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O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. Response to letter by Masse O et al. STOPP/START version 3: clinical pharmacists are raising alarms. Eur Geriatr Med 2024; 15:593-596. [PMID: 38416400 DOI: 10.1007/s41999-024-00958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Denis O'Mahony
- Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland.
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Geriatric Center, Ulm/Alb-Donau, Germany
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de santé et des pratiques médicales, 59000, Lille, France
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gülistan Bahat
- Department of Internal Medicine (Division of Geriatrics), Istanbul University, Istanbul, Turkey
| | - Nathalie van der Velde
- Section of Geriatric Medicine and Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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Bienfait A, Lagreula J, Blum MR, Rodondi N, Sallevelt BTGM, Knol W, O'Mahony D, Spinewine A, Boland B, Dalleur O. Antipsychotic prescribing and drug-related readmissions in multimorbid older inpatients: a post-hoc analysis of the OPERAM population. Int J Clin Pharm 2024:10.1007/s11096-024-01700-6. [PMID: 38367103 DOI: 10.1007/s11096-024-01700-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/01/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Limited data are available on characteristics associated with antipsychotic use in multimorbid older adults. AIM Primary: to identify patient characteristics associated with antipsychotic prescribing in a multimorbid population of older inpatients with polypharmacy. Secondary: (1) to observe if antipsychotics use during an index hospitalisation was associated with a drug related admission (DRA) within one year, and (2) to describe these cases of antipsychotic-related readmissions. METHOD This was a secondary analysis of the OPERAM randomized controlled trial. Multivariate analysis assessed the association between characteristics and comorbidities with antipsychotic use. An expert team assessed DRA occurring during the one-year follow-up. RESULTS Antipsychotics were prescribed to 5.5% (n = 110) patients upon admission while 7.7% (n = 154) inpatients received antipsychotics at any time (i.e. upon admission, during hospitalisation, and/or at discharge). The most frequently prescribed antipsychotics were quetiapine (n = 152), haloperidol (n = 48) and risperidone (n = 22). Antipsychotic prescribing was associated with dementia (OR = 3.7 95%CI[2.2;6.2]), psychosis (OR = 26.2 [7.4;92.8]), delirium (OR = 6.4 [3.8;10.8]), mood disorders (OR = 2.6 [1.6;4.1]), ≥ 15 drugs a day (OR = 1.7 [1.1;2.6]), functional dependency (Activities of Daily Living score < 50/100) (OR = 3.9 [2.5;6.1]) and < 2 units of alcohol per week (OR = 2.2 [1.4;3.6]). DRA occurred in 458 patients (22.8%) within one year. Antipsychotic prescribing at any time was not associated with DRA (OR = 1.0 [0.3;3.9]) however contributed to 8 DRAs, including 3 falls. CONCLUSION In this European multimorbid polymedicated older inpatients, antipsychotics were infrequently prescribed, most often at low dosage. Besides neuro-psychiatric symptoms, risk factors for inhospital antipsychotic prescribing were lower functional status and polymedication.
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Affiliation(s)
- A Bienfait
- Pharmacy Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.
| | - J Lagreula
- Clinical Pharmacy Research Group-Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - M R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - N Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - B T G M Sallevelt
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Knol
- Geriatric Department, University Medical Center, Utrecht, The Netherlands
| | - D O'Mahony
- Geriatric Department, Cork University Hospital, Cork, Ireland
| | - A Spinewine
- Clinical Pharmacy Research Group-Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
- Pharmacy Department, Centre Hospitalier Universitaire UCL-Namur, Université catholique de Louvain, Namur, Belgium
| | - B Boland
- Geriatric Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - O Dalleur
- Pharmacy Department, Cliniques Universitaires Saint Luc, Brussels, Belgium
- Clinical Pharmacy Research Group-Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
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Chinmayee A, Subbarayan S, Myint PK, Cherubini A, Cruz-Jentoft AJ, Petrovic M, Gudmundsson A, Byrne S, O'Mahony D, Soiza RL. Diabetes mellitus increases risk of adverse drug reactions and death in hospitalised older people: the SENATOR trial. Eur Geriatr Med 2024; 15:189-199. [PMID: 38127206 PMCID: PMC10876722 DOI: 10.1007/s41999-023-00903-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Adverse drug reactions (ADRs) are a major cause of morbidity and mortality, especially in older people. Older people with diabetes mellitus may be at especially high risk of ADRs but this risk has not been well studied. This study aimed to compare severity and type of ADRs in hospitalised, multimorbid older people with and without diabetes and secondly to assess the impact of ADRs on mortality, rehospitalisation and length of stay. METHODS Participants in the SENATOR (Software Engine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons) trial were assessed for 12 common and 'other' prevalent and incident adverse drug reactions using a blinded end-point adjudication process. Descriptive analyses, logistic regression and mediation analyses were undertaken. RESULTS Of 1537 people in the SENATOR trial, 540 (35.1%) had diabetes mellitus (mean age 77.4 ± 7.3 years, 58.5% male). In the total population, 773 prevalent and 828 incident ADRs were reported. Both prevalent and incident symptomatic hypoglycaemia and incident acute kidney injury (AKI) were significantly more common in people with diabetes (p < 0.05). Patients with diabetes had higher all-cause mortality at 12 weeks than those without (9.1% vs 6.3%, p = 0.04). Mediation analysis revealed that mortality was significantly higher (OR = 1.43, Sobel test p = 0.048) in people with diabetes and ADRs causing AKI. CONCLUSIONS Older multimorbid people with diabetes presenting to hospital with acute illness have significantly more ADRs than those without, and a significantly higher mortality that is mediated by medication-associated AKI and poorer renal function.
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Affiliation(s)
- Anagha Chinmayee
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Selvarani Subbarayan
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, UK
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
| | - Roy L Soiza
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, UK.
