shinobu Imai
- Depertment of Pharmacoepidemiology, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
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Kröger E, Wilchesky M, Morin M, Carmichael PH, Marcotte M, Misson L, Plante J, Voyer P, Durand P. The OptimaMed intervention to reduce medication burden in nursing home residents with severe dementia: results from a pragmatic, controlled study. BMC Geriatr 2023; 23:520. [PMID: 37641020 PMCID: PMC10464023 DOI: 10.1186/s12877-023-04222-4] [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: 10/05/2022] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed the effect of an interprofessional knowledge exchange (KE) intervention to decrease medication load and the use of medications of questionable benefit among these residents. METHODS A 6-month intervention was performed in 4 NHs in the Quebec City area, while 3 NHs, with comparable admissions criteria, served as controls. Published lists of "mostly", "sometimes" or "exceptionally" appropriate medications, tailored for NH residents with severe dementia, were used. The intervention included 1) information for participants' families about medication use in severe dementia; 2) a 90-min KE session for NH nurses, pharmacists, and physicians; 3) medication reviews by NH pharmacists using the lists; 4) discussions on recommended changes with nurses and physicians. Participants' levels of agitation and pain were evaluated using validated scales at baseline and the end of follow-up. RESULTS Seven (7) NHs and 123 participants were included for study. The mean number of regular medications per participant decreased from 7.1 to 6.6 in the intervention, and from 7.7 to 5.9 in the control NHs (p-value for the difference in differences test: < 0.05). Levels of agitation decreased by 8.3% in the intervention, and by 1.4% in the control NHs (p = 0.026); pain levels decreased by 12.6% in the intervention and increased by 7% in the control NHs (p = 0.049). Proportions of participants receiving regular medications deemed only exceptionally appropriate decreased from 19 to 17% (p = 0.43) in the intervention and from 28 to 21% (p = 0.007) in the control NHs (p = 0.22). The mean numbers of regular daily antipsychotics per participant fell from 0.64 to 0.58 in the intervention and from 0.39 to 0.30 in the control NHs (p = 0.27). CONCLUSIONS This interprofessional intervention to reduce inappropriate medication use in NH residents with severe dementia decreased medication load in both intervention and control NHs, without important concomitant increase in agitation, but mixed effects on pain levels. Practice changes and heterogeneity within these 7 NHs, and a ceiling effect in medication optimization likely interfered with the intervention. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov: # NCT05155748 (first registration 03-10-2017).
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Affiliation(s)
- Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada.
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada.
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Hôpital du Saint-Sacrement, bureau L2-42, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada.
| | - Machelle Wilchesky
- McGill University, Faculty of Medicine and Health Sciences, 3605, Chemin de La Montagne, Montreal (Québec), H3G 2M1, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, (Québec), H3T 1E2, Canada
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Hôpital du Saint-Sacrement, bureau L2-42, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Donald Berman Maimonides Centre for Research in Aging, 5795 Av. Caldwell, Côte Saint-Luc, Montreal (Québec), H4W 1W3, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Lucie Misson
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Jonathan Plante
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
- Université Laval, Faculté de médecine, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec (Québec), G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
- Donald Berman Maimonides Centre for Research in Aging, 5795 Av. Caldwell, Côte Saint-Luc, Montreal (Québec), H4W 1W3, Canada
- Université Laval, Faculté des sciences infirmières, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec (Québec), G1V 0A6, Canada
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Ketenci S, Akpınar G. Potential drug-drug interactions in adults receiving oral anticoagulant and antiaggregant therapy. Expert Opin Drug Saf 2023; 22:733-739. [PMID: 36860167 DOI: 10.1080/14740338.2023.2186397] [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: 11/22/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Anticoagulant and antiaggregant drugs are drug groups with high mortality and the most common cause of malpractice. RESEARCH DESIGN AND METHODS 18 and 65 years were scheduled for pharmacotherapy in the Family Health Center. 122 patients during their anticoagulant and/or antiaggregant treatment were evaluated in terms of drug-drug interactions. RESULTS Drug-drug interactions were detected in 89.7% of the patients included in the study. A total of 212 drug-drug interactions were found in 122 patients. Of these, 12 (5.6%) were identified as A, 16 (7.5%) B, 146 (68.6%) C, 32 (15.2%) D and 6 (2.8%) X risk category. The number of DDI was found to be significantly higher in patients aged between 56 and 65 years. The most drug interactions are significantly higher in the C and D categories, respectively. The most predicted clinical outcomes of DDI's were increased in the therapeutic effect and adverse/toxic reactions. CONCLUSIONS Contrary to expectations, it is seen that although polypharmacy is relatively less in patients aged 18-65 years compared to patients over 65 years of age, it is very important to detect drug interactions in this age group in terms of safety, efficacy and treatment benefit in terms of drug-drug interaction.
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Affiliation(s)
- Sema Ketenci
- Faculty of Medicine, Department of Medical Phamacology, Atlas University, Kagıthane, Turkiye
| | - Gökçe Akpınar
- Turkish Ministry of Health, Gebze Family Health Center, Istanbul, Turkiye
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Orenstein L, Chetrit A, Goldman A, Novikov I, Dankner R. Polypharmacy is differentially associated with 20-year mortality among community-dwelling elderly women and men: The Israel Glucose Intolerance, Obesity and Hypertension cohort study. Mech Ageing Dev 2023; 211:111788. [PMID: 36758642 DOI: 10.1016/j.mad.2023.111788] [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: 11/21/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Elderly individuals are characterized by multimorbidity and high medication intake, entailing risks for adverse events. We examined the overall and sex-specific association of polypharmacy (≥5 drugs concurrently) with 20-year mortality among community-dwelling older adults. METHODS Survivors of the longitudinal Israel Study of Glucose Intolerance, Obesity, and Hypertension underwent extensive evaluation during 1999-2004, and were followed-up for all-cause mortality until 2019. Cox regression examined association of polypharmacy with all-cause mortality. RESULTS Data included 1210 participants (mean baseline age 72.9 ± 7.4 years, 53% females), 50.7% of them died over a median follow-up of 12.8 years. Women received a higher mean number of drugs (4.3 vs 3.5; p < 0.0001), were twice more likely to take vitamins, and had higher comorbidity. Polypharmacy prevalence was 38.3%, and more frequent with age, female sex, European-American origin, sedentary lifestyle and poor self-rated health. Polypharmacy was independently associated with mortality in women only (HR=1.41, 95%CI:1.05-1.89). An interaction was found with sex (p = 0.045). CONCLUSIONS Polypharmacy was more prevalent in older women than men and associated with increased 20-year mortality in women only. Sex-specific adaptation of guidelines for appropriate drug use among community-dwelling older adults is warranted.
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Affiliation(s)
- Liat Orenstein
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel.
| | - Adam Goldman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; Department of Internal Medicine, Sheba Medical Center, Ramat-Gan 52621, Israel.
| | - Ilya Novikov
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel.
| | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
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8
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Grischott T, Rachamin Y, Senn O, Hug P, Rosemann T, Neuner-Jehle S. Medication Review and Enhanced Information Transfer at Discharge of Older Patients with Polypharmacy: a Cluster-Randomized Controlled Trial in Swiss Hospitals. J Gen Intern Med 2023; 38:610-618. [PMID: 36045192 PMCID: PMC9432794 DOI: 10.1007/s11606-022-07728-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication safety in patients with polypharmacy at transitions of care is a focus of the current Third WHO Global Patient Safety Challenge. Medication review and communication between health care professionals are key targets to reduce medication-related harm. OBJECTIVE To study whether a hospital discharge intervention combining medication review with enhanced information transfer between hospital and primary care physicians can delay hospital readmission and impact health care utilization or other health-related outcomes of older inpatients with polypharmacy. DESIGN Cluster-randomized controlled trial in 21 Swiss hospitals between January 2019 and September 2020, with 6 months follow-up. PARTICIPANTS Sixty-eight senior physicians and their blinded junior physicians included 609 patients ≥ 60 years taking ≥ 5 drugs. INTERVENTIONS Participating hospitals were randomized to either integrate a checklist-guided medication review and communication stimulus into their discharge processes, or follow usual discharge routines. MAIN MEASURES Primary outcome was time-to-first-readmission to any hospital within 6 months, analyzed using a shared frailty model. Secondary outcomes covered readmission rates, emergency department visits, other medical consultations, mortality, drug numbers, proportions of patients with potentially inappropriate medication, and the patients' quality of life. KEY RESULTS At admission, 609 patients (mean age 77.5 (SD 8.6) years, 49.4% female) took a mean of 9.6 (4.2) drugs per patient. Time-to-first-readmission did not differ significantly between study arms (adjusted hazard ratio 1.14 (intervention vs. control arm), 95% CI [0.75-1.71], p = 0.54), nor did the 30-day hospital readmission rates (6.7% [3.3-10.1%] vs. 7.0% [3.6-10.3%]). Overall, there were no clinically relevant differences between study arms at 1, 3, and 6 months after discharge. CONCLUSIONS The combination of a structured medication review with enhanced information transfer neither delayed hospital readmission nor improved other health-related outcomes of older inpatients with polypharmacy. Our results may help researchers in balancing practicality versus stringency of similar hospital discharge interventions. STUDY REGISTRATION ISRCTN18427377, https://doi.org/10.1186/ISRCTN18427377.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland.
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Petra Hug
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
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9
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Farrell A, Castro T, Nalubola S, Lakhi N. Trauma-related falls in an urban geriatric population: predictive risk factors for poorer clinical outcomes. Inj Epidemiol 2023; 10:7. [PMID: 36717881 PMCID: PMC9887835 DOI: 10.1186/s40621-023-00418-9] [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: 09/23/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The aim of this study was to elucidate associations between polypharmacy, types of medications, and geriatric comorbidities to identify predictive risk factors for poorer clinical outcomes following trauma-related falls in the geriatric population. Nearly 80% of trauma-related hospital admissions in the older adult population are secondary to falls, accounting for 3 million emergency department visits annually. Numerous studies have demonstrated associations between falls, polypharmacy, and other geriatric comorbidities, but studies outlining predictive risk factors for poor clinical outcomes are lacking. METHODS A retrospective cohort study of 1087 patients ≥ 65 years old who presented to Level 1 Trauma Center after a trauma-related fall. Comorbidities, current medication, demographic information, and clinical outcomes were identified to ascertain predictive risk factors for poorer clinical outcomes. Variables were assessed for statistical significance on unadjusted analysis. Variables found to be significant were entered into a multivariable logistic regression model to test for adjusted associations, with p < 0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals. RESULTS Polypharmacy ≥ 4 medications (aOR 2.38 (1.10-5.15), p < .028) was an independent predictor of hospital readmission within 30 days. Chronic kidney disease, male gender, and Asian race had an increased association with ICU admission. History of malignancy (aOR 3.65 (1.62-8.19), p < .002) and chronic kidney disease (aOR 2.56 (1.11-5.96), p < .027) were independent predictors of 30-day mortality. CONCLUSIONS Polypharmacy, chronic renal disease, malignancy history, male gender, and Asian race had an increased association of adverse clinical outcomes after falls in the geriatric population. Critical evaluation of patients with these risk factors may be needed to mitigate risk in this population.
