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Dietz N, Alkin V, Agarwal N, Bjurström MF, Ugiliweneza B, Wang D, Sharma M, Drazin D, Boakye M. Polypharmacy in spinal cord injury: Matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up. J Spinal Cord Med 2024:1-10. [PMID: 39037335 DOI: 10.1080/10790268.2024.2375892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Polypharmacy in spinal cord injury (SCI) is common and predisposes patients to increased risk of adverse events. Evaluation of long-term health consequences and economic burden of polypharmacy in patients with SCI is explored. DESIGN Retrospective cohort. METHODS The IBM Marketscan Research Databases claims-based dataset was queried to search for adult patients with SCI with a 2-year follow-up. PARTICIPANTS Two matched cohorts were analyzed: those with and without polypharmacy, analyzing index hospitalization, readmissions, payments, and health outcomes. RESULTS A total of 11 569 individuals with SCI were included, of which 7235 (63%) were in the polypharmacy group who took a median of 11 separate drugs over two years. Opioid analgesics were the most common medication, present in 57% of patients with SCI meeting the criteria of polypharmacy, followed by antidepressant medications (46%) and muscle relaxants (40%). Risk of pneumonia was increased for the polypharmacy group (58%) compared to the non-polypharmacy group (45%), as were urinary tract infection (79% versus 63%), wound infection (30% versus 21%), depression (76% versus 57%), and adverse drug events (24% versus 15%) at 2 years. Combined median healthcare payments were higher in polypharmacy at 2 years ($44 333 vs. $10 937, P < .0001). CONCLUSION Majority of individuals with SCI met the criteria for polypharmacy with nearly 60% of those prescribed opioids and taking drugs from high-risk side effect profiles. Polypharmacy in SCI was associated with a greater risk of pneumonia, depression, urinary tract infections, adverse drug events, and emergency room visits over two years with four times higher overall healthcare payments at 1-year post-injury.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Victoria Alkin
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
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Pfefferle A, Binder N, Sauer J, Sofroniou M, Metzner G, Farin E, Voigt-Radloff S, Maun A, Salm C. Association between continuity of care and inappropriate prescribing in outpatient care in Germany: a cross-sectional analysis conducted as part of the LoChro trial. BMJ Open 2024; 14:e082245. [PMID: 39038858 PMCID: PMC11268059 DOI: 10.1136/bmjopen-2023-082245] [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: 11/17/2023] [Accepted: 06/30/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are common in multimorbid patients. This study aims to describe PIMs and PPOs in an open-access outpatient setting and to investigate any association between continuity of care (CoC) and PIMs and PPOs in multimorbid older patients. DESIGN Cross-sectional study using patient-confirmed outpatient medication plans to describe PIMs and PPOs using the 'Screening Tool of Older Person's Prescription/Screening Tool to Alert to Right Treatment' version 2. Four Poisson regressions modelled the number of PIMs and PPOs using context-adapted versions of the Usual Provider of Care (UPC) and the Modified Modified Continuity Index (MMCI) as measures for CoC. SETTING Southern Germany, outpatient setting. PARTICIPANTS 321 participants of the LoChro-trial at 12-month follow-up (both arms). The LoChro-trial compared healthcare involving an additional care manager with usual care. Inclusion criteria were age over 64, local residence and scoring over one in the Identification of Older patients at Risk Screening Tool. PRIMARY OUTCOMES Numbers of PIMs and PPOs. RESULTS The mean number of PIMs was 1.5 (SD 1.5), lower than the average number of PPOs at 2.9 (SD 1.7). CoC showed similar results for both indices with a mean of 0.548 (SD 0.279) for MMCI and 0.514 (SD 0.262) for UPC. Both models predicting PPOs indicated more PPOs with higher CoC; statistical significance was only demonstrated for MMCI (MMCI~PPO: Exp(B)=1.42, 95% CI (1.11; 1.81), p=0.004; UPC~PPO: Exp(B)=1.29, 95% CI (0.99; 1.67), p=0.056). No significant association between PIMs and CoC was found (MMCI~PIM: Exp(B)=0.72, 95% CI (0.50; 1.03), p=0.072; UPC~PIM: Exp(B)=0.83, 95% CI (0.57; 1.21), p=0.337). CONCLUSION The results did not show a significant association between higher CoC and lesser PIMs. Remarkably, an association between increased CoC, represented through MMCI, and more PPOs was found. Consultation of different care providers in open-access healthcare systems could possibly ameliorate under-prescribing in multimorbid older patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00013904.