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Snijders BMG, Kempen TGH, Aubert CE, Koek HL, Dalleur O, Donzé J, Rodondi N, O'Mahony D, Gillespie U, Knol W. Drug-related readmissions in older hospitalized adults: External validation and updating of OPERAM DRA prediction tool. J Am Geriatr Soc 2023; 71:3848-3856. [PMID: 37615214 DOI: 10.1111/jgs.18575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Drug-related readmissions (DRAs) are defined as rehospitalizations with an adverse drug event as their main or significant contributory cause. DRAs represent a major adverse health burden for older patients. A prediction model which identified older hospitalized patients at high risk of a DRA <1 year was previously developed using the OPERAM trial cohort, a European cluster randomized controlled trial including older hospitalized patients with multimorbidity and polypharmacy. This study has performed external validation and updated the prediction model consequently. METHODS The MedBridge trial cohort (a multicenter cluster randomized crossover trial performed in Sweden) was used as a validation cohort. It consisted of 2516 hospitalized patients aged ≥65 years. Model performance was assessed by: (1) discriminative power, assessed by the C-statistic with a 95% confidence interval (CI); (2) calibration, assessed by visual examination of the calibration plot and use of the Hosmer-Lemeshow goodness-of-fit test; and (3) overall accuracy, assessed by the scaled Brier score. Several updating methods were carried out to improve model performance. RESULTS In total, 2516 older patients were included in the validation cohort, of whom 582 (23.1%) experienced a DRA <1 year. In the validation cohort, the original model showed a good overall accuracy (scaled Brier score 0.03), but discrimination was moderate (C-statistic 0.62 [95% CI 0.59-0.64]), and calibration showed underestimation of risks. In the final updated model, the predictor "cirrhosis with portal hypertension" was removed and "polypharmacy" was added. This improved the model's discriminative capability to a C-statistic of 0.64 (95% CI 0.59-0.70) and enhanced calibration plots. Overall accuracy remained good. CONCLUSIONS The updated OPERAM DRA prediction model may be a useful tool in clinical practice to estimate the risk of DRAs in older hospitalized patients subsequent to discharge. Our efforts lay the groundwork for the future development of models with even better performance.
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Affiliation(s)
- Birgitta M G Snijders
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Thomas G H Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
- Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jacques Donzé
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Internal Medicine, Neuchatel Hospital Network, Neuchâtel, Switzerland
- Division of internal medicine, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Ulrika Gillespie
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Hospital Pharmacy Department, Uppsala University, Uppsala, Sweden
| | - Wilma Knol
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. Authors' response to points raised by Boland et al. regarding STOPP/START version 3 criteria. Eur Geriatr Med 2023; 14:1151-1154. [PMID: 37819545 DOI: 10.1007/s41999-023-00875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Denis O'Mahony
- Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland.
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Geriatric Center, Ulm/Alb-Donau, Germany
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gülistan Bahat
- Department of Internal Medicine (Division of Geriatrics), Istanbul University, Istanbul, Turkey
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine & Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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McGettigan S, Nolan Y, Ghosh S, O'Mahony D. The emerging role of blood biomarkers in diagnosis and treatment of Alzheimer's disease. Eur Geriatr Med 2023; 14:913-917. [PMID: 37648817 DOI: 10.1007/s41999-023-00847-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
| | - Yvonne Nolan
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
| | - Subrata Ghosh
- Department of Medicine, University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland.
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Baretella O, Alwan H, Feller M, Aubert CE, Del Giovane C, Papazoglou D, Christiaens A, Meinders AJ, Byrne S, Kearney PM, O'Mahony D, Knol W, Boland B, Gencer B, Aujesky D, Rodondi N. Overtreatment and associated risk factors among multimorbid older patients with diabetes. J Am Geriatr Soc 2023; 71:2893-2901. [PMID: 37286338 DOI: 10.1111/jgs.18465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose-lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA1c ) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors. METHODS In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA1c < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age- and sex-adjusted analyses. RESULTS Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21-1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03-1.46 for 1-2 visits, and PR 1.35, 1.19-1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses. CONCLUSIONS In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non-GP healthcare contacts.
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Affiliation(s)
- Oliver Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Heba Alwan
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Carole E Aubert
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Dimitrios Papazoglou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Antoine Christiaens
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
- Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
| | - Arend-Jan Meinders
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Stephen Byrne
- School of Pharmacy, University College Cork - National University of Ireland, Cork, Republic of Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Republic of Ireland
- Department of Medicine Cork, University College Cork - National University of Ireland, Cork, Republic of Ireland
| | - Denis O'Mahony
- Department of Medicine Cork, University College Cork - National University of Ireland, Cork, Republic of Ireland
- Department of Geriatric Medicine Cork, Cork University Hospital Group, Cork, Republic of Ireland
| | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Benoît Boland
- Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
- Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Baris Gencer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Service de cardiologie, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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8
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O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. Correction: STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 2023; 14:633. [PMID: 37326916 PMCID: PMC10447589 DOI: 10.1007/s41999-023-00812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Denis O'Mahony
- Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland.
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Geriatric Center, Alb-Donau, Ulm, Germany
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Nathalie van der Velde
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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9
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O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 2023; 14:625-632. [PMID: 37256475 PMCID: PMC10447584 DOI: 10.1007/s41999-023-00777-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/31/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs-STOPP criteria) and potential prescribing omissions (PPOs-START criteria). The previous two versions of STOPP/START criteria were published in 2008 and 2015. The present study describes the revised and updated third version of the criteria. METHODS A detailed system-by-system review of the published literature from April 2014 to March 2022 was undertaken with the aim of including clinically important new explicit PIM and PPO criteria and removing any criteria considered to be no longer correct or outdated. A panel of 11 academic physicians with recognized expertise in geriatric pharmacotherapy from 8 European countries participated in a Delphi panel with the task of validating the draft criteria. The panel was presented with the draft new criteria using the SurveyMonkey® on-line platform in which panelists were asked to indicate their level of agreement on a five-point Likert scale. RESULTS Two hundred and four evidence-based draft criteria (one hundred and forty-five STOPP criteria, fifty-nine START criteria) were presented to panelists for assessment using the Delphi validation method. Over the course of four rounds of Delphi validation, the panel achieved consensus on 133 STOPP criteria and 57 START criteria, i.e., 190 STOPP/START criteria in total representing a 66.7% increase in the number of criteria compared to STOPP/START version 2 published in 2015. CONCLUSION A fully revised and updated version of STOPP/START criteria has been validated by a European expert panel using the Delphi consensus process.