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Affiliation(s)
- Alexander Farrell
- grid.430773.40000 0000 8530 6973Touro University College of Osteopathic Medicine, Middletown, NY USA
| | - Taylor Castro
- grid.260914.80000 0001 2322 1832College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY USA
| | - Shreya Nalubola
- grid.260917.b0000 0001 0728 151XSchool of Medicine, New York Medical College, Valhalla, NY USA
| | - Nisha Lakhi
- grid.260917.b0000 0001 0728 151XSchool of Medicine, New York Medical College, Valhalla, NY USA ,grid.416977.a0000 0004 0622 3555Department of Trauma Surgery, Richmond University Medical Center, Staten Island, NY USA
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10
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Szilcz M, Wastesson JW, Morin L, Calderón-Larrañaga A, Lambe M, Johnell K. Potential overtreatment in end-of-life care in adults 65 years or older dying from cancer: applying quality indicators on nationwide registries. Acta Oncol 2022; 61:1437-1445. [PMID: 36495144 DOI: 10.1080/0284186x.2022.2153621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Quality indicators are frequently used to measure the quality of care at the end of life. Whether quality indicators of potential overtreatment (i.e., when the risks outweigh the benefits) at the end of life can be reliably applied to routinely collected data remains uncertain. This study aimed to identify quality indicators of overtreatment at the end of life in the published literature and to investigate their tentative prevalence among older adults dying with solid cancer. MATERIALS AND METHODS Retrospective cohort study of decedents including all older adults (≥65 years) who died with solid cancer between 1 January 2013 and 31 December 2015 (n = 54,177) in Sweden. Individual data from the National Cause of Death Register were linked with data from the Total Population Register, the National Patient Register, and the Swedish Prescribed Drug Register. Quality indicators were applied for the last one and three months of life. RESULTS From a total of 145 quality indicators of overtreatment identified in the literature, 82 (57%) were potentially operationalisable with routine administrative and healthcare data in Sweden. Unidentifiable procedures and hospital drug treatments were the reason for non-operationalisability in 52% of the excluded indicators. Among the 82 operationalisable indicators, 67 measured overlapping concepts. Based on the remaining 15 unique indicators, we tentatively estimated that overall, about one-third of decedents received at least one treatment or procedure indicative of 'potential overtreatment' during their last month of life. CONCLUSION Almost half of the published overtreatment indicators could not be measured in routine administrative and healthcare data in Sweden due to a lack of means to capture the care procedure. Our tentative estimates suggest that potential overtreatment might affect one-third of cancer decedents near death. However, quality indicators of potential overtreatment for specific use in routinely collected data should be developed and validated.
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Affiliation(s)
- Máté Szilcz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas W Wastesson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Inserm CIC 1431, University Hospital of Besançon, Besançon, France
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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11
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Esumi S, Ushio S, Zamami Y. Polypharmacy in Older Adults with Alzheimer’s Disease. Medicina (B Aires) 2022; 58:medicina58101445. [PMID: 36295605 PMCID: PMC9608980 DOI: 10.3390/medicina58101445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
The number of patients with Alzheimer’s disease is increasing annually. Most of these patients are older adults with comorbid physical illnesses, which means that they are often treated with a combination of medications for the disease they have and those for Alzheimer’s disease. Thus, older adults with Alzheimer’s disease are potentially at risk for polypharmacy. In addition, the drug interactions between Alzheimer’s disease medications and those for the treatment of physical illnesses may reduce their efficacy and increase side effects. This article reviews polypharmacy and drug interactions in elderly patients with Alzheimer’s disease, with a focus on psychotropic drugs.
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Affiliation(s)
- Satoru Esumi
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
- The Faculty of Pharmaceutical Science, Kobe Gakuin University, 1-1-3 Minatojima, Chuo-ku, Kobe 650-8586, Japan
- Correspondence: ; Tel.: +81-78-974-1551
| | - Soichiro Ushio
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshito Zamami
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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12
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Turossi-Amorim ED, Camargo B, Schuelter-Trevisol F. Prevalence of Potential Pharmacological Interactions in Patients Undergoing Systemic Chemotherapy in a Tertiary Hospital. Hosp Pharm 2022; 57:646-653. [PMID: 36081531 PMCID: PMC9445545 DOI: 10.1177/00185787211073464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Introduction: Pharmacological interactions are frequently observed in patients with chronic diseases, and their occurrence is proportional to the amount of medication used daily. Patients undergoing chemotherapy treatment commonly have comorbidities, which favor a greater prevalence of polypharmacy, increasing the risk of drug interactions. Therefore, the aim of this study was to estimate the prevalence of drug interactions in patients undergoing intravenous chemotherapy treated at a hospital oncology service in southern Brazil. Methods: This was an observational study with a cross-sectional design that was carried out with the analysis of secondary data obtained through the review of medical records. The population assessed consisted of all cancer patients who received intravenous chemotherapy from October to December 2020. Results: Out of the 297 patients included in the study, 231 (77.8%) had at least 1 potential pharmacological interaction. In total, 1044 drug interactions were found that were classified according to severity, resulting in 18 (1.7%) contraindicated drug-drug interactions (DDI), 699 (67%) severe, 281 (26.9%) moderate, and 46 (4.4%) minor interactions. There was an association between polypharmacy and the prevalence of drug interactions. Conclusion: The results demonstrate that a large percentage of patients undergoing chemotherapy are susceptible to drug interactions. Thus, it is necessary that prescribers consider all drugs used by patients and, when possible, prescribe alternative drugs that have less potential for interaction in order to prevent drug interactions adverse effects and provide a better prognosis for patients.
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Affiliation(s)
| | - Bruna Camargo
- University of Southern Santa Catarina, Tubarao, Brazil
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13
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Jones RP, Ponomarenko A. Trends in Excess Winter Mortality (EWM) from 1900/01 to 2019/20-Evidence for a Complex System of Multiple Long-Term Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063407. [PMID: 35329098 PMCID: PMC8953800 DOI: 10.3390/ijerph19063407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
Trends in excess winter mortality (EWM) were investigated from the winter of 1900/01 to 2019/20. During the 1918–1919 Spanish flu epidemic a maximum EWM of 100% was observed in both Denmark and the USA, and 131% in Sweden. During the Spanish flu epidemic in the USA 70% of excess winter deaths were coded to influenza. EWM steadily declined from the Spanish flu peak to a minimum around the 1960s to 1980s. This decline was accompanied by a shift in deaths away from the winter and spring, and the EWM calculation shifted from a maximum around April to June in the early 1900s to around March since the late 1960s. EWM has a good correlation with the number of estimated influenza deaths, but in this context influenza pandemics after the Spanish flu only had an EWM equivalent to that for seasonal influenza. This was confirmed for a large sample of world countries for the three pandemics occurring after 1960. Using data from 1980 onward the effect of influenza vaccination on EWM were examined using a large international dataset. No effect of increasing influenza vaccination could be discerned; however, there are multiple competing forces influencing EWM which will obscure any underlying trend, e.g., increasing age at death, multimorbidity, dementia, polypharmacy, diabetes, and obesity—all of which either interfere with vaccine effectiveness or are risk factors for influenza death. After adjusting the trend in EWM in the USA influenza vaccination can be seen to be masking higher winter deaths among a high morbidity US population. Adjusting for the effect of increasing obesity counteracted some of the observed increase in EWM seen in the USA. Winter deaths are clearly the outcome of a complex system of competing long-term trends.
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Affiliation(s)
- Rodney P. Jones
- Healthcare Analysis & Forecasting, Wantage OX12 0NE, UK
- Correspondence:
| | - Andriy Ponomarenko
- Department of Biophysics, Informatics and Medical Instrumentation, Odessa National Medical University, Valikhovsky Lane 2, 65082 Odessa, Ukraine;
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14
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Bhagavathula AS, Tesfaye W, Vidyasagar K, Fialova D. Polypharmacy and Hyperpolypharmacy in Older Individuals with Parkinson's Disease: A Systematic Review and Meta-Analysis. Gerontology 2022; 68:1081-1090. [PMID: 35026767 DOI: 10.1159/000521214] [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: 08/10/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Polypharmacy (concomitant use of 5-9 medicines) and hyperpolypharmacy (concomitant use of over 10 medicines) were observed to be more frequent in older adults (≥65 years) and associated with adverse outcomes. Their prevalence and risk in older patients with Parkinson's disease (PD) remain unknown. We aimed to synthesize the extant evidence on the prevalence and risk of polypharmacy and hyperpolypharmacy in older adults with PD. METHODS A systematic literature search was performed in PubMed/MEDLINE, Scopus, and Embase databases to identify pertinent studies published from 2000 to July 2021. Observational studies reporting the prevalence and association with disease of polypharmacy/hyperpolypharmacy in older adults with PD were meta-analyzed. Pooled prevalence and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. RESULTS Out of the total 499 studies identified, 6 fulfilled the inclusion criteria and comprised 7,171 participants. The overall prevalence of polypharmacy and hyperpolypharmacy was 40% (95% CI: 37-44) and 18% (95% CI: 13-23), respectively. A meta-analysis of 4 studies indicated a significant association between polypharmacy (OR: 1.94, 95% CI: 1.26-2.62; p < 0.001) and PD. Hyperpolypharmacy was also strongly associated with PD (OR: 3.11, 95% CI: 2.08-4.14; p < 0.001). CONCLUSION Polypharmacy (40%) and hyperpolypharmacy (18%) are highly prevalent and eventually increase the risk of drug-related problems in older adults with PD. Therefore, interventions that ensure rational geriatric pharmacotherapy are of critical importance for the older population with neurogenerative disorders.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Kota Vidyasagar
- University College of Pharmaceutical Sciences, Kakatiya University, Warangal, India
| | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia.,Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czechia
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15
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Masse M, Henry H, Cuvelier E, Pinçon C, Pavy M, Beeuwsaert A, Barthélémy C, Cuny D, Gautier S, Kambia N, Lefebvre JM, Mascaut D, Mitoumba F, Puisieux F, Standaert A, Wierre P, Beuscart JB, Roche J, Décaudin B. Sleep Medication in Older Adults: Identifying the Need for Support by a Community Pharmacist. Healthcare (Basel) 2022; 10:healthcare10010147. [PMID: 35052310 PMCID: PMC8775744 DOI: 10.3390/healthcare10010147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/23/2022] Open
Abstract
Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.
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Affiliation(s)
- Morgane Masse
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
- Correspondence:
| | - Héloïse Henry
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Elodie Cuvelier
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Claire Pinçon
- Univ. Lille, CHU Lille, ULR2694-METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; (C.P.); (J.-B.B.)
| | - Margot Pavy
- Faculté de Pharmacie, Université de Lille, F-59000 Lille, France; (M.P.); (A.B.)
| | - Audrey Beeuwsaert
- Faculté de Pharmacie, Université de Lille, F-59000 Lille, France; (M.P.); (A.B.)
| | - Christine Barthélémy
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Damien Cuny
- Univ. Lille, ULR 4515-LGCgE, Laboratoire de Génie Civil et Géo-Environnement, F-59000 Lille, France;
| | - Sophie Gautier
- Inserm, UMR-S1172, Center for Pharmacovigilance, CHU de Lille, University Lille, F-59037 Lille, France;
| | - Nicolas Kambia
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - Jean-Marc Lefebvre
- Department of General Practice, University of Lille, F-50045 Lille, France;
| | - Daniel Mascaut
- Association des Conseillers et des Pharmaciens Agréés Maîtres de Stage du Nord—Pas-de-Calais, 21 Rue du Pont-Neuf, F-59000 Lille, France; (D.M.); (P.W.)
| | - Fabrice Mitoumba
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
| | - François Puisieux
- Hôpital Gériatrique Les Bateliers, Pôle de Gérontologie, CHRU de Lille, F-59000 Lille, France;
| | - Annie Standaert
- Univ. Lille, Inserm, CHU Lille, U1286-INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
| | - Patrick Wierre
- Association des Conseillers et des Pharmaciens Agréés Maîtres de Stage du Nord—Pas-de-Calais, 21 Rue du Pont-Neuf, F-59000 Lille, France; (D.M.); (P.W.)
