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Alharkan KS, Alfarea AM, Alkhateeb AF, Alsousi SA, Althwaiqb SA, Alshammari MO. Are primary care physicians familiar enough with potentially inappropriate medications in geriatric care? A cross-sectional study in the Eastern Province of Saudi Arabia. J Family Community Med 2024; 31:251-256. [PMID: 39176015 PMCID: PMC11338396 DOI: 10.4103/jfcm.jfcm_238_23] [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: 09/04/2023] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) and polypharmacy constitute increasing healthcare costs and significant risk for adverse outcomes in older adults. The American Geriatrics Society Beers Criteria form a screening tool for the identification of PIMs and guidance for healthcare providers in prescribing appropriate medications. However, primary care physicians' knowledge of screening tools, of Beers Criteria, in particular, is not known. Therefore, this study was to investigate primary care physicians in the Eastern Province of Saudi Arabia and their awareness of Beers Criteria and knowledge of PIMs. MATERIALS AND METHODS This cross-sectional study was conducted among primary care physicians working in the Eastern Province of Saudi Arabia. Data were collected using an online self-administered questionnaire that consisted of sections on the general characteristics of respondents and their knowledge of Beers Criteria as a screening tool. Eight clinical-based vignettes concerning different therapeutic areas of medication use in the elderly were included, with a score of 1 and 0 for correct and wrong answers, respectively. Data presented as frequency and percentage. Chi-square test was used to determine the association between duration of practice and the level of awareness about Beers criteria. RESULTS Of the 121 physicians who returned completed questionnaires, 41.3% of respondents knew about Beers Criteria. Most respondents (52.9%) were confident in prescribing appropriately for elderly patients. The association between the duration of practice and confidence level was statistically significant (P = 0.040). Respondents showed an above-average knowledge of the clinical vignettes with a correct answer rate >50% in all clinical scenarios. Online search (84.2%) and physician colleagues' knowledge and experiences (39.2%) were the primary source of information reported by the respondents. CONCLUSION Awareness of Beers Criteria of primary care physicians in Saudi Arabia's Eastern Province is low. Therefore, our results will educate healthcare workers on the importance of Beers Criteria in Geriatric patients' prescriptions, in order to significantly improve the well-being of the elderly.
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Affiliation(s)
- Khalid S. Alharkan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz M. Alfarea
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Safaa A. Alsousi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sarah A. Althwaiqb
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Family Medicine, Academy, Eastern Health Cluster, Khobar, Saudi Arabia
| | - Malak O. Alshammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Alqurain AA, Albaharnah M, Al Zayer S, Ameer L, Ghosn S, Al-Shaibi S, Algoraini M, Aldhafeeri A, Alyusuf DA, Alshnbari A, Alsaffar N, Al-Matouq J, Al Khamees M, AlAlwan B, Alomar FA. The prevalence of polypharmacy and hyper-polypharmacy among middle-aged vs . older patients in Saudi Arabia: a cross-sectional study. Front Pharmacol 2024; 15:1357171. [PMID: 38933679 PMCID: PMC11200110 DOI: 10.3389/fphar.2024.1357171] [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: 12/17/2023] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Polypharmacy, the use of multiple medications, is a growing concern among middle-aged and older patients, posing potential risks and challenges in healthcare management. Aim This study aimed to identify the prevalence of polypharmacy and hyper-polypharmacy among populations of middle-aged vs. older patients and identify its associated common comorbidities and prescribed medications in Qatif Central Hospital (QCH), Saudi Arabia. Methods Patients aged 40 years or older who presented to an outpatient medical care clinic at QCH, Saudi Arabia, between 1 January and 31 December 2021 were included, and their comorbidities, prescribed medications, and recent clinical laboratory test results were collected. The Charlson comorbidity index (CCI) score was calculated to predict the risk of mortality. Logistic regression was used to compute the association between the prevalence of polypharmacy and patient characteristics. The results were presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). Results A total of 14,081 patients were included; 31% of the cohort comprised older patients, and 66% of the cohort was identified with polypharmacy. The majority of the polymedicated patients were presented to an internal medicine care unit (34%). The prevalence of polypharmacy was positively associated with CCI (OR = 3.4, 95% CI 3.3-3.6), having a disease related to the musculoskeletal system (MSD) (OR = 4.2, 95% CI 3.8-4.7), and alimentary tract and metabolism (ATM) (OR = 3.8, 95% CI 3.4-4.2). Conversely, the prevalence of polypharmacy was negatively associated with age (OR = 0.9, 95% CI 0.89-0.91) and patients with cardiovascular diseases (OR = 0.6, 95% CI 0.5-0.7). Conclusion Polypharmacy is still an ongoing concern. Patients, particularly those with diseases related to MSD or ATM, should be considered for reviewing prescriptions by pharmacists to reduce the risk of adverse drug reactions and future consequences of polypharmacy.