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Affiliation(s)
- Denis O'Mahony
- Department of Medicine (Geriatric Medicine), School of Medicine, University College Cork, Cork, Ireland.
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Geriatric Center, Alb-Donau, Ulm, Germany
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Nathalie van der Velde
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
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McGettigan S, Curtin D, O'Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: uptake and clinical impact. Expert Rev Clin Pharmacol 2023; 16:1175-1185. [PMID: 37947757 DOI: 10.1080/17512433.2023.2280219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION STOPP/START criteria for potentially inappropriate medications (PIMs, STOPP) and potential prescribing omissions (PPOs, START) have gained considerable interest and traction since they were first published in 2008. This review focuses on their uptake and impact in various clinical settings. AREAS COVERED STOPP/START criteria, now in their third iteration, are explicit criteria designed to facilitate detection of common and clinically important PIMs and PPOs during routine medication review in any clinical setting. We examine the influence of the criteria, particularly in clinical trials that focused on their impact on clinically relevant endpoints. EXPERT OPINION STOPP/START criteria are widely used in several countries within Europe and beyond for medication review and audit. As a discreet intervention, the criteria have been tested in several single-center and two large-scale multi-center clinical trials. The single-center trials indicate that STOPP/START criteria reduce polypharmacy, inappropriate prescribing, ADRs (adverse drug reactions), medication cost and falls. In contrast, the SENATOR and OPERAM multicentre trials did not demonstrate significant reduction in ADRs, all-cause mortality, drug-related hospital readmissions, nor any improvement in quality-of-life. Further clinical trials are required to examine whether STOPP/START criteria as an intervention can deliver significant clinical benefit in a reproducible manner in various clinical settings.
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Affiliation(s)
| | - Denis Curtin
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
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11
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Sibille FX, de Saint-Hubert M, Henrard S, Aubert CE, Goto NA, Jennings E, Dalleur O, Rodondi N, Knol W, O'Mahony D, Schwenkglenks M, Spinewine A. Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial. Drugs Aging 2023; 40:551-561. [PMID: 37221407 DOI: 10.1007/s40266-023-01029-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Benzodiazepine receptor agonists (BZRAs) are commonly prescribed in older adults despite an unfavorable risk-benefit ratio. Hospitalizations may provide a unique opportunity to initiate BZRA cessation, yet little is known about cessation during and after hospitalization. We aimed to measure the prevalence of BZRA use before hospitalization and the rate of cessation 6 months later, and to identify factors associated with these outcomes. METHODS We conducted a secondary analysis of a cluster randomized controlled trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly [OPERAM]), comparing usual care and in-hospital pharmacotherapy optimization in adults aged 70 years or over with multimorbidity and polypharmacy in four European countries. BZRA cessation was defined as taking one or more BZRA before hospitalization and not taking any BZRA at the 6-month follow-up. Multivariable logistic regression was performed to identify factors associated with BZRA use before hospitalization and with cessation at 6 months. RESULTS Among 1601 participants with complete 6-month follow-up data, 378 (23.6%) were BZRA users before hospitalization. Female sex (odds ratio [OR] 1.52 [95% confidence interval 1.18-1.96]), a higher reported level of depression/anxiety (OR up to 2.45 [1.54-3.89]), a higher number of daily drugs (OR 1.08 [1.05-1.12]), use of an antidepressant (OR 1.74 [1.31-2.31]) or an antiepileptic (OR 1.46 [1.02-2.07]), and trial site were associated with BZRA use. Diabetes mellitus (OR 0.60 [0.44-0.80]) was associated with a lower probability of BZRA use. BZRA cessation occurred in 86 BZRA users (22.8%). Antidepressant use (OR 1.74 [1.06-2.86]) and a history of falling in the previous 12 months (OR 1.75 [1.10-2.78]) were associated with higher BZRA cessation, and chronic obstructive pulmonary disease (COPD) (OR 0.45 [0.20-0.91]) with lower BZRA cessation. CONCLUSION BZRA prevalence was high among included multimorbid older adults, and BZRA cessation occurred in almost a quarter of them within 6 months after hospitalization. Targeted BZRA deprescribing programs could further enhance cessation. Specific attention is needed for females, central nervous system-acting co-medication, and COPD co-morbidity. REGISTRATION ClinicalTrials.gov identifier: NCT02986425. December 8, 2016.
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Affiliation(s)
- François-Xavier Sibille
- Department of Geriatric Medicine, CHU UCL Namur, Avenue Dr Gaston Therasse, 1, 5530, Yvoir, Belgium.
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.
| | - Marie de Saint-Hubert
- Department of Geriatric Medicine, CHU UCL Namur, Avenue Dr Gaston Therasse, 1, 5530, Yvoir, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Carole Elodie Aubert
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Namiko Anna Goto
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emma Jennings
- Department of Medicine, School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
- Department of Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine, School of Medicine, University College Cork, Cork, Republic of Ireland
| | | | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
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12
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Daunt R, Curtin D, O'Mahony D. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. Lancet Healthy Longev 2023; 4:e228-e235. [PMID: 37030320 DOI: 10.1016/s2666-7568(23)00036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 04/10/2023] Open
Abstract
With growing global concern regarding medication-related harm, WHO launched a global patient safety challenge, Medication Without Harm, in March, 2017. Multimorbidity, polypharmacy, and fragmented health care (ie, patients attending appointments with multiple physicians in various health-care settings) are key drivers of medication-related harm, which can result in negative functional outcomes, high rates of hospitalisation, and excess morbidity and mortality, particularly in patients with frailty older than 75 years. Some studies have examined the effect of medication stewardship interventions in older patient cohorts, but focused on a narrow spectrum of potentially adverse medication practices, with mixed results. In response to the WHO challenge, we propose the novel concept of broad-spectrum polypharmacy stewardship, a coordinated intervention designed to improve the management of multimorbidities, taking into account potentially inappropriate medications, potential prescribing omissions, drug-drug and drug-disease interactions, and prescribing cascades, aligning treatment regimens with the condition, prognosis, and preferences of the individual patient. Although the safety and efficacy of polypharmacy stewardship need to be tested with well designed clinical trials, we propose that this approach could minimise medication-related harm in older people with multimorbidities exposed to polypharmacy.