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR2694-METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; (C.P.); (J.-B.B.)
| | - Jean Roche
- CHU de Lille, Unité de Psychogériatrie, Pôle de Gérontologie, F-59037 Lille, France;
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365-GRITA—Groupe de Recherche sur les Formes Injectables et les Technologies Associées, F-59000 Lille, France; (H.H.); (E.C.); (C.B.); (N.K.); (F.M.); (B.D.)
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16
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Mahlknecht A, Wiedermann CJ, Sandri M, Engl A, Valentini M, Vögele A, Schmid S, Deflorian F, Montalbano C, Koper D, Bellmann R, Sönnichsen A, Piccoliori G. Expert-based medication reviews to reduce polypharmacy in older patients in primary care: a northern-Italian cluster-randomised controlled trial. BMC Geriatr 2021; 21:659. [PMID: 34814835 PMCID: PMC8609829 DOI: 10.1186/s12877-021-02612-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical benefits for older patients (aged 75+) by means of evidence-based reduction of polypharmacy (defined as ≥8 prescribed drugs) and inappropriate prescribing in general practice. METHODS The cluster-randomised controlled trial involved general practitioners and patients in a northern-Italian region. The intervention consisted of a review of patient's medication regimens by three experts who gave specific recommendations for drug discontinuation. Main outcome measures were non-elective hospital admissions or death within 24 months (composite primary endpoint). Secondary outcomes were drug numbers, hospital admissions, mortality, falls, fractures, quality of life, affective status, cognitive function. RESULTS Twenty-two GPs/307 patients participated in the intervention group, 21 GPs/272 patients in the control group. One hundred twenty-five patients (40.7%) experienced the primary outcome in the intervention group, 87 patients (32.0%) in the control group. The adjusted rates of occurrence of the primary outcome did not differ significantly between the study groups (intention-to-treat analysis: adjusted odds ratio 1.46, 95%CI 0.99-2.18, p = 0.06; per-protocol analysis: adjusted OR 1.33, 95%CI 0.87-2.04, p = 0.2). Hospitalisations as single endpoint occurred more frequently in the intervention group according to the unadjusted analysis (OR 1.61, 95%CI 1.03-2.51, p = 0.04) but not in the adjusted analysis (OR 1.39, 95%CI 0.95-2.03, p = 0.09). Falls occurred less frequently in the intervention group (adjusted OR 0.55, 95%CI 0.31-0.98; p = 0.04). No significant differences were found regarding the other outcomes. Definitive discontinuation was obtained for 67 (16.0%) of 419 drugs rated as inappropriate. About 6% of the prescribed drugs were PIMs. CONCLUSIONS No conclusive effects were found regarding mortality and non-elective hospitalisations as composite respectively single endpoints. Falls were significantly reduced in the intervention group, although definitive discontinuation was achieved for only one out of six inappropriate drugs. These results indicate that (1) even a modest reduction of inappropriate medications may entail positive clinical effects, and that (2) focusing on evidence-based new drug prescriptions and prevention of polypharmacy may be more effective than deprescribing. TRIAL REGISTRATION Current Controlled Trials (ID ISRCTN: 38449870), date: 11/09/2013.
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy. .,Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Christian J Wiedermann
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy.,UMIT - Private University for Health Sciences, Medical Informatics and Technology - Tyrol, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Marco Sandri
- Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy
| | - Martina Valentini
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Anna Vögele
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Sara Schmid
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Felix Deflorian
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Carmelo Montalbano
- Genomedics S.r.L. Health Care Consultants, Via Sestese 61, 50141, Florence, Italy
| | - Dara Koper
- Salzburger Gesundheitsfonds, Sebastian Stief-Gasse 2, 5020, Salzburg, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Medical Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Peter-Anich- Street 35, 6020, Innsbruck, Austria
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy
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17
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Müller BS, Klaaßen-Mielke R, Gonzalez-Gonzalez AI, Grandt D, Hammerschmidt R, Köberlein-Neu J, Kellermann-Mühlhoff P, Trampisch HJ, Beckmann T, Düvel L, Surmann B, Flaig B, Ihle P, Söling S, Grandt S, Dinh TS, Piotrowski A, Meyer I, Karbach U, Harder S, Perera R, Glasziou P, Pfaff H, Greiner W, Gerlach FM, Timmesfeld N, Muth C. Effectiveness of the application of an electronic medication management support system in patients with polypharmacy in general practice: a study protocol of cluster-randomised controlled trial (AdAM). BMJ Open 2021; 11:e048191. [PMID: 34588245 PMCID: PMC8479941 DOI: 10.1136/bmjopen-2020-048191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Clinically complex patients often require multiple medications. Polypharmacy is associated with inappropriate prescriptions, which may lead to negative outcomes. Few effective tools are available to help physicians optimise patient medication. This study assesses whether an electronic medication management support system (eMMa) reduces hospitalisation and mortality and improves prescription quality/safety in patients with polypharmacy. METHODS AND ANALYSIS Planned design: pragmatic, parallel cluster-randomised controlled trial; general practices as randomisation unit; patients as analysis unit. As practice recruitment was poor, we included additional data to our primary endpoint analysis for practices and quarters from October 2017 to March 2021. Since randomisation was performed in waves, final study design corresponds to a stepped-wedge design with open cohort and step-length of one quarter. SCOPE general practices, Westphalia-Lippe (Germany), caring for BARMER health fund-covered patients. POPULATION patients (≥18 years) with polypharmacy (≥5 prescriptions). SAMPLE SIZE initially, 32 patients from each of 539 practices were required for each study arm (17 200 patients/arm), but only 688 practices were randomised after 2 years of recruitment. Design change ensures that 80% power is nonetheless achieved. INTERVENTION complex intervention eMMa. FOLLOW-UP at least five quarters/cluster (practice). recruitment: practices recruited/randomised at different times; after follow-up, control group practices may access eMMa. OUTCOMES primary endpoint is all-cause mortality and hospitalisation; secondary endpoints are number of potentially inappropriate medications, cause-specific hospitalisation preceded by high-risk prescribing and medication underuse. STATISTICAL ANALYSIS primary and secondary outcomes are measured quarterly at patient level. A generalised linear mixed-effect model and repeated patient measurements are used to consider patient clusters within practices. Time and intervention group are considered fixed factors; variation between practices and patients is fitted as random effects. Intention-to-treat principle is used to analyse primary and key secondary endpoints. ETHICS AND DISSEMINATION Trial approved by Ethics Commission of North-Rhine Medical Association. Results will be disseminated through workshops, peer-reviewed publications, local and international conferences. TRIAL REGISTRATION NCT03430336. ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03430336).
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Affiliation(s)
- Beate S Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
| | - Ana Isabel Gonzalez-Gonzalez
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Daniel Grandt
- Department of Internal Medicine, Clinic Saarbrücken, Saarbrücken, Germany
| | - Reinhard Hammerschmidt
- Association of Statutory Health Insurance Physicians, Region Westphalia/Lippe, Dortmund, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | | | - Hans J Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
| | | | | | - Bastian Surmann
- Department of Health Economics and Health Care Management. Faculty of Health Science, Bielefeld University, Bielefeld, Germany
| | - Benno Flaig
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sara Söling
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Department of Health Services Research, University of Cologne, Cologne, Germany
| | | | - Truc Sophia Dinh
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alexandra Piotrowski
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Ingo Meyer
- PMV Research Group, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Department of Rehabilitation Sociology, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Sebastian Harder
- Institute for Clinical Pharmacology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (CREBP), Bond University, Robina, Queensland, Australia
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management. Faculty of Health Science, Bielefeld University, Bielefeld, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
| | - Christiane Muth
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of General Practice and Family Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
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18
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Arita T, Suzuki S, Yagi N, Otsuka T, Kishi M, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Matsuhama M, Iida M, Yajima J, Yamashita T. Association between number of medications and mortality among older adult patients in a specialized cardiology hospital. Geriatr Gerontol Int 2021; 21:985-995. [PMID: 34549500 DOI: 10.1111/ggi.14275] [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: 05/23/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
AIM Although polypharmacy has been associated with poor clinical outcomes, whether taking an increased number of medications is harmful or beneficial for older adult patients treated for cardiovascular diseases might require further discussion. METHODS We analyzed data of 2089 patients aged ≥75 years in a single hospital-based cohort. The study population was divided into three groups according to the tertiles of the number of medications at baseline: <3 (n = 647), 3-7 (n = 707) and ≥8 (n = 735). RESULTS The cumulative incidences of all-cause death at 3 years among patients taking less than three, three to seven and eight or more medications were 3.7%, 4.1% and 7.8%, respectively (log-rank test P = 0.015). In a Cox regression analysis, taking eight or more total medications (vs 0-2) was independently associated with all-cause death (hazard ratio 1.67, 95% CI 1.01-2.78). For predicting mortality using the number of medications, the maximum Youden Index was 7. In subgroups with certain heart diseases, no regular tendency of an increase in the risk of all-cause death was observed with an increase in the number of medications. CONCLUSIONS The number of medications taken was independently associated with mortality among older adult patients, with a relatively high cut-off point. This association was not observed in patients with certain heart diseases, possibly indicating the merit - rather than the harm - of medical treatment in the cardiovascular field. Geriatr Gerontol Int 2021; 21: 985-995.
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Affiliation(s)
- Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikio Kishi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Minoru Matsuhama
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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19
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Rachamin Y, Grischott T, Neuner-Jehle S. Implementation of a complex intervention to improve hospital discharge: process evaluation of a cluster randomised controlled trial. BMJ Open 2021; 11:e049872. [PMID: 34045217 PMCID: PMC8162085 DOI: 10.1136/bmjopen-2021-049872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To study the implementation of a cluster randomised controlled effectiveness-implementation hybrid trial testing the effectiveness of a medication review at hospital discharge combined with a communication stimulus between hospital physicians (HPs) and general practitioners (GPs) on rehospitalisation of multimorbid older patients. DESIGN Extension of Grant's mixed method process evaluation framework to trials with multilevel clustering. SETTING General internal medicine wards in Swiss hospitals. PARTICIPANTS Convenience samples of 15 chief physicians (of 21 hospitals participating in the effectiveness trial), 60 (74) senior HPs, 65 (164) junior HPs and 187 (411) GPs. IMPLEMENTATION STRATEGY Two-hour teaching sessions for senior HPs on a patient-centred, checklist-guided discharge routine. PROCESS EVALUATION COMPONENTS Data collection on recruitment, delivery and response from chief physicians (semistructured interviews), senior HPs, junior HPs, GPs (surveys) and patients (via HPs). Quantitative data were summarised using descriptive statistics, and interviews analysed using thematic analysis. OUTCOME MEASURES Intervention dose (quantitative), implementation fidelity (qualitative), feasibility and acceptability, facilitators and barriers, implementation support strategies. RESULTS Recruitment of hospitals was laborious but successful, with 21 hospitals recruited. Minimal workload and a perceived benefit for the clinic were crucial factors for participation. Intervention dose was high (95% of checklist activities carried out), but intervention fidelity was limited (discharge letters) or unknown (medication review). Recruitment and retention of patients was challenging, partly due to patient characteristics (old, frail) and the COVID-19 pandemic: Only 612 of the anticipated 2100 patients were recruited, and 31% were lost to follow-up within the first month after discharge. The intervention was deemed feasible and helpful by HPs, and the relevance of the topic appreciated by both HPs and GPs. CONCLUSIONS The results from this evaluation will support interpretation of the findings of the effectiveness study and may inform researchers and policy makers who aim at improving hospital discharge. TRIAL REGISTRATION NUMBER ISRCTN18427377.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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20
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Hayward S, Hole B, Denholm R, Duncan P, Morris JE, Fraser SDS, Payne RA, Roderick P, Chesnaye NC, Wanner C, Drechsler C, Postorino M, Porto G, Szymczak M, Evans M, Dekker FW, Jager KJ, Caskey FJ. International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study. Nephrol Dial Transplant 2021; 36:503-511. [PMID: 32543669 DOI: 10.1093/ndt/gfaa064] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study. METHODS The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy. RESULTS Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32-2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15-2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17-0.87); P = 0.021]. CONCLUSIONS Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.