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Affiliation(s)
- Aymen A. Alqurain
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Murtada Albaharnah
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Samanah Al Zayer
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Luma Ameer
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Sherihan Ghosn
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Samaher Al-Shaibi
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Marwa Algoraini
- Foundation Year Department, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Amal Aldhafeeri
- Pharmaceutical Service Department, Al Mana General Hospital, Khobar, Saudi Arabia
| | - Danah A. Alyusuf
- Pharmaceutical Service Department, Qatif General Hospital, Al Qaţīf, Saudi Arabia
| | - Afnan Alshnbari
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Nida Alsaffar
- Department of Medical Science, Mohammed Al-Mana College for Medical Science, Dammam, Saudi Arabia
| | - Jenan Al-Matouq
- Department of Medical Science, Mohammed Al-Mana College for Medical Science, Dammam, Saudi Arabia
| | - Mohammed Al Khamees
- Clinical Laboratory Department, King Fahad Hospital in Hoffuf, Al Hufūf, Saudi Arabia
| | - Bader AlAlwan
- Department of Medical Science, Mohammed Al-Mana College for Medical Science, Dammam, Saudi Arabia
| | - Fadhel A. Alomar
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Hasan S, Chevidikunnan MF, Khan F. Reliability and validity of the Arabic version of the modified falls efficacy scale. Disabil Rehabil 2024; 46:793-801. [PMID: 36727527 DOI: 10.1080/09638288.2023.2175045] [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: 05/26/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. MATERIALS AND METHODS The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). RESULTS The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). CONCLUSION The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.
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Affiliation(s)
- Sami Hasan
- Department of occupational therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Fayaz Khan
- Department of physical therapy, Faculty of medical rehabilitation sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
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Alsultan MM, Alamer R, Alammar F, Alzlaiq W, Alahmari AK, Almalki ZS, Alqarni F, Alshayban DM, Alotaibi FM, Asiri IM, Alsultan F, Kurdi SM, Almalki BA. Prevalence of polypharmacy in heart failure patients: A retrospective cross-sectional study in a tertiary hospital in Saudi Arabia. Saudi Pharm J 2023; 31:101875. [PMID: 38046462 PMCID: PMC10689949 DOI: 10.1016/j.jsps.2023.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
Background Cardiovascular disease is the leading cause of death and disability worldwide. It is a general term used to describe a group of disorders that affect the heart or blood vessels. This study aimed to evaluate the prevalence and predictors of polypharmacy in patients with heart failure. Methods We conducted a cross-sectional study in a tertiary hospital in Saudi Arabia. Data was extracted from an electronic database between January 2019, and December 2022. The study included all adult patients with heart failure who visited outpatient clinics; individuals with cancer were excluded. The outcome variable in our study was "polypharmacy" which was defined as the use of eight or more medications. Descriptive analysis was performed using frequencies and percentages for categorical variables. In addition, Multivariate logistic regression was used to assess the covariates associated with polypharmacy. Results A total of 331 patients with heart failure were included in this study. The prevalence of polypharmacy among our HF population was 39.88 %. Most participants were male (60.73 %), and 60 years or older (68 %). The most frequently used medications were beta-blockers (67.98 %) and diuretics (58.31 %), whereas the least frequently used medications were hydralazine and histamine H2 blockers (5.74, and 3.02 %, respectively). Polypharmacy was likely to be a non-significantly higher in individuals aged between 60 and 69 years (adjusted odds ratio (AOR) = 1.52; 95 % confidence interval (CI) 0.78-2.98) and suffering from hypertension (AOR = 1.48; 95 % CI 0.83-2.64). However, patients with heart failure and diabetes mellitus had a significant six-fold higher of polypharmacy than those without diabetes mellitus (AOR = 6.55; 95 % CI 3.71-11.56). Conclusion Patients with heart failure often use multiple medications. Patients with heart failure together with diabetes have a higher risk of polypharmacy. Therefore, healthcare professionals should manage polypharmacy to improve the outcomes in patients with heart failure.
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Affiliation(s)
- Mohammed M. Alsultan
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Rabab Alamer
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fatimah Alammar
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Wafa Alzlaiq
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdullah K. Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Faisal Alqarni
- Department of Pharmacy, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Dhfer M. Alshayban
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fawaz M. Alotaibi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ibrahim M. Asiri
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fahad Alsultan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sawsan M. Kurdi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Bassem A. Almalki
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Altwaijri Y, Al-Habeeb A, Al-Subaie A, Bruffaerts R, Bilal L, Hyder S, Naseem MT, Alghanim AJ. Dual burden of chronic physical conditions and mental disorders: Findings from the Saudi National Mental Health Survey. Front Public Health 2023; 11:1238326. [PMID: 38089017 PMCID: PMC10715453 DOI: 10.3389/fpubh.2023.1238326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Comorbidities of mental disorders and chronic physical conditions are a common medical burden reported among Western countries. National estimates of such comorbidities among the general population of Arab countries like Saudi Arabia are unknown. This study examined the prevalence of lifetime chronic physical conditions among the Saudi general population with DSM-IV 12-month mental disorders, and the associations with disability in the Kingdom of Saudi Arabia (KSA). Methods The Saudi National Mental Health Survey, a cross-sectional household study - part of the World Mental Health (WMH) Survey Consortium - was conducted between 2013-2016 in the KSA, with 4,001 Saudi citizens aged 15-65 (response rate 61%). The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess prevalence of lifetime chronic physical conditions and 12-month mental disorders; disability was measured in terms of days out of role. Results The prevalence of any comorbid 12-month mental disorder among those with chronic physical conditions was 24%. Major depressive disorder, social phobia, and adult separation anxiety disorder were the most common comorbid mental disorders across all chronic physical conditions. Gender, education, income, urbanicity, region, and employment were associated with the presence of any chronic physical condition. Respondents with mental / physical comorbidities had 2.97 days out of role (on average) in the last 30 days. Conclusion Comorbidities of mental disorders and chronic physical conditions are common among Saudis. National efforts are needed to increase awareness of such comorbidities among the general population, and develop prevention and treatment services tailored to the needs of individuals at-risk for comorbidities.