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Affiliation(s)
- Ruth Daunt
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis Curtin
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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13
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O'Mahony D, Power SP, Power DG. Human epidermal growth factor receptor 2-positive metastatic gastric cancer in complete sustained remission with trastuzumab. Lancet 2023; 401:772. [PMID: 36870727 DOI: 10.1016/s0140-6736(23)00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland; Department of Medicine, University College Cork, Cork, Ireland.
| | - Stephen P Power
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital, Wilton, Cork, Ireland
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14
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L Gleeson L, O'Brien GL, O'Mahony D, Byrne S. Interprofessional communication in the hospital setting : a systematic review of the qualitative literature. J Interprof Care 2023; 37:203-213. [PMID: 35109753 DOI: 10.1080/13561820.2022.2028746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Communication plays a key role in the provision of safe patient care, and miscommunication in healthcare can lead to avoidable patient harm or mortality. Interprofessional communication (IPCom) can be challenging due to differences in training, education and roles between healthcare professions. The aim of this systematic review was to synthesize the qualitative evidence regarding healthcare providers' perceptions of interprofessional communication in the hospital setting. Four databases (PubMed, CINAHL, Web of Science, and Embase) were searched for studies that met the inclusion criteria. Eighteen studies were identified as suitable for inclusion in the review and were examined using thematic synthesis. Thematic synthesis led to the development of five descriptive themes: 1) 'Hierarchy", 2) "Interprofessional Ethos," 3) "Healthcare Environment," 4) "Personal Factors" and 5) "Methods of Communication," and two overarching analytical themes: "Barriers to Communication" and "Facilitators to Communication." Personal factors, such as strong interprofessional relationships, were found to be important facilitators to IPCom, while organizational factors, such as challenging and hierarchical working environments, were found to pose barriers to IPCom.
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Affiliation(s)
- Laura L Gleeson
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - G L O'Brien
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - D O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, School of Medicine, University College Cork, Cork, Ireland
| | - S Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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15
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Gleeson L, McNamara J, Donworth E, Crowley E, Delaney A, Sahm L, O'Mahony D, Russell N, Byrne S. Healthcare provider perceptions of safety culture: A multi-site study using the safety attitudes questionnaire. Explor Res Clin Soc Pharm 2023; 9:100228. [PMID: 36793798 PMCID: PMC9922969 DOI: 10.1016/j.rcsop.2023.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Introduction Patient safety culture, the way in which members of a healthcare organisation think about and prioritise safety, has been linked to positive patient outcomes. The aim of this study was to use the Safety Attitudes Questionnaire (SAQ) to measure the safety culture in a variety of healthcare settings located in the province of Munster of Ireland. Methods The SAQ was applied in six healthcare settings in the Munster province of Ireland between December 2017 and November 2019. The attitudes of healthcare staff towards six domains of safety culture were assessed over 32 Likert-scaled items. The mean, median, interquartile range and percent positive scores for each domain were calculated for the study population, and subgroup analyses were carried out between study sites and professions. Results for each setting were compared to international benchmarking data. Chi-Squared tests were used to determine whether study site or profession were related to domain scores. Reliability analysis was carried out using Cronbach's alpha. Results Study participants (n = 1749) comprising doctors, pharmacists, nurses, and healthcare assistants, were found to have positive attitudes towards patient safety culture but scored poorly in the domains Working Conditions and Perceptions of Management. Perceptions of safety culture were more positive in smaller healthcare settings, and amongst nurses and HCAs. The survey had acceptable internal consistency. Conclusions In this study investigating the safety culture of healthcare organisations in Ireland, study participants had generally positive attitudes towards the safety culture in their organisation, however working conditions, perceptions of management, and medication incident reporting were identified as key areas for improvement.
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Affiliation(s)
- L.L. Gleeson
- School of Pharmacy, University College Cork, Ireland,Corresponding author.
| | - J. McNamara
- School of Pharmacy, University College Cork, Ireland
| | - E. Donworth
- School of Pharmacy, University College Cork, Ireland
| | - E.K. Crowley
- School of Pharmacy, University College Cork, Ireland
| | | | - L. Sahm
- School of Pharmacy, University College Cork, Ireland
| | | | | | - S. Byrne
- School of Pharmacy, University College Cork, Ireland
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Aubert CE, Blum MR, Gastens V, Dalleur O, Vaillant F, Jennings E, Aujesky D, Thompson W, Kool T, Kramers C, Knol W, O'Mahony D, Rodondi N. Prescribing, deprescribing and potential adverse effects of proton pump inhibitors in older patients with multimorbidity: an observational study. CMAJ Open 2023; 11:E170-E178. [PMID: 36854455 PMCID: PMC9981164 DOI: 10.9778/cmajo.20210240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) contribute to polypharmacy and are associated with adverse effects. As prospective data on longitudinal patterns of PPI prescribing in older patients with multimorbidity are lacking, we sought to assess patterns of PPI prescribing and deprescribing, as well as the association of PPI use with hospital admissions over 1 year in this population. METHODS We conducted a prospective, longitudinal cohort study using data from the Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM) trial, a randomized controlled trial testing an intervention to reduce inappropriate prescribing (2016-2018). This trial included adults aged 70 years and older with at least 3 chronic conditions and prescribed at least 5 chronic medications. We assessed prevalence of PPI use at time of hospital admission, and new prescriptions and deprescribing at discharge, and at 2 months and 1 year after discharge, by intervention group. We used a regression with competing risk for death to assess the association of PPI use with readmissions related to their potential adverse effects, and all-cause readmission. RESULTS Overall, 1080 (57.4%) of 1879 patients (mean age 79 yr) had PPI prescriptions at admission, including 496 (45.9%) patients with a potentially inappropriate indication. At discharge, 133 (24.9%) of 534 patients in the intervention group and 92 (16.8%) of 546 patients in the control group who were using PPIs at admission had deprescribing. Among 680 patients who were not using PPIs at discharge, 47 (14.6%) of 321 patients in the intervention group and 40 (11.1%) of 359 patients in the control group had a PPI started within 2 months. Use of PPIs was associated with all-cause readmission (n = 770, subdistribution hazard ratio 1.31, 95% confidence interval 1.12-1.53). INTERPRETATION Potentially inappropriate use of PPI, new PPI prescriptions and PPI deprescribing were frequent among older adults with multimorbidity and polypharmacy. These data suggest that persistent PPI use may be associated with clinically important adverse effects in this population.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Manuel R Blum
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Viktoria Gastens
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Olivia Dalleur
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Fanny Vaillant
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Emma Jennings
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Drahomir Aujesky
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Wade Thompson
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Tijn Kool
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Cornelius Kramers
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Wilma Knol
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Denis O'Mahony
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Nicolas Rodondi
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
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17
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Randles M, Gallagher P, O'Mahony D. 241 STOPPCASCADE: DEVELOPMENT OF A NOVEL EXPLICIT SCREENING TOOL FOR POTENTIALLY CLINICALLY RELEVANT PRESCRIBING CASCADES IN OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Prescribing cascades represent an important, often underrecognized, element of problematic polypharmacy. Cascades occur when an Adverse Drug Event (ADE) is misinterpreted as a new medical condition, with the subsequent prescription of another, potentially inappropriate drug. Our objective was to develop and validate an explicit list of potentially clinically relevant prescribing cascades in older adults to facilitate the detection of more common and clinically important prescribing cascades and assist clinicians in medication review.