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Affiliation(s)
- Samantha Hayward
- UK Renal Registry, Southmead Hospital, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK.,Department of Nephrology, Southmead Hospital, North Bristol Trust, Bristol, UK
| | - Barnaby Hole
- UK Renal Registry, Southmead Hospital, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK.,Department of Nephrology, Southmead Hospital, North Bristol Trust, Bristol, UK
| | - Rachel Denholm
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Polly Duncan
- Bristol Medical School, University of Bristol, Bristol, UK
| | - James E Morris
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton UK
| | - Rupert A Payne
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton UK
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Christiane Drechsler
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Maurizio Postorino
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Gaetana Porto
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marie Evans
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fergus J Caskey
- Bristol Medical School, University of Bristol, Bristol, UK.,Department of Nephrology, Southmead Hospital, North Bristol Trust, Bristol, UK
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21
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Ritter C, Hewitt K, McMorris CA. Psychotropic Polypharmacy Among Children and Youth with Autism: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:244-258. [PMID: 33970024 DOI: 10.1089/cap.2020.0110] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives: Majority of youth with autism are taking two or more medications (psychotropic or nonpsychotropic) simultaneously, also known as polypharmacy. Yet the efficacy and the potential outcomes of polypharmacy in this population are widely unknown. This systematic literature review described the trends of polypharmacy among autistic youth, and identified factors associated with polypharmacy. Methods: Sixteen studies were included, encompassing over 300,000 youth with autism. Results: Rates of polypharmacy varied quite substantially across studies, ranging from 6.8% to 87% of autistic youth. Having psychiatric comorbidities, self-injurious behaviors, and physical aggression, as well as being male and older, were associated with higher rates of polypharmacy. Conclusion: Findings emphasize the importance of further research to determine appropriate practices related to the monitoring of adverse side effects, and the long-term impact of polypharmacy among autistic youth.
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Affiliation(s)
- Chantel Ritter
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Katherine Hewitt
- Werklund School of Education, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
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22
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Schouten B, Merten H, Spreeuwenberg PMM, Nanayakkara PWB, Wagner C. The Incidence and Preventability of Adverse Events in Older Acutely Admitted Patients: A Longitudinal Study With 4292 Patient Records. J Patient Saf 2021; 17:166-173. [PMID: 33734205 DOI: 10.1097/pts.0000000000000727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Acute care crowding is a global issue, jeopardizing patient safety. An important cause of crowding is the growing number of older, vulnerable, and complex patients. This group is at higher risk of experiencing (preventable) adverse events (AEs) than younger patients.This study aimed to identify the incidence, preventability, nature, and prevention strategies of AEs in older patients during an acute hospital admission and to assess changes over time. METHODS We analyzed data of 4292 acutely admitted patients (70+) who died in the hospital, using data of a multicenter Dutch AE record review study (2008, 2012, 2016). Multilevel logistic regression analyses were performed to adjust for patient-mix differences and clustering on department/hospital level per year. RESULTS The incidence of AEs in this group declined significantly (χ2(1) = 8.78, P = 0.003) from 10.7% (95% confidence interval [CI] =8.2-13.9) in 2008, 7.4% (95% CI = 5.6-9.7) in 2012, to 7.2% (95% CI = 5.5-9.3) in 2016. The relative preventability showed a significant parabolic trend (χ2(1) = 4.86, P = 0.027), from 46.2% (95% CI = 34.1-58.7), to 32.4% (95% CI = 21.1-46.1), to 44.6% (95% CI = 32-58). Adverse events were often related to medication (26.3% in 2008, 35.1% in 2012, and 39.5% in 2016), and the preventability in AEs related to diagnosis was highest (88.3%, 70.8%, and 79.9%). CONCLUSIONS The incidence of AEs in older acutely admitted patients declined over the years; however, the preventability increased again after an initial decline. This could be related to crowding or increasing complexity in the acute care chain. Further monitoring and improvement in (preventable) AE rates are necessary to pinpoint areas of improvement to make hospital care for this vulnerable group safer.
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Affiliation(s)
- Bo Schouten
- From the Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam
| | - Hanneke Merten
- From the Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam
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23
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Pu D, Wong MCH, Yiu EML, Chan KMK. Profiles of polypharmacy in older adults and medication associations with signs of aspiration. Expert Rev Clin Pharmacol 2021; 14:643-649. [PMID: 33764819 DOI: 10.1080/17512433.2021.1909474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Polypharmacy and specific medication classes are prevalent in older adults. Their relationships with swallowing disorders are not well explored, which would best be managed holistically, with consideration of medication profiles. This study aimed to establish profiles of polypharmacy in older adults and investigate the associations of polypharmacy and medication class with signs of aspiration during swallowing. METHODS This was a secondary retrospective analysis of data from 291 adults aged 60 years and older. Polypharmacy was profiled numerically and described. Multivariate logistic regression was used to identify associations between medication classes with signs of aspiration, while controlling for independent variables of demographics, functional status, and medical history. RESULTS Three distinct profiles of polypharmacy were described. Higher numbers of medications were associated with higher age, lower functional status, nursing home residency, multimorbidity, and showing signs of aspiration. Thirty-four classes of medications were found in this study, benzodiazepines were the only class independently associated with signs of aspiration. CONCLUSIONS Different profiles of polypharmacy can be observed in older adults, but none were independently associated with signs of aspiration. In addition to known demographic and functional status variables, benzodiazepine-use was found to be independently associated with signs of aspiration (p = .005, B = 7.94).
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michael C H Wong
- Registered Pharmacist, Pharmacy & Poisons Board of Hong Kong, Hong Kong, China
| | - Edwin M L Yiu
- Swallowing Research Laboratory, Faculty of Education, the University of Hong Kong, Hong Kong, China
| | - Karen M K Chan
- Swallowing Research Laboratory, Faculty of Education, the University of Hong Kong, Hong Kong, China
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24
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Brokaar EJ, van den Bos F, Visser LE, Portielje JEA. Deprescribing in Older Adults With Cancer and Limited Life Expectancy: An Integrative Review. Am J Hosp Palliat Care 2021; 39:86-100. [PMID: 33739162 DOI: 10.1177/10499091211003078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Polypharmacy is common in older adults with cancer and deprescribing potentially inappropriate medications becomes very relevant when life expectancy decreases due to metastatic disease. Especially preventive medications may no longer be beneficial, because they may decrease quality of life and reduction in morbidity and mortality may be futile. Although deprescribing of preventive medication is common in the last period of life, it is still unusual during active cancer treatment for advanced disease, although life expectancy is often limited to less than 1 to 2 years in that stage. We performed a systematic search of the literature in Pubmed and Embase on the discontinuation of commonly utilized groups of preventive medication and evaluated the evidence of potential benefits and harms in patients aged 65 years or older with cancer and a limited life expectancy (LLE). From 21 included studies, it can be concluded that deprescribing lipid lowering drugs, antihypertensive drugs, osteoporosis drugs and antihyperglycemic drugs is feasible in a considerable part of patients with a LLE. Discontinuation may be performed safely, without the occurrence of serious adverse events or decrease of survival. The only study that addressed quality of life after deprescribing showed that discontinuation of statins improves quality of life in patients with a LLE. Recurrence of symptoms requiring reintroduction occurred in 0-13% of patients on antihyperglycemic treatment and 8-60% of patients using antihypertensive drugs. In order to reduce pill burden and futile treatment clinicians should discuss deprescribing of preventive medication with older patients with advanced cancer and a LLE.
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Affiliation(s)
- Edwin J Brokaar
- Department of Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - Frederiek van den Bos
- Department of Gerontology & Geriatrics, 4501University Medical Center Leiden, Leiden, the Netherlands
| | - Loes E Visser
- Department of Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands.,Department of Pharmacy, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johanneke E A Portielje
- Department of Internal Medicine-Medical Oncology, 4501University Medical Center Leiden, Leiden, the Netherlands
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25
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Tomandl J, Heinmüller S, Selb M, Graessel E, Freiberger E, Kühlein T, Hueber S, Book S, Gotthardt S. Laying the foundation for a Core Set of the International Classification of Functioning, Disability and Health for community-dwelling older adults in primary care: relevant categories of their functioning from the research perspective, a scoping review. BMJ Open 2021; 11:e037333. [PMID: 33597130 PMCID: PMC7893647 DOI: 10.1136/bmjopen-2020-037333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The objective of this study was to find relevant concepts of functioning in community-dwelling older adults within frequently used assessment instruments published in the scientific literature. This was part of a larger project to develop an International Classification of Functioning, Disability and Health (ICF) Core Set for use in primary care. DESIGN A scoping review was conducted. Articles dealing with functioning in older adults were searched and assessed for eligibility. The study population included community-dwelling adults (≥75 years) without dementia, living in high-resource countries. Relevant concepts were extracted from assessment instruments and linked to the ICF using standardised linking rules. Finally, a frequency analysis was conducted. SETTING Home, primary care. PARTICIPANTS Community-dwelling adults aged 75 years and above. RESULTS From 5060 identified publications, 68 were included and 30 assessment instruments extracted. Overall, 1182 concepts were retrieved. Most were linked to the 'activities and participation' component. The most frequently identified categories were 'memory functions', 'dressing' and 'changing basic body position'. CONCLUSIONS This review provides a list of relevant ICF categories from the research perspective that will be used for developing an ICF Core Set for older primary care patients. TRIAL REGISTRATION NUMBERS PROSPERO (CRD42017067784), Versorgungsforschung Deutschland Datenbank (VfD_17_003833) and ClinicalTrials.gov (NCT03384732).