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Affiliation(s)
- Yasmin Altwaijri
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhameed Al-Habeeb
- National Center for Mental Health Promotion, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Al-Subaie
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Psychiatry, Edrak Medical Center, Riyadh, Saudi Arabia
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Lisa Bilal
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sanaa Hyder
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Talal Naseem
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Salhia H, Mutlaq A, Alshaiban A, Alsaleh A, Alzahrani R, Alshennawi M. Patterns in counselling services provided at Saudi Ministry of Health medication counselling clinics - Reasons for referrals and subjects discussed: A cross-sectional study. Saudi Pharm J 2023; 31:1157-1166. [PMID: 37287507 PMCID: PMC10242628 DOI: 10.1016/j.jsps.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Background Pharmacists provide medication counselling services to improve patient knowledge and their adherence to prescription instructions, and to achieve the best possible health-related outcomes. Our study aim was to describe the patterns of the reasons for referral to counselling and the subjects discussed between pharmacists and patients, and the possible associations related to the susceptible patient groups (chronic and elderly), in Saudi Ministry of Health (MOH) medication counselling clinics. Method This was a descriptive cross-sectional study. An electronic data collection form was developed to document details about the medication counselling services that were provided to patients. The form consisted of three main areas: (1) patient demographics and counselling services characteristics; (2) reasons for referrals to the medication counselling clinics; and (3) the subjects that were discussed between pharmacists and patients in the counselling session. A comparison was conducted between chronic and non-chronic, and elderly and non-elderly patients. Results From May 2020 to December 2021, a total of 36,672 counselling service sessions were provided to 28,998 patients. The greatest proportion of reasons for referrals to counselling was that patients had chronic diseases (50.84%), patients were added a new medication (33.69%) or patients received multiple medications (polypharmacy) (22.71%). The most frequent subject discussed during counselling was general knowledge about medication (85.62%), the duration of therapy (68.42%) and the action that patients should take if they missed a dose of their medication (44.51%). Patients with chronic diseases showed a significantly greater frequency of referral to counselling compared to patients without chronic disease, due to polypharmacy, medication use during Ramadhan, adverse drug reactions (ADRs), dosing/interactions, high-alert medication and suspected nonadherence (P < 0.001). This led to a significantly greater frequency of discussions with patients with chronic conditions about their general medication knowledge, the duration of their therapy, missed doses, ADRs, medication reconciliation and medication use during Ramadhan (P < 0.001). Elderly patients recorded significantly more referrals to counselling related to chronic diseases and polypharmacy than their younger counterparts (P < 0.001); however, there was no significant difference between the elderly and non-elderly in the patterns of subjects discussed that were related to polypharmacy and chronic disease consequences. A significant spike was also reported in the frequency of delivery of counselling services to caregivers for the elderly (P < 0.001). Conclusion The current state of medication counselling services in Saudi MOH facilities indicates that chronic disease and polypharmacy are the most significant reasons for referral to counselling, and that the subjects discussed the most during counselling are general knowledge about medication, duration of therapy and missed doses. Patients with chronic diseases have a higher frequency of referral to counselling and discussion about polypharmacy and its consequences than those without chronic conditions. Elderly patients also show a high frequency of referral to counselling about chronic diseases and polypharmacy. Caregivers of elderly patients require more education to maximise counselling effectiveness as they attend the majority of elderly patient counselling sessions.
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Affiliation(s)
- Huda Salhia
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Alaa Mutlaq
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulrahman Alshaiban
- King Faisal Medical City for Southern Region, Ministry of Health, Abha, Saudi Arabia
| | - Ahmad Alsaleh
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Rasha Alzahrani
- Assistant Agency for Hospital Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed Alshennawi
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
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Seyedtabib M, Kamyari N. Predicting polypharmacy in half a million adults in the Iranian population: comparison of machine learning algorithms. BMC Med Inform Decis Mak 2023; 23:84. [PMID: 37147615 PMCID: PMC10161984 DOI: 10.1186/s12911-023-02177-5] [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: 10/08/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Polypharmacy (PP) is increasingly common in Iran, and contributes to the substantial burden of drug-related morbidity, increasing the potential for drug interactions and potentially inappropriate medications. Machine learning algorithms (ML) can be employed as an alternative solution for the prediction of PP. Therefore, our study aimed to compare several ML algorithms to predict the PP using the health insurance claims data and choose the best-performing algorithm as a predictive tool for decision-making. METHODS This population-based cross-sectional study was performed between April 2021 and March 2022. After feature selection, information about 550 thousand patients were obtained from National Center for Health Insurance Research (NCHIR). Afterwards, several ML algorithms were trained to predict PP. Finally, to assess the models' performance, the metrics derived from the confusion matrix were calculated. RESULTS The study sample comprised 554 133 adults with a median (IQR) age of 51 years (40 - 62) that nested in 27 cities within the Khuzestan province of Iran. Most of the patients were female (62.5%), married (63.5%), and employed (83.2%) during the last year. The prevalence of PP in all populations was about 36.0%. After performing the feature selection, out of 23 features, the number of prescriptions, Insurance coverage for prescription drugs, and hypertension were found as the top three predictors. Experimental results showed that Random Forest (RF) performed better than other ML algorithms with recall, specificity, accuracy, precision and F1-score of 63.92%, 89.92%, 79.99%, 63.92% and 63.92% respectively. CONCLUSION It was found that ML provides a reasonable level of accuracy in predicting polypharmacy. Therefore, the prediction models based on ML, especially the RF algorithm, performed better than other methods for predicting PP in Iranian people in terms of the performance criteria.