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Affiliation(s)
- Aline Pfefferle
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Nadine Binder
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Julia Sauer
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Mario Sofroniou
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
- Wyvern Health Partnership, NHS Bath Gloucestershire Swindon and Wiltshire Local Area Team, Swindon, UK
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Andy Maun
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Claudia Salm
- Insitute of General Practice/Family Medicine, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
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Andrade A, Nascimento T, Cabrita C, Leitão H, Pinto E. Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults. Healthcare (Basel) 2024; 12:1275. [PMID: 38998810 PMCID: PMC11241476 DOI: 10.3390/healthcare12131275] [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: 05/18/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.
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Affiliation(s)
- Amanda Andrade
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Tânia Nascimento
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
| | - Catarina Cabrita
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Helena Leitão
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal
| | - Ezequiel Pinto
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
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Wehling M, Weindrich J, Weiss C, Heser K, Pabst A, Luppa M, Bickel H, Weyerer S, Pentzek M, König HH, Lühmann D, van der Leeden C, Scherer M, Riedel-Heller SG, Wagner M, Pazan F. Validation of MyFORTA: An Automated Tool to Improve Medications in Older People Based on the FORTA List. Drugs Aging 2024; 41:555-564. [PMID: 38848020 PMCID: PMC11193825 DOI: 10.1007/s40266-024-01120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Listing tools have been developed to improve medications in older patients, including the Fit fOR The Aged (FORTA) list, a clinically validated, positive-negative list of medication appropriateness. Here, we aim to validate MyFORTA, an automated tool for individualized application of the FORTA list. METHODS 331 participants of a multi-center cohort study (AgeCoDe) for whom the FORTA score (sum of overtreatment and undertreatment errors) had been determined manually (gold standard [GS]) were reassessed using the automated MyFORTA (MF) tool. This tool determines the score from ATC and ICD codes combined with clinical parameters. RESULTS The FORTA scores were 9.01 ± 2.91 (mean ± SD, MF) versus 6.02 ± 2.52 (GS) (p < 0.00001). Removing undertreatment errors for calcium/vitamin D (controversial guidelines) and influenza/pneumococcal vaccinations (no robust information in the database), the difference decreased: 7.5 ± 2.7 (MF) versus 5.98 ± 2.55 (GS) (p < 0.00001). The remaining difference was driven by, for example, missing nitro spray in coronary heart disease/acute coronary syndrome as the related information was rarely found in the database, but notoriously detected by MF. Three hundred and forty errors from those 100 patients with the largest score deviation accounted for 68% of excess errors by MF. CONCLUSION MF was more sensitive to detect medication errors than GS, all frequent errors only detected by MF were plausible, and almost no adaptations of the MF algorithm seem indicated. This automated tool to check medication appropriateness according to the FORTA list is now validated and represents the first clinically directed algorithm in this context. It should ease the application of FORTA and help to implement the proven beneficial effects of FORTA on clinical endpoints.
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Affiliation(s)
- Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Johannes Weindrich
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty of the University of Heidelberg in Mannheim, Mannheim, Germany
| | - Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Alexander Pabst
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice/Family Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin van der Leeden
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Lee EA, Steinberg SG, Cheng SC, Lieu WL, Yoshinaga MA, Powers DC, Kanter MH, Broder BI. Reduction of concurrent use of highly anticholinergic medications in an integrated healthcare system: 2018-2021. J Am Geriatr Soc 2023; 71:3921-3923. [PMID: 37737472 DOI: 10.1111/jgs.18604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Eric A Lee
- Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, California, USA
- Department of Clinical Science, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Steven G Steinberg
- Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, California, USA
- Department of Health Systems Research, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Stephen C Cheng
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - William L Lieu
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Monica A Yoshinaga
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Daniel C Powers
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Michael H Kanter
- Department of Clinical Science, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA
| | - Benjamin I Broder
- Department of Health Systems Research, Kaiser Permanente - Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, Pasadena, California, USA
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Lee EA, Steinberg SG, Cheng SC, Lieu WL, Yoshinaga MA, Powers DC, Kanter MH, Broder BI. Reduction of poly-central nervous systems medications in older adults in an integrated healthcare system: 2018-2020. J Am Geriatr Soc 2023; 71:3319-3321. [PMID: 37350654 DOI: 10.1111/jgs.18471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Eric A Lee
- Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, California, USA
- Department of Clinical Science, Kaiser Permanente-Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Steven G Steinberg
- Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, California, USA
- Department of Health Systems Research, Kaiser Permanente-Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Stephen C Cheng