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Affiliation(s)
- Johanna Tomandl
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Stefan Heinmüller
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Melissa Selb
- ICF Research Branch, a cooperation partner within the WHO Collaborating Center for the Family of International Classifications in Germany (at DIMDI), SwissParaplegic Research, Nottwil, Switzerland
| | - Elmar Graessel
- Department of Psychiatry and Psychotherapy, Center for Health Services Research in Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nuremberg, Nuremberg, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Book
- Department of Psychiatry and Psychotherapy, Center for Health Services Research in Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Susann Gotthardt
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nuremberg, Nuremberg, Germany
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26
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Didone TVN, Borelli P, Casari PBB, Souza RRD, Jorge TR, Guerra-Shinohara EM. Appropriate knowledge of the indications for medications in use among older individuals assisted in the Jornada Científica dos Acadêmicos de Farmácia-Bioquímica. BRAZ J PHARM SCI 2021. [DOI: 10.1590/s2175-97902020000419043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - Elvira Maria Guerra-Shinohara
- Federal University of Sao Paulo, Brazil; University of Sao Paulo, Brazil; Federal University of Mato Grosso do Sul, Brazil
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27
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Dellinger JK, Pitzer S, Schaffler-Schaden D, Schreier MM, Fährmann LS, Hempel G, Likar R, Osterbrink J, Flamm M. Improving medication appropriateness in nursing homes via structured interprofessional medication-review supported by health information technology: a non-randomized controlled study. BMC Geriatr 2020; 20:506. [PMID: 33243145 PMCID: PMC7690110 DOI: 10.1186/s12877-020-01895-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background In nursing home residents (NHRs), polypharmacy is widespread, accompanied by elevated risks of medication related complications. Managing medication in NHRs is a priority, but prone to several challenges, including interprofessional cooperation. Against this background, we implemented and tested an interprofessional intervention aimed to improve medication appropriateness for NHRs. Methods A non-randomized controlled study (SiMbA; “Sicherheit der Medikamentherapie bei AltenheimbewohnerInnen”, Safety of medication therapy in NHRs) was conducted in six nursing homes in Austria (2016–2018). Educational training, introduction of tailored health information technology (HIT) and a therapy check process were combined in an intervention aimed at healthcare professionals. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI). Data was collected before (t0), during (t1, month 12) and after (t2, month 18) intervention via self-administered assessments and electronic health records. Results We included 6 NHs, 17 GPs (52.94% female) and 240 NHRs (68.75% female; mean age 85.0). Data of 159 NHRs could be included in the analysis. Mean MAI-change was − 3.35 (IG) vs. − 1.45 (CG). In the subgroup of NHRs with mean MAI ≥23, MAI-change was − 10.31 (IG) vs. −3.52 (CG). The intervention was a significant predictor of improvement in MAI when controlled for in a multivariable regression model. Conclusions Improvement of medication appropriateness was clearest in residents with inappropriate baseline MAI-scores. This improvement was independent of variances in certain covariates between the intervention and the control group. We conclude that our intervention is a feasible approach to improve NHRs’ medication appropriateness. Trial registration DRKS Data Management, ID: DRKS00012246. Registered 16.05.2017 – Retrospectively registered.
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Affiliation(s)
| | - Stefan Pitzer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Dagmar Schaffler-Schaden
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Laura Sandre Fährmann
- Institute of Pharmaceutic and Medical Chemistry, University of Münster, Münster, Germany
| | - Georg Hempel
- Institute of Pharmaceutic and Medical Chemistry, University of Münster, Münster, Germany
| | - Rudolf Likar
- Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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28
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Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP Open 2020; 4:bjgpopen20X101096. [PMID: 32723784 PMCID: PMC7465575 DOI: 10.3399/bjgpopen20x101096] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 01/07/2023] Open
Abstract
Background Managing polypharmacy is a challenge for healthcare systems globally. It is also a health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care for most patients with multimorbidity and polypharmacy occurs in primary care. Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy. However, these are not fully accepted or routinely implemented. Aim To identify barriers and facilitators to safe deprescribing interventions for adults with multimorbidity and polypharmacy in primary care. Design & setting A systematic review of studies published from 2000, examining safe deprescribing interventions for adults with multimorbidity and polypharmacy. Method A search of electronic databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINHAL), Cochrane, and Health Management Information Consortium (HMIC) from inception to 26 Feb 2019, using an agreed search strategy. This was supplemented by handsearching of relevant journals, and screening of reference lists and citations of included studies. Results In total, 40 studies from 14 countries were identified. Cultural and organisational barriers included: a culture of diagnosing and prescribing; evidence-based guidance focused on single diseases; a lack of evidence-based guidance for the care of older people with multimorbidities; and a lack of shared communication, decision-making systems, tools, and resources. Interpersonal and individual-level barriers included: professional etiquette; fragmented care; prescribers’ and patients’ uncertainties; and gaps in tailored support. Facilitators included: prudent prescribing; greater availability and acceptability of non-pharmacological alternatives; resources; improved communication, collaboration, knowledge, and understanding; patient-centred care; and shared decision-making. Conclusion A whole systems, patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients, and carers.
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Vidoni ED, Kamat A, Gahan WP, Ourso V, Woodard K, Kerwin DR, Binder EF, Burns JM, Cullum M, Hynan LS, Vongpatanasin W, Zhu DC, Zhang R, Keller JN. Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer's Disease Study (rrAD). J Alzheimers Dis 2020; 77:175-182. [PMID: 32716358 PMCID: PMC8108402 DOI: 10.3233/jad-200122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about the prevalence of polypharmacy, the taking of five or more medications a day, in older adults with specific dementia risk factors. OBJECTIVE To examine the prevalence of polypharmacy in participants at baseline in a vascular risk reduction focused Alzheimer's disease (rrAD) trial targeting older patients with hypertension and elevated dementia risk. METHODS We conducted a detailed review of medications in a cross-sectional study of community-dwelling older adults with hypertension and elevated dementia risk. Medications were identified in a structured interview process with an onsite pharmacist or qualified designee. Polypharmacy was defined as use of five or more medications on a regular basis. Descriptive analyses were conducted on the sample as well as direct comparisons of subgroups of individuals with hypertension, diabetes, and hyperlipidemia. RESULTS The 514 rrAD participants, mean age 68.8 (standard deviation [sd] 6), reported taking different combinations of 472 unique medications at their baseline visit. The median number of medications taken by participants was eight [Range 0-21], with 79.2% exhibiting polypharmacy (n = 407). Sites differed in their prevalence of polypharmacy, χ2(3) = 56.0, p < 0.001. A nearly identical percentage of the 2,077 prescribed (51.8%) and over the counter (48.2%) medications were present in the overall medication profile. The presence of diabetes (87.5%), hyperlipidemia (88.2%), or both (97.7%) was associated with a higher prevalence of polypharmacy than participants who exhibited hypertension in the absence of either of these conditions (63.2%), χ2(3) = 35.8, p < 0.001. CONCLUSION Participants in a dementia risk study had high levels of polypharmacy, with the co-existence of diabetes or hyperlipidemia associated with a greater prevalence of polypharmacy as compared to having hypertension alone.
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Affiliation(s)
- Eric D Vidoni
- KU Alzheimer's Disease Center, Fairway KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Victoria Ourso
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kaylee Woodard
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Diana R Kerwin
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ellen F Binder
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey M Burns
- KU Alzheimer's Disease Center, Fairway KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Munro Cullum
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, USA
| | - Rong Zhang
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: A cross-sectional study. PLoS One 2020; 15:e0234386. [PMID: 32525902 PMCID: PMC7289385 DOI: 10.1371/journal.pone.0234386] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Polypharmacy has become a global public health concern particularly in the elderly population. The elderly population is the most susceptible to the negative effects of polypharmacy due to their altered pharmacokinetics and decreased drug clearance. Therefore, polypharmacy can lead to poor health status and higher rates of morbidity and mortality. OBJECTIVE The objective of this study was to determine the prevalence of polypharmacy (≥ 5 drugs) and its association with non-communicable diseases (NCDs) in elderly (≥65 years) Qatari patients attending Primary Healthcare (PHC) centers in Qatar. METHODS A retrospective cross-sectional analysis was conducted using the Electronic Medical Record (EMR) database of all PHC centers in Qatar for six months (April-September 2017). RESULTS Out of 5639 patients screened, 75.5% (95% CI: 74.3-76.6) were exposed to polypharmacy. Females were 1.18 times more likely to have polypharmacy compared to males (95% CI: 1.03-1.34). The multivariate analysis identified having hypertension (AOR 1.71; 95% CI: 1.38-2.13), diabetes (AOR 2.38; 95% CI: 1.97-2.87), dyslipidemia (AOR 1.29; 95% CI: 1.06-1.56), cardiovascular disease (AOR 1.56; 95% CI: 1.25-1.95) and asthma (AOR 1.39; 95% CI: 1.13-1.72) to be independent parameters associated with polypharmacy. Also, the Body Mass Index (BMI) and number of NCDs were found to be significant independent parameters associated with polypharmacy. CONCLUSIONS The prevalence of polypharmacy among Qatari elderly attending PHC Centers is very high. Our findings confirm the strong relationship between polypharmacy and BMI, and certain NCDs. Healthcare professionals should be educated about the magnitude of polypharmacy, its negative effects, and its associated factors. Best practice guidelines should be developed for improved medical practice in the prescription of medications for such a vulnerable population.
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Thanoo N, Gilbert AL, Trainor S, Semanik PA, Song J, Lee J, Dunlop DD, Chang RW. The Relationship between Polypharmacy and Physical Activity in Those with or at Risk of Knee Osteoarthritis. J Am Geriatr Soc 2020; 68:2015-2020. [PMID: 32441333 DOI: 10.1111/jgs.16501] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Physical activity is associated with improved pain, functional status, and less disability in persons with knee osteoarthritis (KOA). Because polypharmacy is related to several adverse health outcomes in older persons, we hypothesized that it might also be associated with decreased physical activity in those with KOA. This study evaluates the relationship between the number of prescription medications and weekly moderate to vigorous physical activity (MVPA). DESIGN We used hierarchical median quantile regression analysis to examine the cross-sectional association between the number of prescription medications taken in the past 30 days and the median objectively measured MVPA minutes controlling for demographic and clinical variables. SETTING Four Osteoarthritis Initiative (OAI) recruitment centers in Providence, Rhode Island; Columbus, Ohio; Baltimore, Maryland; and Pittsburgh, Pennsylvania. PARTICIPANTS Accelerometer monitoring occurred in 2,127 OAI participants. Of these, 1,889 participants had 4 or more days of valid physical activity monitoring data and complete medication/covariate data. Data were collected at the 48-month OAI follow-up visit (2008-2010). MEASUREMENTS The outcome was weekly minutes of MVPA measured with an accelerometer. Number/type of prescribed medications and covariate data (age, sex, race/ethnicity, body mass index, presence of comorbidities, pain, depressive symptoms, and radiographic KOA severity) were taken from the public OAI database. Polypharmacy was defined as taking five or more prescribed medications. RESULTS The prevalence of polypharmacy in the study population was 28.2%. Each additional prescription medication was related to a decrease of 3.6 minutes (95% confidence interval [CI] = -4.8 to -2.1) in median weekly MVPA minutes. Participants meeting the polypharmacy criterion exhibited a decrease of 12.6 minutes (95% CI = -21.2 to -4.7) in median weekly MVPA minutes compared with those not meeting the criterion. CONCLUSION An increased number of prescription medications and polypharmacy are associated cross-sectionally with decreased MVPA in adults with KOA. Further study is necessary to establish the causal nature of this association.