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Affiliation(s)
- Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran.
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Iqbal A, Richardson C, Iqbal Z, O’Keefe H, Hanratty B, Matthews FE, Todd A. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC Geriatr 2023; 23:149. [PMID: 36934249 PMCID: PMC10024437 DOI: 10.1186/s12877-023-03835-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status. METHODS A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. RESULTS Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. CONCLUSIONS There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
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Affiliation(s)
- Anum Iqbal
- grid.1006.70000 0001 0462 7212School of Pharmacy, Population Health Sciences Institute, Newcastle University, King George VI Building, King’s Road, Newcastle Upon Tyne, NE1 7RU England
| | - Charlotte Richardson
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
| | - Zain Iqbal
- grid.419481.10000 0001 1515 9979Novartis International, Basel, Switzerland
| | - Hannah O’Keefe
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Barbara Hanratty
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Fiona E. Matthews
- grid.1006.70000 0001 0462 7212Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, England
| | - Adam Todd
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle Upon Tyne, England
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Bawazeer G, Alsaad S, Almalag H, Alqahtani A, Altulaihi N, Alodhayani A, AlHossan A, Sales I. Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital. Saudi Pharm J 2022; 30:1027-1035. [PMID: 35903532 PMCID: PMC9315319 DOI: 10.1016/j.jsps.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
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Aljawadi MH, Khoja AT, Alaboud NM, AlEnazi ME, Al-Shammari SA, Khoja TA, AlMuqbil MS, Alsheikh AM, Alwhaibi M. Prevalence of Polypharmacy and Factors Associated with it among Saudi Older Adults – Results from the Saudi National Survey for Elderly Health (SNSEH). Saudi Pharm J 2022; 30:230-236. [PMID: 35498218 PMCID: PMC9051952 DOI: 10.1016/j.jsps.2022.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
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Matthias AT, Fernando GVMC, Somathilake BGGK, Prathapan S. Predictors and patterns of polypharmacy in chronic diseases in a middle-income country. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2021; 13:158-165. [PMID: 35103098 PMCID: PMC8784655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
Low and middle-income countries (LMIC) are increasingly affected by non-communicable diseases (NCDs), which overburden the health system. With the rising prevalence of multimorbidity, polypharmacy is inevitable. Sri Lanka too faces the burden of polypharmacy and multimorbidity, and it is a strain on the economy as Sri Lankan health care is free-of-charge to all citizens. Therefore, steps to reduce inappropriate polypharmacy are a necessity. The aim of the study was to assess the prevalence and patterns of polypharmacy and its associated factors. In the medical clinics of a tertiary care hospital and a University primary care department, a descriptive cross-sectional study was carried out. Data were extracted from the clinical records of patients over the age of 20 years with a minimum of one NCD diagnosed by either a consultant physician or a consultant family physician. The sample size was 1600. Multimorbidity was present among 63.5% of patients. Polypharmacy (five or more than five drugs) was seen in 36.8% of the patients. Diabetes, hypertension, and coronary heart disease were the commonest of all diseases. Those on more than 11 drugs were found to have diabetes mellitus, hypertension, coronary heart disease, chronic kidney disease, and cardiac failure. 15% of the patients in the primary care setting and 59% of the patients in tertiary care experienced polypharmacy. Multiple regression analysis confirmed that polypharmacy increased with male gender, advancing age, and the degree of multimorbidity. Horizontal and vertical integration of multidisciplinary teams in all disciplines to manage patients is needed to combat inappropriate polypharmacy. This will help in optimizing the management of patients with NCDs.