Methods
A structured literature search of PubMed, Cinahl and Google Scholar was undertaken. Search terms included Prescribing Cascades OR Cascades OR Cascade AND Older Adults OR Adults Over 65 OR Older People OR Gero* OR Geri*. We included adults aged ≥65 including studies in all settings i.e. community, hospital and residential care. We included all study designs including reviews, experimental and observational studies, case series and case reports. We also included published abstracts from scientific meetings in the literature search. Studies that didn’t include prescribing cascades in the abstract, studies with no access to full text article or English version of article and studies exclusively describing patients aged ≤65 were excluded. A physiological systems-based short-list was compiled with Anatomical Therapeutic Chemical codes identifying the initial prescribed drug (Drug A). Three assessment panellists (academic geriatricians) were asked to evaluate each individual published cascade and the accompanying evidence using a 5-point Likert scale to evaluate each cascade for inclusion/exclusion in the list. Potential cascades scored Likert 4 or 5 by 2 or 3 of the panellists were included in the final list.
Results
131 potential cascades were reviewed by the panel, 71 individual cascades were accepted, involving 41 drugs/drug classes.
Conclusion
The STOPPCascade list comprises 71 potentially important prescribing cascades in older adults. This novel explicit list is designed to identify potential prescribing cascades and to facilitate appropriate deprescribing.
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Affiliation(s)
- M Randles
- Cork University Hospital Department Of Geriatric Medicine, , Cork, Ireland
- University College Cork , Cork, Ireland
| | - P Gallagher
- Bon Secours Hospital Department Of Geriatric Medicine, , Cork, Ireland
- University College Cork , Cork, Ireland
| | - D O'Mahony
- Cork University Hospital Department Of Geriatric Medicine, , Cork, Ireland
- University College Cork , Cork, Ireland
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18
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Monahan J, O'Mahony D, Curtin D. 28 DRUG-DRUG INTERACTIONS IN OLDER HOSPITALISED PATIENTS: A PROSPECTIVE PREVALENCE STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Drug-Drug Interactions (DDIs) are common in older adults and are associated with increased risk of adverse drug events and hospitalisation. Older adults are particularly susceptible to DDIs due to multimorbidity, polypharmacy and age-related changes in pharmacokinetics. A recently published standardised list of 66 potentially significant DDIs specifically relevant to adults aged ≥ 65 years has been validated by an expert consensus group. The aim of the present study was to prospectively assess the prevalence of DDIs in multimorbid older patients with polypharmacy at the point of unscheduled acute hospital admission, using this 66-item DDI list.
Methods
77 unselected consecutive patients aged ≥65 years with ≥3 comorbidities and prescribed ≥5 daily regular medications were included. Medication reconciliations were conducted within 48 hours of admission. Medications were confirmed with two or more sources: the patient, their carer, the general practitioner, or the community pharmacist. Drug prescriptions reflecting pre-admission medication lists were manually screened for DDIs according to the 66-item DDI list.
Results
47 participants (61.04%) had ≥1 listed DDI. The most commonly identified DDI was concomitant use of ≥3 centrally-acting neuropsychiatric drugs (n=18, 23.28%), which increases the risk of falls and impaired cognition. A highly significant correlation was found between the number of daily medications and the number of DDIs experienced (Spearman’s ρ=0.512, P<0.001). No statistically significant relationship was found between the number of comorbidities and the number of DDIs (Spearman’s ρ=0.194, P=0.107). No significant differences were detected in the number of DDIs, medications or comorbidities between men and women (P=0.818, P=0.428, P=0.281, respectively).
Conclusion
The majority (61%) of participants had at least one clinically significant DDI. Given the high prevalence of DDIs in this rapidly growing patient population, frequent review and rationalisation of medications using the 66-item DDI list is indicated to minimize DDIs and enhance medication safety.
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Affiliation(s)
- J Monahan
- University College Cork , Cork, Ireland
| | - D O'Mahony
- University College Cork , Cork, Ireland
- Cork University Hospital , Cork, Ireland
| | - D Curtin
- Cork University Hospital , Cork, Ireland
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19
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Randles M, Gannon E, Gallagher P, O'Mahony D. 242 FALLS-RISK INCREASING DRUGS AND FRAILTY IN OLDER ADULTS EXPERIENCING FALLS: A PROSPECTIVE OBSERVATIONAL STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of falls, a leading cause of injury and injury-related mortality. One of the more prominent extrinsic risk factors for falls in older adults is the use of Falls-Risk Increasing Drugs (FRIDS). This study aims to examine the relationship between measured frailty and FRIDS in older people who have experienced a fall in the previous 12 months.
Methods
A prospective observational study was undertaken. Inclusion criteria were age ≥ 65 years and a history of falling in the preceding 12 months. Exclusion criteria were age <65 years of age, inability to provide informed consent or participation declined. Medical chart and drugs Kardex review was carried out, followed by a short interview with the patient using a standardised data collection proforma. Frailty was measured using the Clinical Frailty Scale (CFS) and the point-prevalence of FRIDS was established using the STOPPFall screening tool.