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - William L Lieu
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Monica A Yoshinaga
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Daniel C Powers
- Drug Use Management, Kaiser Permanente Southern California, Downey, California, USA
| | - Michael H Kanter
- Department of Clinical Science, Kaiser Permanente-Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA
| | - Benjamin I Broder
- Department of Health Systems Research, Kaiser Permanente-Bernard J Tyson School of Medicine, Pasadena, California, USA
- Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, Pasadena, California, USA
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Perpétuo C, Plácido AI, Aperta J, Figueiras A, Herdeiro MT, Roque F. Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4955. [PMID: 36981864 PMCID: PMC10048997 DOI: 10.3390/ijerph20064955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Aging is associated with an increase in the prevalence of chronic diseases and polypharmacy, and with the prescription of potentially inappropriate medications (PIMs). This study aimed to analyze the variation in PIMs from hospital admission to discharge. A retrospective cohort study was conducted on inpatients of an internal medicine service. According to the Beers criteria, 80.7% of the patients had been prescribed at least one PIM at admission and 87.2% at discharge; metoclopramide was the most-prescribed PIM from admission to discharge, and acetylsalicylic acid was the most-deprescribed one. According to the STOPP criteria, 49.4% of patients had been prescribed at least one PIM at admission and 62.2% at discharge; quetiapine was the most-prescribed PIM from admission to discharge, and captopril was the most-deprescribed one. According to the EU(7)-PIM list, 51.3% of patients had been prescribed at least one PIM at admission and 70.3% at discharge, and bisacodyl was the most-prescribed PIM from admission to discharge and propranolol the most-deprescribed one. It was found that the number of PIMs at discharge was higher than at admission, suggesting the need to develop a guide with adapted criteria to be applied in an internal medicine service.
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Affiliation(s)
- Carla Perpétuo
- Research Unit for Inland Development, Polytechnic of Guarda (UDI/IPG), 6300-559 Guarda, Portugal
- Local Health Unit of Guarda, 6300-035 Guarda, Portugal
| | - Ana I. Plácido
- Research Unit for Inland Development, Polytechnic of Guarda (UDI/IPG), 6300-559 Guarda, Portugal
| | - Jorge Aperta
- Local Health Unit of Guarda, 6300-035 Guarda, Portugal
- Sociedade Portuguesa de Farmacêuticos dos Cuidados de Saúde (SPFCS), Rua D. Manuel I, 74 1° Piso, 3030-320 Coimbra, Portugal
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15786 Santiago de Compostela, Spain
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786 Santiago de Compostela, Spain
| | - Maria Teresa Herdeiro
- Sociedade Portuguesa de Farmacêuticos dos Cuidados de Saúde (SPFCS), Rua D. Manuel I, 74 1° Piso, 3030-320 Coimbra, Portugal
- Institute of Biomedicine (iBiMED-UA), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI/IPG), 6300-559 Guarda, Portugal
- Health Science Research Center (CICS/UBI), University of Beira Interior, 6201-001 Covilhã, Portugal
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Gillespie R, Mullan J, Harrison L. Exploring Older Adult Health Literacy in the Day-to-Day Management of Polypharmacy and Making Decisions About Deprescribing: A Mixed Methods Study. Health Lit Res Pract 2023; 7:e14-e25. [PMID: 36629783 PMCID: PMC9833258 DOI: 10.3928/24748307-20221216-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Polypharmacy use in older adults is increasing and sometimes leads to poor health outcomes. The influence of health literacy in managing polypharmacy and making decisions about stopping medication has received limited attention. OBJECTIVE A mixed methods design was used to measure and investigate the influence of health literacy in the management of polypharmacy and decisions about deprescribing. Phase 1 involved two cross-sectional surveys, one with older adults using five or more medications and the other with general practitioners (GPs). METHODS Older adult health literacy was measured using the All Aspects of Health Literacy Scale. Phase 2 employed individual interviews with both older adults and GPs and further explored the reported use of health literacy in practice. SPSS version 24 was used to conduct descriptive statistical analysis of the Phase 1 survey responses and Phase 2 interviews were analyzed using thematic analysis with the assistance of NVivo 12. KEY RESULTS Phase 1 survey responses were received from 85 GPs and 137 older adults. Phase 2 interviews were conducted with 16 GPs and 25 older adults. Phase 1 results indicated that self-reported older adult health literacy was high, and that GPs believed older patients could engage in decisions about deprescribing. Phase 2 findings showed that older adults developed and employed complex health literacy practices to manage medications between consultations; however, few reported using their health literacy skills in consultations with their GPs. GPs noted that older adult involvement in decision-making varied and generally thought that older adults had low health literacy. CONCLUSION Older adults reported using health literacy practices in the management of their sometimes-complex medication regimens. However, the role of health literacy in deprescribing decision-making was limited. The mixed methods approach allowed greater insight into older adult and GP practices that influence the acquisition and use of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(1):e14-e25.] Plain Language Summary: This report explores health literacy in the use of multiple medications and decisions to stop using medication/s in older age. Older adults reported good heath literacy and practiced many health literacy skills in the management of their medications. However, they did not always report the use of their health literacy skills when discussing their medications with their family doctor.