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Affiliation(s)
- Anne Thushara Matthias
- Department of Medicine, Faculty of Medical Sciences, University of Sri JayewardenepuraSri Lanka
| | - Gunasekara Vidana Mestrige Chamath Fernando
- National Centre for Primary Care and Allergy Research, University of Sri JayewardenepuraSri Lanka
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri JayewardenepuraSri Lanka
| | | | - Shamini Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri JayewardenepuraSri Lanka
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Balkhi B, AlQahtani N, Alwhaibi M, Alshammari TM, Alhawassi TM, Mahmoud MA, Almetwazi M, Ata S, Basyoni M, Aljadhey H. Prevalence and Factors Associated With Polypharmacy Use Among Adult Patients in Saudi Arabia. J Patient Saf 2021; 17:e1119-e1124. [PMID: 29087978 DOI: 10.1097/pts.0000000000000439] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Polypharmacy is very common in clinical practice, especially among adult patients. The use of multiple medications may increase the risk of adverse drug events, medication cost, and medication errors. In addition, polypharmacy exacerbates treatment complexity, which consequently leads to poor patients' adherence to their medications. Despite being a well-recognized problem, few studies have investigated the prevalence and predictors of polypharmacy in Saudi Arabia. OBJECTIVES The aims of the study were to investigate the prevalence of polypharmacy among adult patients in a tertiary teaching hospital and to determine patients' characteristics that are associated with polypharmacy. METHODS This was a retrospective cross-sectional study using data extracted from the electronic health records database for a period of 6 months between January and June 2016 in outpatient setting. Descriptive statistics were used to analyze the study sample. A multivariate logistic regression model was used to examine the association between different variables and polypharmacy. Statistical analysis software (SAS 9.2) was used to analyze the study data. RESULTS A total of 17,237 observations (67.2% females) were included in the final analysis. Of these, nearly 54% (n = 9222) of reported observations were found using up to four prescription drugs and the other 46% (n = 8015) were using five or more prescription drugs. Interestingly, the prevalence of polypharmacy use was doubled among adults with hypertension as compared with those without hypertension (odds ratio [OR] = 2.68, 95% confidence interval [CI] = 2.51-2.87). In addition, polypharmacy use was two times more prevalent among adults with diabetes as compared with those without diabetes (OR = 2.31, 95% CI = 1.99-2.28) and five times more prevalent in patient with dementia (OR = 5.57, 95% CI = 1.26-24.7). Moreover, polypharmacy in adult patients was significantly influenced by sex (OR = 1.69, 95% CI = 1.59-1.80) and nationality (OR = 2.15, 95% CI = 2.00-2.31). CONCLUSIONS Polypharmacy is common among adult patients especially those who are older than 60 years. Polypharmacy may affect the overall process of drug therapy. It can be a risk factor to develop undesirable adverse drug events, especially in those with chronic health conditions. A special care should be taken to manage polypharmacy among adults in Saudi Arabia.
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Affiliation(s)
| | | | | | | | | | - Mansour A Mahmoud
- Medication Safety Research Chair, College of Pharmacy, King Saud University
| | | | - Sondus Ata
- Investigational Drugs and Research Unit, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Mada Basyoni
- Investigational Drugs and Research Unit, King Khalid University Hospital, Riyadh, Saudi Arabia
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van Oort S, Rutters F, Warlé‐van Herwaarden MF, Schram MT, Stehouwer CD, Tack CJ, Abbink EJ, Wolffenbuttel BH, van der Klauw MM, DeVries JH, Siegelaar SE, Sijbrands EJ, Özcan B, de Valk HW, Silvius B, Schroijen MA, Jazet IM, van Ballegooijen AJ, Beulens JWJ, Elders PJ, Kramers C. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med 2021; 38:e14406. [PMID: 32961611 PMCID: PMC8048843 DOI: 10.1111/dme.14406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 09/11/2020] [Indexed: 12/30/2022]
Abstract
AIM To describe the prevalence and characteristics of polypharmacy in a Dutch cohort of individuals with type 2 diabetes. METHODS We included people with type 2 diabetes from the Diabetes Pearl cohort, of whom 3886 were treated in primary care and 2873 in academic care (secondary/tertiary). With multivariable multinomial logistic regression analyses stratified for line of care, we assessed which sociodemographic, lifestyle and cardiometabolic characteristics were associated with moderate (5-9 medications) and severe polypharmacy (≥10 medications) compared with no polypharmacy (0-4 medications). RESULTS Mean age was 63 ± 10 years, and 40% were women. The median number of daily medications was 5 (IQR 3-7) in primary care and 7 (IQR 5-10) in academic care. The prevalence of moderate and severe polypharmacy was 44% and 10% in primary care, and 53% and 29% in academic care respectively. Glucose-lowering and lipid-modifying medications were most prevalent. People with severe polypharmacy used a relatively large amount of other (i.e. non-cardiovascular and non-glucose-lowering) medication. Moderate and severe polypharmacy across all lines of care were associated with higher age, low educational level, more smoking, longer diabetes duration, higher BMI and more cardiovascular disease. CONCLUSIONS Severe and moderate polypharmacy are prevalent in over half of people with type 2 diabetes in primary care, and even more in academic care. People with polypharmacy are characterized by poorer cardiometabolic status. These results highlight the significance of polypharmacy in type 2 diabetes.
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Affiliation(s)
- S. van Oort
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
| | - F. Rutters
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | | | - M. T. Schram
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. D. Stehouwer
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. J. Tack
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - E. J. Abbink
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - B. H. Wolffenbuttel
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - M. M. van der Klauw
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - J. H. DeVries
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - S. E. Siegelaar
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - E. J. Sijbrands
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - B. Özcan
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - H. W. de Valk
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - B. Silvius
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - M. A. Schroijen
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - I. M. Jazet
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - A. J. van Ballegooijen
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of NephrologyAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research InstituteAmsterdamthe Netherlands
| | - J. W. J. Beulens
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - P. J. Elders
- Department of General Practice and Elderly Care MedicineAmsterdam University Medical Center, location VUmc, Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - C. Kramers
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
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Ayalew MB, Dieberg G, Quirk F, Spark MJ. Potentially inappropriate prescribing for adults with diabetes mellitus: a scoping review protocol. JBI Evid Synth 2020; 18:1557-1565. [PMID: 32813395 DOI: 10.11124/jbisrir-d-19-00136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aims to explore and map studies investigating potentially inappropriate prescribing (PIP) for adults with diabetes mellitus. INTRODUCTION Inappropriate prescribing for people with diabetes mellitus has been reported by various authors focusing on different aspects of inappropriateness. A preliminary search revealed no published reviews on PIP for adults with diabetes mellitus. As a result, it is difficult to obtain a comprehensive map of PIP in this patient group. INCLUSION CRITERIA This scoping review will consider all studies on PIP for adults with the diagnosis of type 1 or type 2 diabetes mellitus from any clinical setting. Studies conducted in pediatric populations or in adults with pre-diabetes or gestational diabetes will be excluded. METHODS A three-step search strategy (i.e. an initial limited search in PubMed and ProQuest Central databases, a main search of eight databases and gray literature, and manual searches of reference lists of included articles) will be utilized. No language restrictions will be applied. All retrieved articles will be screened against the inclusion/exclusion criteria at title, abstract, and full-text stages. Data to be extracted from each study will include, but not be limited to, country, objective, study population, study methodology, type of PIP studied, examples of PIP events, medications involved, and criteria used for PIP identification. Data will be extracted by study team members using an online application for conducting systematic synthesis of evidence.