Results
Results are presented for the first 100 participants: The mean (±standard deviation [SD]) age of study participants was 82.1 (±6.2), 63% were female. The prevalence of frailty measured using the CFS was 60% (CFS ≥5). The median number of falls in the previous 12 months was 3 (IQR 3). 82% of people who had fallen in the previous 12 months had ≥1 STOPPFall FRID. The difference between number of FRIDs in Frail vs Non-Frail people was not statistically significant.
Conclusion
Prescription of FRIDS was detected in over 4 out 5 older fallers. Structured medication review using the STOPPFall screening tool for older adults at risk of falls is one useful and easy way of detecting FRIDS with a view to deprescription. Measured frailty does not appear to increase the prevalence of FRIDS in older fallers.
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Affiliation(s)
- M Randles
- Cork University Hospital Department of Geriatric Medicine, , Cork, Ireland
- University College Cork , Cork, Ireland
| | - E Gannon
- Cork University Hospital Department of Geriatric Medicine, , Cork, Ireland
| | - P Gallagher
- University College Cork , Cork, Ireland
- Bon Secours Hospital Department of Geriatric Medicine, , Cork, Ireland
| | - D O'Mahony
- Cork University Hospital Department of Geriatric Medicine, , Cork, Ireland
- University College Cork , Cork, Ireland
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20
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Chawla N, O'Mahony D. 33 PREVALENCE OF FALLS RISK-INCREASING DRUGS (FRIDS) DEFINED BY STOPPFALL CRITERIA AMONG MULTI-MORBID OLDER PATIENTS PRESENTING TO HOSPITAL WITH FALLS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Several drug classes e.g. antidepressants, hypnotics significantly the risk of falls in older people. As an intervention in several studies, withdrawal of Falls Risk-Increasing Drugs (FRIDs) has led to a significantly decreased incidence of falls and injuries in older people. Recently, an explicit deprescribing tool focusing on FRIDs known as STOPPFall (Screening Tool of Older Persons Prescriptions with high Fall risk) has been validated. STOPPFall consists of 14 drug classes, most of which are psychotropics, known to increase falls risk in older people. There are no prospective studies of STOPPFall-defined prevalence of FRIDs in the literature.
Methods
We undertook a prospective study of 200 consecutively enrolled patients aged ≥65 years (mean age ± SD: 80.9±7.4 years) presenting with falls to the emergency department and Geriatric Medicine OPD clinics between August 2021 to February 2022. We screened for STOPPFall criteria FRIDs in this cohort with additional data collected to define age, sex and comorbidity status.
Results
STOPPFall FRIDs were detected in 59.5% of this cohort which was predominantly female (68%). Comparison of falls incidence between the youngest subgroup (65-74 years) and the oldest subgroup (>85 years) showed that patients aged >85 years fell repeatedly (i.e. ≥ 2 falls in the previous year) more than younger fallers (35.5% vs 21%). Of the 14 drug classes in STOPPFall criteria, antidepressants were the most prevalent FRID category (24%), followed by diuretics (17%). There was a significant positive correlation between the number of reported falls and the number of STOPPFall FRIDs prescribed (R=0.17; p=.016). Almost two-thirds of fallers were prescribed two or more STOPPFall drugs.
Conclusion
STOPPFall medications are highly prevalent among older people presenting to hospital with falls. STOPPFall represents an important tool for attending doctors to identify and deprescribe medications contributing to falls in older people.
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Affiliation(s)
- N Chawla
- University College Cork , Cork, Ireland
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21
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McCarthy LM, Savage R, Dalton K, Mason R, Li J, Lawson A, Wu W, Sternberg SA, Byrne S, Petrovic M, Onder G, Cherubini A, O'Mahony D, Gurwitz JH, Pegreffi F, Rochon PA. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging 2022; 39:829-840. [PMID: 36107399 PMCID: PMC9477172 DOI: 10.1007/s40266-022-00964-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Prescribing cascades occur when a drug is prescribed to manage side effects of another drug, typically when a side effect is misinterpreted as a new condition. A consensus list of clinically important prescribing cascades that adversely affect older persons' health (i.e., where risks of the prescribing cascade usually exceed benefits) was developed to help identify, prevent, and manage prescribing cascades. METHODS Three rounds of a modified Delphi process were conducted with a multidisciplinary panel of 38 clinicians from six countries with expertise in geriatric pharmacotherapy. The clinical importance of 139 prescribing cascades was assessed in Round 1. Cascades highly rated by ≥ 70% of panelists were included in subsequent rounds. Factors influencing ratings in Rounds 1 and 3 were categorized. After three Delphi rounds, highly rated prescribing cascades were reviewed by the study team to determine the final list of clinically important cascades consistent with potentially inappropriate prescribing. RESULTS After three rounds, 13 prescribing cascades were highly rated by panelists. Following a study team review, the final tool includes nine clinically important prescribing cascades consistent with potentially inappropriate prescribing. Panelists reported that their ratings were influenced by many factors (e.g., how commonly they encountered the medications involved and the cascade itself, the severity of side effects, availability of alternatives). The relative importance of these factors in determining clinical importance varied by panelist. CONCLUSIONS A nine-item consensus-based list of clinically important prescribing cascades, representing potentially inappropriate prescribing, was developed. Panelists' decisions about what constituted a clinically important prescribing cascade were multi-factorial. This tool not only raises awareness about these cascades but will also help clinicians recognize these and other important prescribing cascades. This list contributes to the prevention and management of polypharmacy and medication-related harm in older people.