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Affiliation(s)
- Nivaas Thanoo
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail L Gilbert
- Department of Medicine, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sean Trainor
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pamela A Semanik
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Jing Song
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dorothy D Dunlop
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rowland W Chang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia. BJGP Open 2020; 4:bjgpopen20X101009. [PMID: 32019777 PMCID: PMC7330182 DOI: 10.3399/bjgpopen20x101009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events. AIM To determine the prevalence of PIM use, according to Beers criteria, among an older population (aged ≥65 years) in a large family medicine setting, and to identify the associated risks. DESIGN & SETTING A prospective cross-sectional study of patients aged ≥65 years was conducted from June 2017 to June 2018 at the Family and Community Medicine (FCM) clinics of King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. METHOD This cross-sectional study included patients aged ≥65 years who were seen at new appointments or followed-up at the FCM clinics of KSMC in Riyadh, Saudi Arabia. Data were collected by extensive face-to-face interviews and from the patients' medical records. RESULTS A total of 270 older patients aged 72.41 ±6.23 years (mean ±standard deviation [SD]) were included in the present study. The prevalence of PIMs was 60.7% (n = 164). Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] 1.47, 95% confidence intervals [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95, 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21, 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use. CONCLUSION This study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIM use. The frequency of morbidities was not significantly different among patients with PIMs compared to those without PIMs, except for hypertension and osteoarthritis, which were more common in the PIMs group. The present study reinforces the importance of comprehensive medication management and reviews.
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Panda M, Pathak R, Islam F, Agarwalla R, Singh V, Singh F. Interplay of multimorbidity and polypharmacy on a community dwelling frail elderly cohort in the peri-urban slums of Delhi, India. J Family Med Prim Care 2020; 9:1647-1655. [PMID: 32509666 PMCID: PMC7266258 DOI: 10.4103/jfmpc.jfmpc_945_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/21/2022] Open
Abstract
The United Nations Population Fund suggests that the number of elderly persons is expected to grow to 173 million by 2026. The aging phase is further made adverse by conditions such as failty, multimorbidity and polypharmacy.
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Affiliation(s)
- Meely Panda
- Asst. Prof, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Rambha Pathak
- Professor, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Farzana Islam
- Associate Prof, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Rashmi Agarwalla
- Asst. Prof, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Vishal Singh
- Residents, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Farishta Singh
- Residents, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Medication exposure and frailty in older community-dwelling patients: a cross-sectional study. Int J Clin Pharm 2020; 42:508-514. [PMID: 32140916 DOI: 10.1007/s11096-020-01007-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
Objective To investigate the association between the medication exposure, measured by the polypharmacy/excessive polypharmacy and the anticholinergic and/or sedative drug exposure, on frailty status among French older community-dwelling patients. Setting day-care unit in France (Lyon), with retrospective data from July, 2017 to March, 2018. Method This monocentric cross-sectional study included community-dwelling patients aged 65 years and over and admitted at the day-care unit for a geriatric evaluation. Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and excessive polypharmacy were defined as the concomitant use of 5-9 and 10 or more drugs, respectively. The cumulative anticholinergic and sedative exposure was measured using the drug burden index (DBI). The DBI score was presented in 4 differentiated scores: a null score (DBI = 0), a combined score (anticholinergic and sedative score), an anticholinergic score, and a sedative score. The association between medication and frailty was assessed by logistic regression models controlled for multiple potential confounders. Main outcome measure Association between medication exposure (polypharmacy, anticholinergic and sedative exposure) and frailty. Results In this study, 403 patients were included: 44.7% were frail and 40.7% were pre-frail. Polypharmacy and excessive polypharmacy affected 44.7% and 17.1% of the population respectively. The mean DBI was 0.33 ± 0.43, with 16.4% of patients with only sedative exposure, 9.7% with only anticholinergic exposure and 33.0% with both exposures. After adjustment, polypharmacy and excessive polypharmacy were associated with frailty with adjusted odds ratios (95% confidence interval) of 2.18 (1.03-4.22) and 2.72 (1.01-7.37) respectively. The cumulative exposure to anticholinergic and sedative drugs (combined score) was significantly associated to an increased risk for frailty with adjusted odds ratios (95% confidence interval) of 3.54 (1.47-8.57). Conclusion The study showed that polypharmacy and cumulative anticholinergic and sedative exposure are associated with frailty. Further research should address the potential benefit of collaborative medication review for preventing medication-associated frailty.
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Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse Outcomes of Polypharmacy in Older People: Systematic Review of Reviews. J Am Med Dir Assoc 2020; 21:181-187. [PMID: 31926797 DOI: 10.1016/j.jamda.2019.10.022] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Polypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on the adverse health, social, medicines management, and health care utilization outcomes of polypharmacy in older people. DESIGN A systematic review, of systematic reviews and meta-analyses of observational studies, was conducted. Eleven bibliographic databases were searched from 1990 to February 2018. Quality was assessed using AMSTAR (A Measurement Tool to Assess Systematic Reviews). SETTING AND PARTICIPANTS Older people in any health care setting, residential setting, or country. RESULTS Twenty-six reviews reporting on 230 unique studies were included. Almost all reviews operationalized polypharmacy as medication count, and few examined medication classes or disease states within this. Evidence for an association between polypharmacy and many adverse outcomes, including adverse drug events and disability, was conflicting. The most consistent evidence was found for hospitalization and inappropriate prescribing. No research had explored polypharmacy in the very old (aged ≥85 years), or examined the potential social consequences associated with medication use, such as loneliness and isolation. CONCLUSIONS AND IMPLICATIONS The literature examining the adverse outcomes of polypharmacy in older people is complex, extensive, and conflicting. Until polypharmacy is operationalized in a more clinically relevant manner, the adverse outcomes associated with it will not be fully understood. Future studies should work toward this approach in the face of rising multimorbidity and population aging.
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Affiliation(s)
- Laurie E Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Gemma Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Joy Adamson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Shrestha S, Poudel A, Steadman K, Nissen L. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: A systematic review. Br J Clin Pharmacol 2019; 86:1931-1945. [PMID: 31483057 DOI: 10.1111/bcp.14113] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Older patients with life-limiting illness (LLI) and limited life expectancy (LLE) continue to receive potentially inappropriate medicines, consequently deprescribing is often necessary. However, deprescribing in this population can be complex and challenging. Therefore, we aimed to investigate the evidence for outcomes of deprescribing interventions in older patients with LLI and LLE. METHODS Studies on deprescribing intervention and their outcomes in age ≥65 years with LLI and LLE were searched using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar. Medication appropriateness was primary outcome, while clinical and cost-related outcomes were secondary. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. RESULTS Of 9 studies (1375 participants), 3 reported on primary outcome. One study showed a significant reduction in medication inappropriateness by 34.9% (P < .001) from admission to close-out, the second achieved 29.4% (P < .001) and 15.1% (P = .003) reduction at 12 and 24 months, respectively. The third reported that their intervention stopped (17.2%) and altered the dose (2.6%) of high-risk medications. Commonly reported clinical outcomes were mortality (n = 3), quality of life (n = 2) and falls (n = 2). Outcomes in terms of cost were reported as overall cost (n = 2), medication cost (n = 1) and health care expenditure (n = 1). CONCLUSION Our findings suggest that deprescribing in older patients with LLI and LLE can improve medication appropriateness, and has potential for enhancement of several clinical outcomes and cost savings, but the evidence needs to be better established.
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Affiliation(s)
- Shakti Shrestha
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kathryn Steadman
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Pariseault CA. An Integrative Review of Methods of Measurement of Polypharmacy. J Nurs Meas 2019; 27:554-574. [PMID: 31871291 DOI: 10.1891/1061-3749.27.3.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this integrative review is to synthesize research on the measurement of polypharmacy. METHODS A comprehensive search of the literature databases Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed was conducted using a combination of terms/keywords to search existing studies to explore measures used to address polypharmacy. RESULTS Several methods of measuring the existence of polypharmacy have been used in research. In addition to screening tools, the number of medications taken was used as an indicator of polypharmacy. CONCLUSIONS Multiple methods of the measurement of polypharmacy have been used throughout the literature. Most methods related to the intended study objectives and population. The most frequently reported measure of screening was the Beers Criteria.
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Laurent C, Aho Glele LS, Lazzarotti A, Petit JM, Vergès B, Bouillet B. [Who is at risk for drug-drug interactions in type 2 diabetic patients?]. Presse Med 2019; 48:1576-1578. [PMID: 31761604 DOI: 10.1016/j.lpm.2019.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Claire Laurent
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France
| | - Ludwig Serge Aho Glele
- Centre hospitalier universitaire, service d'épidémiologie et d'hygiène hospitalière, Dijon, France
| | - Aline Lazzarotti
- Centre hospitalier universitaire, service de pharmacie, Dijon, France
| | - Jean Michel Petit
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France; Université de Bourgogne, unité inserm LNC-UMR 1231, Dijon, France
| | - Bruno Vergès
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France; Université de Bourgogne, unité inserm LNC-UMR 1231, Dijon, France
| | - Benjamin Bouillet
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France; Université de Bourgogne, unité inserm LNC-UMR 1231, Dijon, France.
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Witte J, Scholz S, Surmann B, Gensorowsky D, Greiner W. [Efficacy of decision support systems to improve medication safety - results of the evaluation of the "Arzneimittelkonto NRW"]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2019; 147-148:80-89. [PMID: 31761651 DOI: 10.1016/j.zefq.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
Polypharmacy increases the risk of adverse drug reactions, especially in the elderly. Therefore, the reduction of potentially inadequate medication (PIM), an improvement in drug therapy safety and, in general, a more rational use of drugs is an objective of various interventions. The aim of this prospective single-arm interventional study is to investigate the potential of a decision support system (DSS; "Arzneimittelkonto NRW") to improve medication safety in outpatient care. 15 primary care physicians participating in the study recruited 874 patients. Prescription data and results of medication safety tests were available for 654 patients. Data of at least 12 months were available for 86% of these patients. PIM prevalence declined within 12 months (-11.3%), but not at a statistically significant level. The number of prescriptions after the introduction of the DSS is significantly below the prescription volume before the introduction of the DSS (-14.1%). Constantly high alteration rates of up to 85% were observed, for example, on drug interaction system warnings made by the DSS. Technical decision support systems have the potential to support a safer and cost-saving drug use. For the first time, this pilot study provides evidence for this in the context of standard outpatient care in Germany. However, further investigations are necessary to establish a robust body of evidence. A particular focus should be on the qualitative monitoring of the studies and the involvement of other actors in the care process.