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Affiliation(s)
- Mohammed B Ayalew
- 1Department of Pharmacy, School of Rural Medicine, University of New England, Armidale, Australia 2Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia 3Biomedical Science, School of Science and Technology, University of New England, Armidale, Australia 4New England Institute of Healthcare Research, Faculty of Medicine and Health, University of New England, Armidale, Australia
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Nusair MB, Arabyat R, Al‐Azzam S, El‐Hajji FD, Nusir AT, Al‐Batineh M. Translation and psychometric properties of the Arabic version of the revised Patients' Attitudes Towards Deprescribing questionnaire. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Mohammad B. Nusair
- Pharmacy Practice Department Faculty of Pharmacy Yarmouk University Irbid Jordan
| | - Rasha Arabyat
- Pharmacy Practice Department Faculty of Pharmacy Yarmouk University Irbid Jordan
| | - Sayer Al‐Azzam
- Faculty of Pharmacy Jordan University of Science and Technology Irbid Jordan
| | | | - Amal T. Nusir
- Arabic Department Faculty of Arts Yarmouk University Irbid Jordan
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Gomes MS, Amorim WW, Morais RS, Gama RS, Graia LT, Queiroga HM, Oliveira MG. Polypharmacy in older patients at primary care units in Brazil. Int J Clin Pharm 2019; 41:516-524. [PMID: 30680513 DOI: 10.1007/s11096-018-00780-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/31/2018] [Indexed: 01/03/2023]
Abstract
Background Despite extensive studies of polypharmacy in older patients, no consensus regarding the definition of this practice exists in the literature. Several studies have defined polypharmacy as problematic when considering only the numbers of medications used by patients. Objective This study aimed to assess the prevalence of polypharmacy prescribing by comparing two different definitions (quantitative and qualitative) and evaluating factors associated with this practice in older patients. Setting Twenty-three basic health units. Method A cross-sectional study involving 386 older adults who received a prescription after a medical consultation. Multivariate analyses were conducted using a Poisson regression with robust variance. Main outcome measure The main outcome measures included patients with a prescription of five or more medications (quantitative polypharmacy) and those with a prescription of five or more medications including at least one drug considered potentially inappropriate for older adults (qualitative polypharmacy). Results The frequency of quantitative polypharmacy was 20.5%. The results of an adjusted analysis showed that the frequency of quantitative polypharmacy was associated with a higher number of self-reported morbidities and the prescription of potentially inappropriate drugs. The prevalence of qualitative polypharmacy was 10.4%, and after adjustment, this outcome remained significantly associated with the presence of three or more self-reported morbidities. Conclusions The presence of multiple comorbidities was identified as the main factor associated with the prescription of both quantitative and qualitative polypharmacy.
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Affiliation(s)
- Milena Santos Gomes
- Programa de Mestrado em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Rio de Contas 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, Bahia, 45055-090, Brazil
| | - Welma Wildes Amorim
- Curso de Medicina, Campus de Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Brazil
| | | | | | | | | | - Márcio Galvão Oliveira
- Programa de Mestrado em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Rio de Contas 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, Bahia, 45055-090, Brazil.
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Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, Drweesh H, Sambamoorthi U. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open 2018; 8:e020852. [PMID: 29794097 PMCID: PMC5988096 DOI: 10.1136/bmjopen-2017-020852] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED ObjectivesPatients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes. METHODS A cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record database for a period of 12 months (January-December 2016). Polypharmacy was defined as the cumulative use of five or more medications. Polypharmacy among adults with diabetes was measured by calculating the average number of medications prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy. RESULTS A total of 8932 adults with diabetes were included in this study. Of these, nearly 78% had polypharmacy which was more likely among women as compared with men and more likely among older adults (age ≥60 years) as compared with the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular conditions (adjusted OR (AOR)=2.89; 95% CI 2.54 to 3.29), respiratory disease (AOR=2.42; 95% CI 1.92 to 3.03) and mental health conditions (AOR=2.19; 95% CI 1.74 to 2.76), and three times as likely among patients with coexisting musculoskeletal disease (AOR=3.16; 95% CI 2.31 to 4.30) as compared with those without these coexisting chronic conditions categories. CONCLUSIONS Polypharmacy is common among patients with diabetes, with an even higher rate in older adults patients. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimising medications to enhance the outcome of diabetes care.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacy Service, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alduhaim
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Rawan Alabdulali
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Drweesh
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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Najjar MF, Sulaiman SAS, Al Jeraisy M, Balubaid H. The impact of a combined intervention program: an educational and clinical pharmacist's intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Ther Clin Risk Manag 2018; 14:557-564. [PMID: 29588595 PMCID: PMC5859904 DOI: 10.2147/tcrm.s157469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage. Aim The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients. Methods This was a prospective pre-test versus post-test design study. The screening tool of older persons’ prescriptions, 2nd version, and 2015 American Geriatric Society Beers’ criteria were used to assess the appropriateness of medications prescribed for geriatric inpatients. The study was carried out in the medical wards of the Department of Medicine at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Results Four hundred geriatric patients were enrolled in the study: 200 in a pre-intervention group (control) and 200 in the intervention group. After the combined intervention, the incidence rate of PIMs decreased significantly from 61% to 29.5% (p<0.001). Out of 317 recommendations given by the clinical pharmacist, the physicians accepted a total of 196 (61.83%) recommendations. The most common PIMs to avoid regardless of diagnosis of geriatric patients before interventions were first-generation antihistamines (46%), sliding scale insulin (18.5%), antipsychotics (6.5%), benzodiazepines (9.5%), and antiarrhythmic drugs (15%). Conclusion Using a combined intervention program that comprises an educational intervention of updated evidence-based guidelines and clinical pharmacist intervention would add a significant value to improve prescribing patterns in hospitalized geriatric patients.