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Affiliation(s)
- Lisa M McCarthy
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
- Leslie Dan Faculty of Pharmacy and Temerty Faculty of Medicine, University of Toronto, 100 Queensway West, Mississauga, Toronto, ON, L5B 1B8, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Rachel Savage
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Robin Mason
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joyce Li
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Andrea Lawson
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Wei Wu
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Cherubini
- Accettazione geriatrica e Centro di Ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), University College Cork, Cork, Ireland
| | - Jerry H Gurwitz
- Division of Geriatric Medicine and Meyers Health Care Institute, U Mass Chan Medical School, Worcester, MA, USA
| | - Francesco Pegreffi
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Paula A Rochon
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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22
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Abstract
Prescribing cascades are increasingly recognized since they were described in the mid-1990s. Cascades are more likely in older people with multimorbidity and associated polypharmacy where multiple medications can induce a variety of side effects that manifest with various non-specific symptoms that may be misidentified as new geriatric syndromes such as falls, dizziness and new-onset incontinence. Geriatricians encounter medication side effects frequently and will usually consider if an older patient presenting with new symptoms could be experiencing an adverse drug reaction or event. However, most medications prescribed to multimorbid older patients are initiated and continued by prescribers without specialist geriatric training who may not detect medication-induced morbidity. Therefore, novel approaches to the detection and management of prescribing cascades in older people are needed. Currently, the knowledge base surrounding prescribing cascades in older people is evolving towards better methods for cascade detection and secondary prevention. However, the large number of cascades described in the literature, the wide-ranging symptomatology of cascades and the rapidly increasing number of multimorbid older people at risk of cascades represent major challenges for prescribers. Furthermore, prospective prevalence studies of prescribing cascades in older people are lacking. To detect and correct prescribing cascades during routine medication review in multimorbid older people, awareness of cascades is essential. Prescribing cascade awareness in turn requires novel explicit ways of defining cascades to facilitate their rapid detection and correction during medication review. Given that prescribing cascades represent another aspect of inappropriate prescribing (IP), explicit cascades criteria should be integrated with other explicit IP criteria.
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Affiliation(s)
- Denis O'Mahony
- Department of Medicine (Geriatrics), University College Cork & Cork University Hospital, T12DC4A Cork, Ireland
| | - Paula A Rochon
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, ON M5S 1B2, Canada.,Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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23
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Randles MA, O'Mahony D, Gallagher PF. Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship? Drugs Aging 2022; 39:597-606. [PMID: 35764865 PMCID: PMC9355920 DOI: 10.1007/s40266-022-00952-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 01/10/2023]
Abstract
Frail older adults commonly experience multiple co-morbid illnesses and other risk factors for potentially inappropriate prescribing. However, determination of frailty varies depending on the frailty instrument used. Older people’s degree of frailty often influences their care and treatment priorities. Research investigating the association between frailty and potentially inappropriate prescribing is hindered by a wide variety of frailty definitions and measurement tools. We undertook a narrative review of selected articles of PubMed and Google Scholar databases. Articles were selected on the basis of relevance to the core themes of frailty and potentially inappropriate prescribing. We identified observational studies that clearly link potentially inappropriate prescribing, potential prescribing omissions, and adverse drug reactions with frailty in older adults. Equally, the literature illustrates that measured frailty in older adults predisposes to inappropriate polypharmacy and associated adverse drug reactions and events. In essence, there is a bi-directional relationship between frailty and potentially inappropriate prescribing, the underlying substrates being multimorbidity and inappropriate polypharmacy. We conclude that there is a need for consensus on rapid and accurate identification of frailty in older people using appropriate and user-friendly methods for routine clinical practice as a means of identifying older multimorbid patients at risk of potentially inappropriate prescribing. Detection of frailty should, we contend, lead to structured screening for inappropriate prescribing in this high-risk population. Of equal importance, detection of potentially inappropriate prescribing in older people should trigger screening for frailty. All clinicians undertaking a medication review of multimorbid patients with associated polypharmacy should take account of the important interaction between frailty and potentially inappropriate prescribing in the interest of minimizing patient harm.
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Affiliation(s)
- Mary A Randles
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland. .,Department of Medicine, University College Cork, Cork, Ireland.
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Paul F Gallagher
- Department of Medicine, University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Bon Secours Hospital, Cork, Ireland
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24
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Ward C, Tsvetanova Z, O'Keane C, O'Mahony D. A case of multiple metastases from a primary renal solitary fibrous tumour; The uncertain long road. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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Thevelin S, Pétein C, Metry B, Adam L, van Herksen A, Murphy K, Knol W, O'Mahony D, Rodondi N, Spinewine A, Dalleur O. Experience of hospital-initiated medication changes in older people with multimorbidity: a multicentre mixed-methods study embedded in the OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial. BMJ Qual Saf 2022; 31:888-898. [PMID: 35351779 DOI: 10.1136/bmjqs-2021-014372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND A patient-centred approach to medicines optimisation is considered essential. The OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial evaluated the effectiveness of medication review with shared decision-making (SDM) in older people with multimorbidity. Beyond evaluating the clinical effectiveness, exploring the patient experience facilitates a better understanding of contextual factors and mechanisms affecting medication review effectiveness. OBJECTIVE To explore experiences of hospital-initiated medication changes in older people with multimorbidity. METHODS We conducted a multicentre mixed-methods study, embedded in the OPERAM trial, combining semi-structured interviews and the Beliefs about Medicines Questionnaire (BMQ) with a purposive sample of 48 patients (70-94 years) from four European countries. Interviews were analysed using the Framework approach. Trial implementation data on SDM were collected and the 9-item SDM questionnaire was conducted with 17 clinicians. RESULTS Patients generally displayed positive attitudes towards medication review, yet emphasised the importance of long-term, trusting relationships such as with their general practitioners for medication review. Many patients reported a lack of information and communication about medication changes and predominantly experienced paternalistic decision-making. Patients' beliefs that 'doctors know best', 'blind trust', having limited opportunities for questions, use of jargon terms by clinicians, 'feeling too ill', dismissive clinicians, etc highlight the powerlessness some patients felt during hospitalisation, all representing barriers to SDM. Conversely, involvement of companions, health literacy, empathetic and trusting patient-doctor relationships, facilitated SDM. Paradoxical to patients' experiential accounts, clinicians reported high levels of SDM. The BMQ showed that most patients had high necessity and low concern beliefs about medicines. Beliefs about medicines, experiencing benefits or harms from medication changes, illness perception, trust and balancing advice between different healthcare professionals all affected acceptance of medication changes. CONCLUSION To meet patients' needs, future medicines optimisation interventions should enhance information exchange, better prepare patients and clinicians for partnership in care and foster collaborative medication reviews across care settings.