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Affiliation(s)
- Robyn Gillespie
- Address correspondence to Robyn Gillespie, PhD, MPH, BN, via
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9
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Lee A. Many drugs are available for hypertension, with more in development. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00951-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Gillespie R, Mullan J, Harrison L. Factors which influence the deprescribing decisions of community-living older adults and GPs in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6206-e6216. [PMID: 36165345 PMCID: PMC10087828 DOI: 10.1111/hsc.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Deprescribing aims to reduce polypharmacy and inappropriate medication use. Both General Practitioners (GPs) and older adults have expressed a willingness to consider deprescribing. However, deprescribing is often deferred in practice. The aim of this study was to identify factors which influence GP and older adult decisions about deprescribing in primary care. Semi-structured interviews were used in this qualitative study, conducted in a regional area in Australia. Participants included GPs and adults aged 65 years or older, using five or more medications and living independently in the community. Data were collected between January 2018 and May 2019. Thematic analysis was used to analyse the verbatim transcribed interviews using NVivo 12. A total of 41 interviews were conducted, 25 with older adults and 16 with GPs. Four key themes influenced deprescribing decisions: views of ageing, shared decision-making, attitudes toward medication use and characteristics of the health care environment. Discussions of deprescribing were limited by the influence of negative stereotypes toward age and ageing, a lack of older adult participation in shared decision-making, a positive attitude towards ongoing medication use and perception of the normality of using medications in older age. Time constraints, poor communication about prescribing information and unclear roles regarding responsibility for deprescribing also prevented discussions. Continuity of care, involvement of older adults in medication reviews and GPs who asserted their generalist role were the main factors which promoted discussion of deprescribing. GPs are well placed to discuss deprescribing with their older patients because they are trusted and can provide continuity of care. Actively encouraging and involving older adults in medication reviews in order to understand their preferences, supports shared decision-making about deprescribing. Active involvement may also reduce the influence of negative views of ageing held by both older adults and GPs.
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Affiliation(s)
- Robyn Gillespie
- School of MedicineUniversity of WollongongWollongongNew South WalesAustralia
| | - Judy Mullan
- Centre for Health Research Illawarra—Shoalhaven PopulationUniversity of WollongongWollongongNew South WalesAustralia
| | - Lindsey Harrison
- School of Health and SocietyUniversity of WollongongWollongongNew South WalesAustralia
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Stevenson MH, McPherson A, Tavares C, Groninger H. Re: Polypharmacy in palliative care for advanced heart failure: the PAL-HF Experience. J Card Fail 2022; 28:1382-1383. [PMID: 35550426 DOI: 10.1016/j.cardfail.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Maximillian H Stevenson
- MedStar Washington Hospital Center, Section of Palliative Care, 110 Irving Street NW, Room 2A68, District of Columbia, Washington 20010, USA.
| | - Alexandra McPherson
- MedStar Washington Hospital Center, Section of Palliative Care, 110 Irving Street NW, Room 2A68, District of Columbia, Washington 20010, USA
| | - Candice Tavares
- MedStar Washington Hospital Center, Section of Palliative Care, 110 Irving Street NW, Room 2A68, District of Columbia, Washington 20010, USA
| | - Hunter Groninger
- MedStar Washington Hospital Center, Section of Palliative Care, 110 Irving Street NW, Room 2A68, District of Columbia, Washington 20010, USA
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12
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Abstract
INTRODUCTION The use of medications with anticholinergic (ACh) properties is associated with numerous adverse effects especially in older adults. Emerging evidence suggests the presence of long-term effects with ACh use. AREAS COVERED Our article presents an overview of ACh effects and falls in older individuals including examination of emerging evidence on ACh use and cumulative exposure on short-term and long-term falls risk. The databases CINAHL, MEDLINE, EMBASE, and Web of Science were searched for articles published from January 2002 to December 2021. EXPERT OPINION Anticholinergic side effects include muscle weakness, blurred vision, and mental confusion which are likely to lead to increased falls risk. Many commonly used medications such as beta-blockers, calcium-channel blockers, and antihistamines are now known to have mild ACh properties. With polypharmacy now considered unavoidable in older patients, the cumulative effects of the use of multiple drugs with mild ACh properties may also lead to increased falls risk. The relationship between ACh drugs and falls may also be irreversible as ACh effects may extend beyond the period of drug use, due to cognitive and physical deconditioning following the initial exposure to ACh drugs. Future long-term studies with accurate quantification of cumulative ACh exposure and measurement of actual falls outcomes are urgently required.