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Affiliation(s)
- Julian Witte
- Universität Bielefeld, Gesundheitsökonomie und Gesundheitsmanagement, D-33501, Bielefeld, Deutschland.
| | - Stefan Scholz
- Universität Bielefeld, Gesundheitsökonomie und Gesundheitsmanagement, D-33501, Bielefeld, Deutschland
| | - Bastian Surmann
- Universität Bielefeld, Gesundheitsökonomie und Gesundheitsmanagement, D-33501, Bielefeld, Deutschland
| | - Daniel Gensorowsky
- Universität Bielefeld, Gesundheitsökonomie und Gesundheitsmanagement, D-33501, Bielefeld, Deutschland
| | - Wolfgang Greiner
- Universität Bielefeld, Gesundheitsökonomie und Gesundheitsmanagement, D-33501, Bielefeld, Deutschland
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Beuscart JB, Petit S, Gautier S, Wierre P, Balcaen T, Lefebvre JM, Kambia N, Bertoux E, Mascaut D, Barthélémy C, Cuny D, Puisieux F, Décaudin B. Polypharmacy in older patients: identifying the need for support by a community pharmacist. BMC Geriatr 2019; 19:277. [PMID: 31638909 PMCID: PMC6802481 DOI: 10.1186/s12877-019-1276-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The community pharmacist is a key player in medication reviews of older outpatients. However, it is not always clear which individuals require a medication review. The objective of the present study was to identify high-priority older patients for intervention by a community pharmacist. METHODS As part of their final-year placement in a community pharmacy, pharmacy students conducted 10 interviews each with older adults (aged 65 or over) taking at least five medications daily. The student interviewer also offered to examine the patient's home medicine cabinet. An interview guide was developed by an expert group to assess the difficulties in managing and taking medications encountered by older patients. RESULTS The 141 students interviewed a total of 1370 patients (mean age: 81.5; mean number of medications taken daily: 9.3). Of the 1370 interviews, 743 (54.2%) were performed in the patient's home, and thus also included an examination of the home medicine cabinet. Adverse events were reported by 566 (42.0%) patients. A total of 378 patients (27.6%) reported difficulties in preparing, administering and/or swallowing medications. The inspections of medicine cabinets identified a variety of shortcomings: poorly located cabinets (in 15.0% of inspections), medication storage problems (21.7%), expired medications (40.7%), potentially inappropriate medications (15.0%), several different generic versions of the same drug (19.9%), and redundant medications (20.4%). CONCLUSIONS In a community pharmacy setting, high-priority older patients for intervention by a community pharmacist can be identified by asking simple questions about difficulties in managing, administering, taking or storing medications.
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Affiliation(s)
- Jean-Baptiste Beuscart
- University of Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France. .,Department of Geriatrics, CHU Lille, F-59000, Lille, France.
| | - Ségolène Petit
- Department of Pharmacy, CHU Lille, F-59000, Lille, France
| | - Sophie Gautier
- Department of Pharmacology, CHU Lille, F-59000, Lille, France
| | - Patrick Wierre
- Association des Conseillers et des Pharmaciens Agréés Maîtres de stage du Nord Pas de Calais, Lille, France
| | - Thibaut Balcaen
- University of Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France.,Department of Public Health, CHU Lille, F-59000, Lille, France
| | - Jean-Marc Lefebvre
- Department of General Practice, University of Lille, F-50045, Lille Cedex, France
| | - Nicolas Kambia
- University of Lille, EA 7365 - Groupe de recherche sur les injectables et les technologies associées, F-59000, Lille, France
| | - Elisabeth Bertoux
- Association des Conseillers et des Pharmaciens Agréés Maîtres de stage du Nord Pas de Calais, Lille, France
| | - Daniel Mascaut
- Association des Conseillers et des Pharmaciens Agréés Maîtres de stage du Nord Pas de Calais, Lille, France
| | - Christine Barthélémy
- University of Lille, EA 7365 - Groupe de recherche sur les injectables et les technologies associées, F-59000, Lille, France
| | - Damien Cuny
- University of Lille, EA 4483, Impacts de l'environnement chimique sur la santé humaine (IMPECS), F- 59000, Lille, France
| | - François Puisieux
- University of Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France.,Department of Geriatrics, CHU Lille, F-59000, Lille, France
| | - Bertrand Décaudin
- Department of Pharmacy, CHU Lille, F-59000, Lille, France.,University of Lille, EA 7365 - Groupe de recherche sur les injectables et les technologies associées, F-59000, Lille, France
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Jeon SM, Park S, Rhie SJ, Kwon JW. Prescribing patterns of polypharmacy in Korean pediatric patients. PLoS One 2019; 14:e0222781. [PMID: 31574095 PMCID: PMC6773215 DOI: 10.1371/journal.pone.0222781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 09/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background Several studies have examined the risk and health outcomes related to polypharmacy among the elderly. However, information regarding polypharmacy among pediatric patients is lacking. Objective The aim of this study was to investigate the prevalence of polypharmacy and its related factors among the pediatric population of South Korea. Methods We used national claim data from the Health Insurance Review and Assessment Service—Pediatric Patients Sample (HIRA-PPS) in Korea originating from 2012 through 2016. Polypharmacy was defined as a daily average of two or more drugs used yearly. Complex chronic conditions (CCCs) were examined to evaluate concomitant chronic diseases in pediatric patients. Age-specific contraindications and potential drug-drug interactions were assessed according to criteria established by the Korea Institute of Drug Safety & Risk Management (KIDS). Descriptive statistics and logistic regression were conducted to analyze the status of polypharmacy and its associated risk factors in pediatric patients. Results The 5-year prevalence of pediatric polypharmacy in pediatric patients was 3.7%. The prevalence of polypharmacy was much higher in younger pediatric patients: 9.5% for patients between the ages of 1–7 years, 0.9% for ages 6–11 years, and 1.1% for ages 12–19 years. Pediatric patients with CCCs, Medical Aid benefits, or a hospital admission history had a significantly higher prevalence of polypharmacy when compared to their counterparts without those conditions. The most commonly prescribed drugs were respiratory agents (29%) followed by anti-allergic drugs (18.7%), central nervous system agents (15.9%), antibiotics (10.1%), and gastrointestinal drugs (7.7%). There was a positive correlation between the daily average number of inappropriate prescriptions and the degree of polypharmacy, especially in pediatric patients between the ages of 1–7 years. Contraindications and potential drug-drug interactions occurred in 11.0% and 10.1% of patients exposed to polypharmacy, respectively. Conclusions One in ten pediatric patients under the age of 7 years was prescribed two or more concurrent drugs on average per day. Furthermore, pediatric patients exposed to polypharmacy showed an increased risk of inappropriate drug use. The implementation of a medication review system that considers pediatric patient polypharmacy exposure would reduce inappropriate drug use and prevent unwanted adverse outcomes.
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Affiliation(s)
- Soo-Min Jeon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Sandy Jeong Rhie
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
- * E-mail:
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Mahlknecht A, Krisch L, Nestler N, Bauer U, Letz N, Zenz D, Schuler J, Fährmann L, Hempel G, Flamm M, Osterbrink J. Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT. BMC Geriatr 2019; 19:257. [PMID: 31533630 PMCID: PMC6749664 DOI: 10.1186/s12877-019-1263-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncoordinated interprofessional communication in nursing homes increases the risk of polypharmacy and inappropriate medication use. This may lead to augmented frequency of adverse drug events, hospitalizations and mortality. The aims of this study were (1) to improve interprofessional communication and medication safety using a combined intervention and thus, (2) to improve medication appropriateness and health-related outcomes of the included residents. METHODS The single-arm interventional study (2014-2017) was conducted in Muenster, Germany and involved healthcare professionals and residents of nursing homes. The intervention consisted of systematic education of participating healthcare professionals and of a structured interprofessional medication review which was performed via an online communication platform. The primary endpoint was assessed using the Medication Appropriateness Index MAI. Secondary endpoints were: cognitive performance, delirium, agitation, mobility, number of drugs, number of severe drug-drug interactions and appropriateness of analgesics. Outcomes were measured before, during and after the intervention. Data were analyzed using descriptive and inference-statistical methods. RESULTS Fourteen general practitioners, 11 pharmacists, 9 nursing homes and 120 residents (n = 83 at all testing times) participated. Overall MAI sum-score decreased significantly over time (mean reduction: -7.1, CI95% -11.4 - - 2.8; median = - 3.0; dCohen = 0.39), especially in cases with baseline sum-score ≥ 24 points (mean reduction: -17.4, CI95% -27.6 - - 7.2; median = - 15.0; dCohen = 0.86). MAI sum-score of analgesics also decreased (dCohen = 0.45). Mean number of severe drug-drug interactions rose slightly over time (dCohen = 0.17). The proportion of residents showing agitated behavior diminished from 83.9 to 67.8%. Remaining secondary outcomes were without substantial change. CONCLUSION Medication appropriateness increased particularly in residents with high baseline MAI sum-scores. Cognitive decline of participating residents was seemingly decelerated when compared with epidemiologic studies. A controlled trial is required to confirm these effects. Interprofessional interaction was structured and performance of medication reviews was facilitated as the online communication platform provided unlimited and consistent access to all relevant and updated information. TRIAL REGISTRATION DRKS Data Management, ID: DRKS00007900 , date of registration: 2015-09-02 (retrospectively registered i.e. 6 weeks after commencement of the first data collection).
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Laura Krisch
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Nadja Nestler
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Ulrike Bauer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Nina Letz
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Daniel Zenz
- smart-Q Softwaresysteme GmbH, BioMedizinZentrum Bochum, Universitätsstraße 136, 44799 Bochum, Germany
| | - Jochen Schuler
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Laura Fährmann
- Department of Pharmaceutical and Medical Chemistry - Clinical Pharmacy, Westfaelische Wilhelms-University, Corrensstraße 48, 48149 Muenster, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry - Clinical Pharmacy, Westfaelische Wilhelms-University, Corrensstraße 48, 48149 Muenster, Germany
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
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Polypharmacy Definitions for Multimorbid Older Adults Need Stronger Foundations to Guide Research, Clinical Practice and Public Health. PHARMACY 2019; 7:pharmacy7030126. [PMID: 31470621 PMCID: PMC6789889 DOI: 10.3390/pharmacy7030126] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/08/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022] Open
Abstract
There are numerous definitions of polypharmacy to describe the use of many medications among older adults, but there is a need to clarify if they are purposive and meaningful. By means of a systematic review, we identified definitions of polypharmacy used in multimorbid older adults (≥65 years). We evaluated if the definitions align among the domains of research, clinical practice, and public health and appraised whether concepts of polypharmacy are based on strong foundations. More than 46 definitions of polypharmacy were retrieved from 348 publications (research: n = 243; clinical practice: n = 88; public health: n = 17). Several thresholds based on the number of medications were mentioned. The majority of the publications (n = 202, 58%) used a minimal threshold of five medications. Heterogeneous qualitative definitions were identified, mostly stating that polypharmacy is “more drugs than needed”. There was no significant divergence between domains as to the type of definitions used, although qualitative definitions were more common in clinical practice. Nearly half (n = 156, 47%) of the publications provided no justification for the polypharmacy definition used. The wide variety of definitions for polypharmacy precludes comparisons, appropriate identification and management of polypharmacy in multimorbid older adults. Standardized definitions would allow more coherent judgments regarding the individual and collective stakes of polypharmacy.
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Keine D, Zelek M, Walker JQ, Sabbagh MN. Polypharmacy in an Elderly Population: Enhancing Medication Management Through the Use of Clinical Decision Support Software Platforms. Neurol Ther 2019; 8:79-94. [PMID: 30900186 PMCID: PMC6534631 DOI: 10.1007/s40120-019-0131-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Polypharmacy is a growing problem in the United States. The use of multiple medications increases the likelihood that a patient will experience potential drug interactions and adverse drug reactions (ADRs). Those individuals with dementia or Alzheimer's disease (AD) are at greater risk, due to age, comorbidities, and an increased likelihood of being on a greater number of neuroactive medications. METHODS uMETHOD Health (uMH) has developed a precision medicine platform to address dementia and mild AD through the creation of personalized, multidomain treatment plans. Many interactions and ADRs may be observed, such as drug-drug interactions (DDIs), drug-gene interactions (DGIs), anticholinergic cognitive burden (ACB), and depression-inducing drugs (DIDs). uMH's algorithms can parse these interactions, rate them based on input from open-source databases, and then record all these interactions in a generated treatment plan. A total of 295 individuals aged 65 and older were included in this analysis. RESULTS Of 295 individuals, 97.59% were on at least one medication, with an overall mean of 11.5 medications per person; 83.66% were on five or more medications. A total of 102 DGIs, 3642 DDIs, and one high-priority DDI were found in this population. There was a significant increase in the number of DDIs as medications per person increased (P value < 0.0001). Of the population, 65.86% were on one or more anticholinergic drugs. There was a significant difference in the ACB score between individuals with cognitive decline and those without. In total, 60.98% of the overall population were on DIDs, with a mean of 1.19 medications per person. CONCLUSIONS The results of this work show that older populations have a high medication burden. With the growing elderly and AD populations, medication management for polypharmacy is a need that grows direr every year. uMH's platform was able to identify a multitude of polypharmacy problems that individuals are currently facing. FUNDING uMETHOD Health.