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Affiliation(s)
- Muath Fahmi Najjar
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Pharmacy, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,Pharmaceutical Sciences School, Clinical Pharmacy Discipline, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Pharmaceutical Sciences School, Clinical Pharmacy Discipline, Universiti Sains Malaysia, Penang, Malaysia
| | - Majed Al Jeraisy
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Pharmacy, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hashim Balubaid
- King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Medicine, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Abstract
Introduction: Older people are at risk for polypharmacy due to multiple chronic diseases. Considering the lack of information in this regard, the aim of this study was to investigate the state of polypharmacy among the elderly in the city of Amirkola in northern part of Iran. Materials and Methods: This descriptive/analytical cross-sectional study is a part of Amirkola Health and Aging Project that was conducted on 1616 individuals aged 60 years and over. The data about medications were gathered through interviews and observation of prescriptions and medications consumed by patients. The data were analyzed by SPSS software version 18, and P ≤ 0.05 was regarded significant. Results: In this study, 1616 individuals including 883 men (54.6%) and 733 women (45.3%) were investigated. The average age of individuals was 69.37 ± 7.42. Among the investigated individuals, 526 including 368 men (41.7%) and 158 women (21.6%) consumed no medications. The prevalence of polypharmacy in this study was 23.1%, which was 32.7% in women and 15.2% in men (odds ratio = 1.51, 95% confidence interval: 1.10–1.93). The most prevalent group of medications used in both genders was cardiovascular drugs. Conclusions: Regarding the considerable prevalence of polypharmacy among the elderly, especially in aged women, serious efforts are required to manage polypharmacy. Provision of educational programs for physicians, personnel of pharmacies, and the staff of health-care centers in order for appropriate and safe consumption of medications in aged people is absolutely necessary.
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Affiliation(s)
- Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Nursing Care Research Center, Babol University of Medical Sciences, Babol, Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Diseases Linked to Polypharmacy in Elderly Patients. Curr Gerontol Geriatr Res 2017; 2017:4276047. [PMID: 29434639 PMCID: PMC5757103 DOI: 10.1155/2017/4276047] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/07/2017] [Indexed: 01/10/2023] Open
Abstract
Introduction Polypharmacy in several cases is deemed necessary and elderly patients are prone to this phenomenon. The objective of this study was to identify the prevalence and the predictors of polypharmacy among consecutively unplanned admissions of patients aged ≥65 years. Patients and Methods In 310 patients (51% women), mean age 80.24 years (95% CI 79.35–81.10), demographic characteristics, medical history, medications, and cause of admission were recorded. Parametric tests and multiple logistic regression analysis were applied to identify the factors that have significant association with polypharmacy. Results 53.5% of patients belonged to polypharmacy group. In multivariate analysis the independent predictors of polypharmacy were arterial hypertension (p = 0.003, OR = 2.708, and 95% CI 1.400–5.238), coronary artery disease (p = 0.001, OR = 8.274, and 95% CI 3.161–21.656), heart failure (p = 0.030, OR = 4.042, and 95% CI 1.145–14.270), atrial fibrillation (p = 0.031, OR = 2.477, and 95% CI 1.086–5.648), diabetes mellitus (p = 0.010, OR = 2.390, and 95% CI 1.232–4.636), dementia (p = 0.001, OR = 4.637, and 95% CI 1.876–11.464), and COPD (p = 0.022, OR = 3.626, and 95% CI 1.208–10.891). Conclusions Polypharmacy mainly was linked to cardiovascular diseases. If deprescribing is not feasible, physicians must oversee those patients in order to recognise early, possible drug reactions.