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Affiliation(s)
- Xiang Jiang Xu
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Selangor, Malaysia
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13
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Al Shidhani A, Al Salmani A, Al Saidi Y, Al Shehhi M, Al Khanjari H, Al Aamri M, Al Hadabi F. Polypharmacy and Medication Compliance among Patients with Type 2 Diabetes in Oman: A Cross-Sectional Study. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/zimw7hb8od] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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14
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Chen C, Feng Z, Fu Q, Wang J, Zheng Z, Chen H, Feng D. Predictors of Polypharmacy Among Elderly Patients in China: The Role of Decision Involvement, Depression, and Taking Chinese Medicine Behavior. Front Pharmacol 2021; 12:745688. [PMID: 34938179 PMCID: PMC8685318 DOI: 10.3389/fphar.2021.745688] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: The prevalence of polypharmacy is gradually increasing in geriatrics, which may contribute to adverse effects, such as potential drug-drug and drug-disease interactions. These side effects remain an important challenge in patient safety, which has a significant impact on mortality and incidence rate. Aims: Therefore, this study aims to understand the epidemiology of polypharmacy and identify factors that have an impact on the management of potentially inappropriate prescribing. Methods: This study is a cross-sectional study, analyzing the prescription data from 720 hospitalized patients aged 50+ with a random cluster sampling method. We used inverse probability treatment weighting (IPTW) method to group and match polypharmacy and non-polypharmacy patients, and logistic regression was conducted to explore the factors associated with polypharmacy. Results: The prevalence of polypharmacy accounted for 50.14% among the old patients in this study. Female patients (67.34%) have more polypharmacy than male patients, and key predictors associated with polypharmacy in the logistic regression model included the following: domicile (AOR = 0.63, 95% CI 0.42-0.95), annual income (AOR = 0.38, 95% CI 0.20-0.70), the number of chronic diseases (AOR = 3.68, 95% CI 2.69-5.06), taking Chinese medicine (AOR = 1.70, 95% CI 1.22-2.36), decision involvement (AOR = 1.49 95% CI 1.10-2.03), and depression (AOR = 1.42, 95% CI 1.03-1.96). Conclusion: Polypharmacy is common among the participants with chronic diseases in Hubei province, China. The study emphasizes that gerontology practitioners should be prudent in applying clinical guidelines to provide personalized, comprehensive assessment of decision making of prescriptions, especially in socioeconomically deprived areas.
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Affiliation(s)
- Chaoyi Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wang
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- Second People's Hospital of Yichang City, Yichang, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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15
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Vatcharavongvan P, Puttawanchai V. Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications. J Prim Care Community Health 2021; 12:21501327211035088. [PMID: 34315288 PMCID: PMC8323440 DOI: 10.1177/21501327211035088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Most older adults with comorbidities in primary care clinics use multiple
medications and are at risk of potentially inappropriate medications (PIMs)
prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai
criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected
from electronic medical records in a primary care clinic in 2018. Samples
were patients aged ≥65 years old with at least 1 prescription. Variables
included age, gender, comorbidities, and medications. The list of risk drugs
for Thai elderly version 2 was the criteria for PIMs. The prevalence of
polypharmacy and PIMs were calculated, and multiple logistic regression was
conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively.
Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were
anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory
drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM
prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI
2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing
unnecessary medications is crucial to prevent negative health outcomes from
PIMs. Computer-based clinical decision support, pharmacy-led interventions,
and patient-specific drug recommendations are promising interventions to
reduce PIMs in a primary care setting.
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16
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Perpétuo C, Plácido AI, Rodrigues D, Aperta J, Piñeiro-Lamas M, Figueiras A, Herdeiro MT, Roque F. Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria. Front Pharmacol 2021; 12:676020. [PMID: 34393774 PMCID: PMC8362883 DOI: 10.3389/fphar.2021.676020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM. Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant. Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria. Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.