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Affiliation(s)
| | | | | | - Marwan N Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Shih WY, Chang CC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Incidence and Risk Factors for Urinary Tract Infection in an Elder Home Care Population in Taiwan: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040566. [PMID: 30781460 PMCID: PMC6406410 DOI: 10.3390/ijerph16040566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
Abstract
Urinary tract infection (UTI) is a common infection worldwide. Numerous studies have demonstrated risk factors for UTI in facilities and communities. In this study, we aimed to identify risk factors for UTI in home care patients. Patients who received home care for at least three months in 2017 were included. A UTI episode was defined by admission for UTI treatment, and/or a visit to an outpatient department for UTI and receiving antibiotic prescription. A total of 598 patients aged 81.9 years were included. Overall 47% (281) had at least one UTI episode. After analysis, urinary catheter indwelling was the most important risk factor (odds ratio (OR), 3.21). Underlying diseases (coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM)) were related to UTI with OR ranging from 1.46 to 1.79. Higher Alb (albumin) (OR 0.68) and Hb (hemoglobin) (OR 0.91) were inversely related to UTI. Polypharmacy (OR 1.84) and lower Barthel index scores (OR 1.62) were also related to UTI by different degrees. In conclusion, apart from the unmodifiable factors, avoiding prolonged urinary catheter placement, unnecessary prescriptions, and keeping good nutritional status may help to prevent UTI in home care patients.
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Affiliation(s)
- Wei-Yi Shih
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Chia-Chen Chang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Hsin-Lung Chan
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Ying-Ju Chen
- Telehealth and Home Care Center, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Lee-Ching Hwang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
- Department of Medicine, MacKay Medical College No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
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Romano-Lieber NS, Corona LP, Marques LFG, Secoli SR. Survival of the elderly and exposition to polypharmacy in the city of São Paulo, Brazil: SABE Study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 21Suppl 02:e180006. [PMID: 30726351 DOI: 10.1590/1980-549720180006.supl.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/15/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The use of polypharmacy may be due to the concomitant presence of chronic conditions, medical care by several doctors simultaneously and self-medication. Combined with the vulnerability of the elderly to the effects of drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this population more susceptible to adverse outcomes. In Brazil, studies show that polypharmacy is a common problem among elderly people. However, few information is available on the association between polypharmacy and mortality. OBJECTIVE It was assessed the survival of the elderly from São Paulo city exposed to the use of polypharmacy (five or more medications). METHODS That was a population-based cohort, the Health, Well-Being and Aging Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258 individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional risks model were used to examine the association between polypharmacy and mortality. RESULTS The probability of survival after five years of the users of polypharmacy at baseline was 77.2%, while among the non-users was 85.5%. Polypharmacy remained as a risk factor for death even after adjustment in other conditions associated with mortality, such as age, gender, income, chronic diseases and hospitalization. CONCLUSION The results point polypharmacy as an indicator of mortality in elderly people. The use of multiple medications by the elderly should be carefully assessed to avoid or minimize the damage to this population.
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Affiliation(s)
- Nicolina Silvana Romano-Lieber
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Ligiana Pires Corona
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Liete Fatima Gouveia Marques
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Silvia Regina Secoli
- Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem, Universidade de São Paulo - São Paulo (SP), Brasil
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The Basics of Antithrombotic Medications. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grischott T, Zechmann S, Rachamin Y, Markun S, Chmiel C, Senn O, Rosemann T, Rodondi N, Neuner-Jehle S. Improving inappropriate medication and information transfer at hospital discharge: study protocol for a cluster RCT. Implement Sci 2018; 13:155. [PMID: 30591069 PMCID: PMC6309068 DOI: 10.1186/s13012-018-0839-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/15/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Inappropriate medication and polypharmacy increase morbidity, hospitalisation rate, costs and mortality in multimorbid patients. At hospital discharge of elderly patients, polypharmacy is often even more pronounced than at admission. However, the optimal discharge strategy in view of sustained medication appropriateness remains unclear. In particular, unreflectingly switching back to the pre-hospitalisation medication must be avoided. Therefore, both the patients and the follow-up physicians should be involved in the discharge process. In this study, we aim to test whether a brief medication review which takes the patients' priorities into account, combined with a standardised communication strategy at hospital discharge, leads to sustained medication appropriateness and extends readmission times among elderly multimorbid patients. METHODS The study is designed as a two-armed, double-blinded, cluster-randomised trial, involving 42 senior hospital physicians (HPs) with their junior HPs and 2100 multimorbid patients aged 60 years or older. Using a randomised minimisation strategy, senior HPs will be assigned to either intervention or control group. Following instructions of the study team, the senior HPs in the intervention group will teach their junior HPs how to integrate a simple medication review tool combined with a defined communication strategy into their ward's discharge procedure. The untrained HPs in the control group will provide data on usual care, and their patients will be discharged following usual local routines. Primary outcome is the time until readmission within 6 months after discharge, and secondary outcomes cover readmission rates, number of emergency and GP visits, classes and numbers of drugs prescribed, proportions of potentially inappropriate medications, and the patients' quality of life after discharge. Additionally, the characteristics of both the HPs as well as the patients will be collected before the intervention. Process evaluation outcomes will be assessed parallel to the ongoing core study using qualitative research methods. DISCUSSION So far, interventions to reduce polypharmacy are still scarce at the crucial interface between HPs and GPs. To our knowledge, this trial is the first to analyse the combination of a brief deprescribing intervention with a standardised communication strategy at hospital discharge and in the early post-discharge period. TRIAL REGISTRATION ISRCTN, ISRCTN18427377 . Registered 11 January 2018.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Stefan Zechmann
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Yael Rachamin
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Stefan Markun
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Corinne Chmiel
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
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Eggebrecht L, Nagler M, Göbel S, Lamparter H, Keller K, Wagner B, Panova-Noeva M, Ten Cate V, Bickel C, Lauterbach M, Espinola-Klein C, Hardt R, Münzel T, Prochaska JH, Wild PS. Relevance of Polypharmacy for Clinical Outcome in Patients Receiving Vitamin K Antagonists. J Am Geriatr Soc 2018; 67:463-470. [PMID: 30536652 DOI: 10.1111/jgs.15712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although polypharmacy is associated with a negative clinical outcome in various settings and commonly observed in patients receiving oral anticoagulation therapy, evidence on the relevance for the clinical outcome of anticoagulated patients is currently limited. The aim of the study was to investigate the effect of polypharmacy on the clinical outcomes among patients taking phenprocoumon. DESIGN Prospective cohort study. SETTING Regular medical care. PARTICIPANTS Information on 2011 individuals receiving vitamin K antagonists was available for analysis from the prospective multicenter thrombEVAL study. MEASUREMENTS Data were obtained from clinical visits, computer-assisted interviews, and laboratory measurements. Information on clinical outcome was obtained during a 3-year follow-up period and subsequently validated via medical records. RESULTS The prevalence of polypharmacy (five drugs or more) was 84.1% (n = 1691). Quality of anticoagulation therapy assessed by time in therapeutic range was lower in individuals on five to eight drugs and nine drugs or more (70.7% and 64.7%, respectively) compared with subjects without polypharmacy (73.4%). In addition, a significantly higher variability of international normalized ratio measurements was found in the presence of polypharmacy. The cumulative incidence of bleeding, hospitalization, and all-cause mortality, but not for thromboembolic events, increased across groups of medication. In adjusted Cox regression analysis, polypharmacy is an independent risk factor for bleeding (hazard ratio [HR]≥ 9 drugs vs 1-4 drugs = 1.62; 95% confidence interval [CI] = 1.04-2.52; p = .033); hospitalization (HR≥ 9 drugs vs 1-4 drugs = 1.60; 95% CI = 1.26-2.03; p < .001; and all-cause mortality (HR≥ 9 drugs vs 1-4 drugs = 2.16; 95% CI = 1.43-3.27; p < .001) in a dose-dependent relationship. Per additional drug, bleeding risk was increased by 4%. CONCLUSIONS Polypharmacy influences the quality of anticoagulation therapy and translates into an elevated risk of adverse events in anticoagulated patients. This suggests that additional medication intake in such patients should be critically reviewed by physicians, and it highlights the importance of initiating investigations aimed at reducing multiple medication intake. J Am Geriatr Soc 67:463-470, 2019.
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Affiliation(s)
- Lisa Eggebrecht
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Nagler
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sebastian Göbel
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Heidrun Lamparter
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bianca Wagner
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marina Panova-Noeva
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Vincent Ten Cate
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Bickel
- Department of Medicine I, Federal Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Michael Lauterbach
- Department of Medicine 3, Barmherzige Brüder Hospital Trier, Trier, Germany
| | - Christine Espinola-Klein
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roland Hardt
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for General Medicine and Geriatric Medicine, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
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Cheong TTS, Alhamid SM, Li FY, Ang STW, Lim KHJ. Improving prescribing for older patients - 'Yes S-I-R-E!'. Singapore Med J 2018; 60:298-302. [PMID: 30488080 DOI: 10.11622/smedj.2018153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Polypharmacy and inappropriate prescribing are associated with negative health outcomes in the elderly. Several prescribing tools have been developed to assess medication appropriateness. Explicit (criteria-based) tools often do not take into account patients' preferences and comorbidities, and have little room for individualised clinical judgement. METHODS A cross-sectional observational study was conducted in 243 elderly patients admitted to the Geriatric Medicine service in a Singapore tertiary hospital over one month. We incorporated an implicit (judgement-based) tool developed by Scott et al into a mnemonic, 'S-I-R-E', to assess medication appropriateness: S = symptoms ('Have symptoms resolved?'), I = indication ('Is there a valid indication?'), R = risks ('Do risks outweigh benefits?') and E = end of life ('Is there short life expectancy limiting clinical benefit?'). RESULTS Inappropriate prescribing was present in 27.6% of patients. The most common reason for inappropriateness of medications was lack of valid indication (62.2%), followed by high risk-benefit ratio (20.7%). The most common medications that lacked valid indication were supplements and proton pump inhibitors. Polypharmacy was found in 93% of patients and was significantly associated with inappropriate prescribing (p = 0.047). CONCLUSION Inappropriate prescribing and polpharmacy are highly prevalent in the hospitalised elderly. The 'S-I-R-E' mnemonic can be used as a memory aid and practical framework to guide appropriate prescribing in the elderly.
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Affiliation(s)
| | | | - Fu Yin Li
- Department of Nursing, Changi General Hospital, Singapore
| | | | - Kim Hwa Jim Lim
- Department of Geriatric Medicine, Changi General Hospital, Singapore
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