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Al-Hashar A, Al Sinawi H, Al Mahrizi A, Al-Hatrushi M. Prevalence and Covariates of Polypharmacy in Elderly Patients on Discharge from a Tertiary
Care Hospital in Oman. Oman Med J 2016; 31:421-425. [PMID: 27974957 DOI: 10.5001/omj.2016.85] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence of polypharmacy in relation to gender, comorbidity, and age among elderly patients upon discharge from an academic tertiary care hospital in Muscat, Oman. METHODS This cross-sectional study was conducted at Sultan Qaboos University Hospital between February and July 2014. We reviewed the electronic medical records of elderly patients aged ≥ 60 years who were admitted to any of the hospital's medical wards during the study period and collected data on age, gender, and diagnoses. We also collected information on the medications prescribed on discharge. Polypharmacy was defined as the concurrent use of ≥ 5 medications. RESULTS A total of 431 elderly inpatients were enrolled, of which approximately 50% were female. Polypharmacy was identified in 76.3% of discharge prescriptions. Gender (adjusted odds ratio (aOR), 1.17; 95% CI 0.73, 1.88, p = 0.502) and age (aOR, 0.98; 95% CI 0.95, 1.00, p = 0.075) had no impact on polypharmacy. On the other hand, a significant association between polypharmacy and comorbidity was observed (aOR, 1.31; 95% CI 1.12, 1.54, p = 0.001). Cardiovascular diagnosis on admission was also identified as being associated with polypharmacy (aOR, 2.66; 95% CI 1.49, 4.75, p = 0.001). More patients had cardiovascular diseases on admission (31.0%), followed by infections (23.0%), and gastrointestinal diseases (13.0%). The most commonly prescribed drugs on discharge were cardiovascular drugs (48.0%), followed by drugs acting on the gastrointestinal system (11.0%), endocrine system (9.2%), and nutrition and blood (7.5%). CONCLUSIONS The prevalence of polypharmacy among elderly medical patients discharged from our hospital was high (76.3%) and was associated with a number of comorbidities and cardiovascular disease as a cause of admission, but not with age or gender. The prevalence of polypharmacy in our institution raises significant concerns over its potential impact on patients' health outcomes and requires further investigation. Raising physicians' awareness of health implications of polypharmacy may help reduce the incidence of medication-related adverse events and improve treatment outcomes.
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Affiliation(s)
- Amna Al-Hashar
- Pharmacy Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamed Al Sinawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Anwar Al Mahrizi
- Pharmacy Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Manal Al-Hatrushi
- Pharmacy Department, Sultan Qaboos University Hospital, Muscat, Oman
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Al-Tannir M, Alharbi AI, Alfawaz AS, Zahran RI, AlTannir M. Saudi adults satisfaction with community pharmacy services. SPRINGERPLUS 2016; 5:774. [PMID: 27386260 PMCID: PMC4912500 DOI: 10.1186/s40064-016-2442-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 05/27/2016] [Indexed: 11/13/2022]
Abstract
Background Community pharmacists play a significant role in patient health care in Saudi Arabia and are directly responsible for medication-related counseling. Aim To assess Saudi Adults satisfaction with community pharmacy services and the secondary objective is obtaining an insight of their needs in patient counseling service. Methods This cross-sectional survey was conducted via a questionnaire distributed to a representative sample of 650 Saudi adults approached at pharmacists and public places in areas of Riyadh during March 2014. Results 500 Complete questionnaires were collected, and the response rate was 77 %. Around 41 % were satisfied with Saudi pharmacy services. Out of these, 57 % attributed their satisfaction to pharmacist counseling on current medication, 96 % to appropriate dosage regimen explanation and 73 % to appropriate time spent in counseling (p < 0.001). When asked about reasons for dissatisfaction, 82 % of the unsatisfied group stated that pharmacists fail to ask about comorbid diseases and 78 % reported unavailability of dedicated pharmacist for patient counseling (p < 0.001). Conclusion Saudi adults have variable levels of satisfaction with community pharmacy services. To increase levels of satisfaction, it is necessary to provide adequate pharmacist training in community pharmacies.
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Affiliation(s)
| | - Afnan I Alharbi
- College of Pharmacy, Princess Nora bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Arwa S Alfawaz
- College of Pharmacy, Princess Nora bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Razan I Zahran
- College of Pharmacy, Princess Nora bint Abdulrahman University, Riyadh, Saudi Arabia
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Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open 2016; 6:e010989. [PMID: 27013600 PMCID: PMC4809106 DOI: 10.1136/bmjopen-2015-010989] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Ageing--along with its associated physiological and pathological changes--places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all populations. In recent decades, several scientific investigations have studied polypharmacy and its correlates, using different approaches and definitions, and their results have been inconclusive. Differences in definitions and approaches in these studies form a barrier against reaching a conclusion regarding the risk factors and consequences of polypharmacy. It is therefore imperative to establish an appropriate definition of polypharmacy. METHODS AND ANALYSIS A systematic review will be conducted using PubMed, Scopus, Web of Science, EMBASE, PsycINFO and AgeLine bibliographic databases, as well as the grey literature on polypharmacy in older adults to answer these two questions: What definitions in the literature are being used for polypharmacy in older people?, and Which definitions are more comprehensive and applicable? 2 independent reviewers will conduct the primary screening of the articles and data extraction, and eligible sources will be selected after discussing non-conformities. All extracted data from selected articles will be categorised based on the type of study participants, study design and setting, the methodological quality of primary studies and any other potential source of heterogeneity, and results will be summarised in a table, which will contain the levels of evidence and methodological quality of the included studies. The most comprehensive definition of polypharmacy will be selected from the final list of definitions through an international expert webinar. ETHICS AND DISSEMINATION This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.
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Affiliation(s)
- Seyede Salehe Mortazavi
- Mental Health Research Center, Tehran Institute of Psychiatry–School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shati
- Department of Aging, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Abasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Center, Tehran Institute of Psychiatry–School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, USA
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Center for Research on Ethnicity, Culture, and Health, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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