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Affiliation(s)
- Carla Perpétuo
- Health Sciences School, Polytechnic Institute of Guarda, Guarda, Portugal.,Local Health Unit of Guarda, Guarda, Portugal
| | - Ana I Plácido
- Health Sciences School, Polytechnic Institute of Guarda, Guarda, Portugal.,Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), Guarda, Portugal
| | - Daniela Rodrigues
- Health Sciences School, Polytechnic Institute of Guarda, Guarda, Portugal.,Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), Guarda, Portugal
| | - Jorge Aperta
- Health Sciences School, Polytechnic Institute of Guarda, Guarda, Portugal.,Local Health Unit of Guarda, Guarda, Portugal
| | - Maria Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Santiago de Compostela, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Santiago de Compostela, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED-UA), University of Aveiro, Aveiro, Portugal
| | - Fátima Roque
- Health Sciences School, Polytechnic Institute of Guarda, Guarda, Portugal.,Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), Guarda, Portugal.,Health Science Research Center (CICS/UBI), University of Beira Interior, Covilhã, Portugal
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17
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Paiva AR, Plácido AI, Curto I, Morgado M, Herdeiro MT, Roque F. Acceptance of Pharmaceutical Services by Home-Dwelling Older Patients: A Case Study in a Portuguese Community Pharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147401. [PMID: 34299855 PMCID: PMC8303520 DOI: 10.3390/ijerph18147401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 12/26/2022]
Abstract
Background: Aging-related comorbidities predispose older adults to polypharmacy and consequently an increased risk of adverse drug reactions and poor compliance. Pharmacists’ interventions can have a beneficial impact on the improvement of clinical outcomes. Thus, this work aimed to assess the acceptance of Portuguese home-dwelling older adults regarding a pharmaceutical service paid by patients for medication management and pharmacotherapy follow-up. We also intended to analyze medication, characterize the medication consumption profile, and identify the main difficulties of our sample during their daily medication management. Methods: A questionnaire on adherence and medication therapy management was applied to polymedicated patients ≥65 years old, in a community pharmacy. Results: Of the 88 participants, 92.2% would be willing to pay for a pharmacotherapy management service, and 75.6% answered that they would be willing to pay for an individual medication preparation service. In addition, 45.7% of the participants were categorized as lower adherents to a medication therapeutic regimen. Our sample reported that during their daily lives, they felt difficulty: to remember to take their pills (17%), to manage so many medicines (15.9%), and to swallow the pills (9.1%). Conclusions: Polymedicated older adults are willing to pay for a service to improve the management of their medicines, suggesting that they recognize the role of pharmacists in medication management. This study provides useful information for the conceptualization of a pharmacotherapy management service that includes medication review and a pharmacotherapy follow-up.
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Affiliation(s)
- Ana Rita Paiva
- Health Sciences School, Polytechnic of Guarda, Rua da Cadeia, 6300-035 Guarda, Portugal; (A.R.P.); (A.I.P.); (M.M.)
| | - Ana Isabel Plácido
- Health Sciences School, Polytechnic of Guarda, Rua da Cadeia, 6300-035 Guarda, Portugal; (A.R.P.); (A.I.P.); (M.M.)
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Av. Dr. Francisco Sá Carneiro 50, 6300-559 Guarda, Portugal
| | - Isabel Curto
- Pharmacy Mousaco Torrão, Estrada Municipal 506 11, R/C, 6200-571 Ferro, Portugal;
| | - Manuel Morgado
- Health Sciences School, Polytechnic of Guarda, Rua da Cadeia, 6300-035 Guarda, Portugal; (A.R.P.); (A.I.P.); (M.M.)
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Av. Dr. Francisco Sá Carneiro 50, 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Pharmaceutical Services of University Hospital Centre of Cova da Beira, 6200-251 Covilhã, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine, University of Aveiro (iBIMED-UA), 3810-193 Aveiro, Portugal;
| | - Fátima Roque
- Health Sciences School, Polytechnic of Guarda, Rua da Cadeia, 6300-035 Guarda, Portugal; (A.R.P.); (A.I.P.); (M.M.)
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Av. Dr. Francisco Sá Carneiro 50, 6300-559 Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
- Correspondence:
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18
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Krüger C, Schäfer I, van den Bussche H, Baehr M, Bickel H, Fuchs A, Gensichen J, Maier W, Riedel-Heller SG, König HH, Dahlhaus A, Schön G, Weyerer S, Wiese B, von Renteln-Kruse W, Langebrake C, Scherer M. Non-random relations in drug use expressed as patterns comprising prescription and over-the-counter drugs in multimorbid elderly patients in primary care: Data of the exploratory analysis of the multicentre, observational cohort study MultiCare. Eur J Gen Pract 2021; 27:119-129. [PMID: 34132623 PMCID: PMC8211130 DOI: 10.1080/13814788.2021.1933425] [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] [Indexed: 11/11/2022] Open
Abstract
Background The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication – including prescription and over-the-counter (OTC) drugs – of elderly patients in primary care is still insufficient. Objectives This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort. Methods MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation. Results Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322–0.430; female: ρ = 0.301, CI 0.624–0.340). Conclusion The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.
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Affiliation(s)
- Caroline Krüger
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Baehr
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University Munich, Munich, Germany
| | - Angela Fuchs
- Institute of General Practice, University Dusseldorf, Dusseldorf, Germany
| | - Jochen Gensichen
- Family Medicine, Institute of General Practice, University Hospital Jena, Jena, Germany.,Family Medicine, Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University Bonn, Bonn, Germany
| | - Steffi G Riedel-Heller
- Occupational Health and Public Health, University Leipzig, Institute for Social Medicine, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Dahlhaus
- Family Medicine, Institute of General Practice, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Birgitt Wiese
- Institute of General Practice, WG Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | | | - Claudia Langebrake
- Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Perpétuo C, Plácido AI, Aperta J, Herdeiro MT, Roque F. Profile of Prescription Medication in an Internal Medicine Ward. Healthcare (Basel) 2021; 9:healthcare9060704. [PMID: 34200609 PMCID: PMC8229020 DOI: 10.3390/healthcare9060704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Aging-related loss of resilience associated with the lack of evidence regarding the therapeutic efficacy of medicines can prompt a lack of efficacy of treatments and multiple prescriptions. This work aims to characterize the medication profile of Portuguese older adult inpatients and explore the relationship between hospitalization days and the consumption of medicines. A retrospective data analysis study in older patients who were admitted to a medical internal medicine ward during 2019. The median age of the 616 patients included was 85 years. During the hospitalized period, patients took on average 18.08 medicines. The most prescribed drugs belong to the subgroup of (a) anti-thrombotic agents (6.7%), with enoxaparin being the most prescribed, (b) other analgesics and antipyretics (6.6%), paracetamol being the most frequent, and (c) the Angiotensin Conversion Enzyme Inhibitor (ACE) (6.5%), captopril being the most frequent. The high number of prescriptions in older adults during their hospitalization suggests the need of changing therapeutics to achieve a better efficacy of treatment, which corroborates the hypothesis that the lack of scientific evidence concerning the risk/benefits of many medical therapies in older adults can make it difficult to achieve good clinical outcomes and promote the wastage of health resources.
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Affiliation(s)
- Carla Perpétuo
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal; (C.P.); (J.A.)
- Local Health Unit of Guarda, 6300-035 Guarda, Portugal;
| | - Ana I. Plácido
- Local Health Unit of Guarda, 6300-035 Guarda, Portugal;
- Institute of Biomedicine (iBiMED-UA), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Jorge Aperta
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal; (C.P.); (J.A.)
- Local Health Unit of Guarda, 6300-035 Guarda, Portugal;
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED-UA), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI-IPG), 6300-559 Guarda, Portugal; (C.P.); (J.A.)
- Health Science Research Center (CICS-UBI), University of Beira Interior, 6201-001 Covilhã, Portugal
- Correspondence:
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20
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Krüger C, Schäfer I, van den Bussche H, Bickel H, Fuchs A, Gensichen J, König HH, Maier W, Mergenthal K, Riedel-Heller SG, Schön G, Weyerer S, Wiese B, von Renteln-Kruse W, Langebrake C, Scherer M. Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study. BMJ Open 2021; 11:e044230. [PMID: 33757948 PMCID: PMC7993236 DOI: 10.1136/bmjopen-2020-044230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aims of our study were to examine the anticholinergic drug use and to assess the association between anticholinergic burden and cognitive function in the multimorbid elderly patients of the MultiCare cohort. SETTING MultiCare was conducted as a longitudinal cohort study in primary care, located in eight different study centres in Germany. PARTICIPANTS 3189 patients (59.3% female). PRIMARY AND SECONDARY OUTCOME MEASURES Baseline data were used for the following analyses. Drugs were classified according to the well-established anticholinergic drug scale (ADS) and the recently published German anticholinergic burden (German ACB). Cognitive function was measured using a letter digit substitution test (LDST) and a mixed-effect multivariate linear regression was performed to calculate the influence of anticholinergic burden on the cognitive function. RESULTS Patients used 1764 anticholinergic drugs according to ADS and 2750 anticholinergics according to the German ACB score (prevalence 38.4% and 53.7%, respectively). The mean ADS score was 0.8 (±1.3), and the mean German ACB score was 1.2 (±1.6) per patient. The most common ADS anticholinergic was furosemide (5.8%) and the most common ACB anticholinergic was metformin (13.7%). The majority of the identified anticholinergics were drugs with low anticholinergic potential: 80.2% (ADS) and 73.4% (ACB), respectively. An increasing ADS and German ACB score was associated with reduced cognitive function according to the LDST (-0.26; p=0.008 and -0.24; p=0.003, respectively). CONCLUSION Multimorbid elderly patients are in a high risk for using anticholinergic drugs according to ADS and German ACB score. We especially need to gain greater awareness for the contribution of drugs with low anticholinergic potential from the cardiovascular system. As anticholinergic drug use is associated with reduced cognitive function in multimorbid elderly patients, the importance of rational prescribing and also deprescribing needs to be further evaluated. TRIAL REGISTRATION NUMBER ISRCTN89818205.
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Affiliation(s)
- Caroline Krüger
- Department of Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Angela Fuchs
- Institute of General Practice, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-Universitat Munich, Munich, Germany
- Institut for General Practice, Jena University Hospital, Jena, Germany
| | - Hans-Helmut König
- Department for Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Siegfried Weyerer
- Department of Medical Faculty Mannheim/Heidelberg, Central Institute of Mental Health, Mannheim, Germany
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Wolfgang von Renteln-Kruse
- Department of Research, Albertinen-Haus Zentrum fur Geriatrie und Gerontologie Medizinisch-Geriatrische Klinik, Hamburg, Germany
| | - Claudia Langebrake
- Department of Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021; 12:443-452. [PMID: 33694123 PMCID: PMC8149355 DOI: 10.1007/s41999-021-00479-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. METHODS The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. RESULTS One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. CONCLUSION The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.
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Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Iloanusi S, Mgbere O, Essien EJ. Polypharmacy among COVID-19 patients: A systematic review. J Am Pharm Assoc (2003) 2021; 61:e14-e25. [PMID: 34120855 PMCID: PMC8149164 DOI: 10.1016/j.japh.2021.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Polypharmacy, the concomitant use of 5 or more medications, is highly prevalent among older adults and individuals with multimorbid conditions and has been linked to suboptimal clinical outcomes in various diseases. However, little is known about the impact of polypharmacy on clinical outcomes among coronavirus disease 2019 (COVID-19) patients. OBJECTIVE This systematic review summarizes the available literature on the association between polypharmacy and specific drug classes, and clinical outcomes among COVID-19 patients. METHODS We conducted an electronic database search on Embase, Medline, Cochrane, Scopus, Google Scholar, clinicaltrials.gov, LITCOVID, PubMed, PubMed Central (PMC), and China national knowledge infrastructure for studies on Polypharmacy among COVID-19 patients using relevant combinations of the keywords. Only studies published between November 2019 to September 2020 were included. Seven articles out of 1502 unique articles met the inclusion criteria and were used for the current study. We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in conducting and reporting this systematic review. RESULTS The total sample size of all studies was 474,342, out of which 10,519 patients were COVID-19 positive, and 4818 COVID-19 positive patients experienced polypharmacy. Five out of the 7 included studies found associations between polypharmacy and negative clinical outcomes among COVID-19 patients. Polypharmacy was associated with increase in the relative risk of a positive COVID-19 test result (P < 0.01), death among male COVID-19 patients (P < 0.001), increase in the rate of acute kidney injury (P = 0.003), and adverse drug reactions (P < 0.001). Antipsychotic drugs were associated with severe COVID-19 morbidity (OR = 2.79; 95% CI 2.23-3.49) and increased risk of death among COVID-19 infected men (OR = 1.71; 95% CI 1.18-2.48) and women (OR = 1.96; 95% CI 1.41-2.73). CONCLUSION Polypharmacy and selected drug classes are associated with increased risk of adverse clinical outcomes among COVID-19 patients. Understanding these relationships can enhance risk stratification and evidence-based decision-making that may improve care and clinical outcomes of COVID-19 patients.
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Affiliation(s)
- Sorochi Iloanusi
- Correspondence: Sorochi Iloanusi, BPharm, Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun, HSB2, Room-4059, Houston ,TX 77204-504
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Ali T, Boateng GO, Medeiros AP, Raj M. 11. Caregiving. HEALTHY AGING THROUGH THE SOCIAL DETERMINANTS OF HEALTH 2021. [DOI: 10.2105/9780875533162ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Aches and Pain in the Geriatric Trauma Patient. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00202-w] [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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