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Affiliation(s)
- Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Beatrice Metry
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anniek van Herksen
- Department of Geriatric Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Kevin Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, Cavanagh Pharmacy Building, University College Cork, Cork, Ireland
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital and Department of Medicine, University College Cork, Cork, Ireland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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26
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Huibers CJA, Sallevelt BTGM, Heij JMJO, O'Mahony D, Rodondi N, Dalleur O, van Marum RJ, Egberts ACG, Wilting I, Knol W. Hospital physicians' and older patients' agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting. Eur Geriatr Med 2022; 13:541-552. [PMID: 35291025 PMCID: PMC9151543 DOI: 10.1007/s41999-022-00633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
Aim To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team. Findings In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement (74%) was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors. Message Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid irrelevant recommendations, will likely result in higher adherence with future pharmacotherapy optimisation recommendations. Objective To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START-based medication optimisation recommendations from a pharmacotherapy team. Methods This study was embedded within a large European, multicentre, cluster randomised controlled trial examining the effect of a structured medication review on drug-related hospital admissions in multimorbid (≥ 3 chronic conditions) older people (≥ 70 years) with polypharmacy (≥ 5 chronic medications), called OPERAM. Data from the Dutch intervention arm of this trial were used for this study. Medication review was performed jointly by a physician and pharmacist (i.e. pharmacotherapy team) supported by a Clinical Decision Support System with integrated STOPP/START criteria. Individualised STOPP/START-based medication optimisation recommendations were discussed with patients and attending hospital physicians. Results 139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9–14). In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Factors associated with higher agreement in multivariate analysis were: female gender (+ 17.1% [3.7; 30.4]), ≥ 1 falls in the past year (+ 15.0% [1.5; 28.5]) and renal impairment i.e. eGFR 30–50 ml/min/1.73 m2; (+ 18.0% [2.0; 34.0]). The main reason for disagreement (40%) was patients’ reluctance to discontinue or initiate medication. Conclusion Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid irrelevant recommendations, will likely result in higher adherence with future pharmacotherapy optimisation recommendations. Clinical trial registration Trial Registration Number NCT02986425.
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Affiliation(s)
- C J A Huibers
- Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - B T G M Sallevelt
- Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M J Op Heij
- Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D O'Mahony
- Department of Medicine (Geriatrics), University College Cork and Cork University Hospital, Cork, Ireland
| | - N Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - O Dalleur
- Pharmacy Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Louvain, Belgium.,Louvain Drug Research Institute-Clinical Pharmacy, Université catholique de Louvain, Louvain, Belgium
| | - R J van Marum
- Department of Elderly Care Medicine, Amsterdam, UMC, Location VUmc, Amsterdam, The Netherlands.,Departments of Geriatrics and Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - A C G Egberts
- Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - I Wilting
- Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Knol
- Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands
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Aubert CE, Rodondi N, Terman SW, Feller M, Schneider C, Oberle J, Dalleur O, Knol W, O'Mahony D, Aujesky D, Donzé J. HOSPITAL Score and LACE Index to Predict Mortality in Multimorbid Older Patients. Drugs Aging 2022; 39:223-234. [PMID: 35260994 PMCID: PMC8934762 DOI: 10.1007/s40266-022-00927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/15/2022]
Abstract
Background Estimating life expectancy of older adults informs whether to pursue future investigation and therapy. Several models to predict mortality have been developed but often require data not immediately available during routine clinical care. The HOSPITAL score and the LACE index were previously validated to predict 30-day readmissions but may also help to assess mortality risk. We assessed their performance to predict 1-year and 30-day mortality in hospitalized older multimorbid patients with polypharmacy. Methods We calculated the HOSPITAL score and LACE index in patients from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial (patients aged ≥ 70 years with multimorbidity and polypharmacy, admitted to hospital across four European countries in 2016–2018). Our primary and secondary outcomes were 1-year and 30-day mortality. We assessed the overall accuracy (scaled Brier score, the lower the better), calibration (predicted/observed proportions), and discrimination (C-statistic) of the models. Results Within 1 year, 375/1879 (20.0%) patients had died, including 94 deaths within 30 days. The overall accuracy was good and similar for both models (scaled Brier score 0.01–0.08). The C-statistics were identical for both models (0.69 for 1-year mortality, p = 0.81; 0.66 for 30-day mortality, p = 0.94). Calibration showed well-matching predicted/observed proportions. Conclusion The HOSPITAL score and LACE index showed similar performance to predict 1-year and 30-day mortality in older multimorbid patients with polypharmacy. Their overall accuracy was good, their discrimination low to moderate, and the calibration good. These simple tools may help predict older multimorbid patients’ mortality after hospitalization, which may inform post-hospitalization intensity of care.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Samuel W Terman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jolanda Oberle
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium.,Pharmacy Department, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, Belgium
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), University College Cork, Cork, Munster, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Munster, Ireland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland.,Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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28
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O'Sullivan HM, Conroy M, Power DG, Bambury RM, O'Mahony D, Collins DC, O'Leary MJ, O'Reilly S. Immune Checkpoint Inhibitors and Palliative Care at the End of Life: An Irish Multicentre Retrospective Study. J Palliat Care 2022:8258597221078391. [PMID: 35129002 DOI: 10.1177/08258597221078391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background and Objectives: Immune checkpoint inhibitors (ICIs) have less toxicity than standard chemotherapy and are now standard of care for many patients with advanced cancer. A manageable side effect profile and potential for durable responses may lead to aggressive care of the palliative patient. We sought to evaluate palliative care input and ICI use at the end of life at two Irish cancer centres. Methods: We identified deceased patients who received at least one dose of an ICI between first of January 2013 to 31st of December 2018. A retrospective electronic chart review was performed. Results: The electronic records of 102 patients were analysed. Fifty eight percent were male and the median age of diagnosis of advanced disease was 60 years (range 17-78). Median time from last dose of ICI to death was 57 days (range 8-574) and 20% of patients died within 30 days of last dose of ICI. Most patients, 92%, were referred to palliative care. The median time from palliative care referral to death was 64 days (range 1- 1010). In the last 30 days of life, 39% of patients attended the emergency department (ED) and 46% had at least one hospital admission. Late palliative care referrals, ≤3 months before death, were associated with hospitalisations in the last month of life (64% vs. 36%, P = .02). Timing of palliative care referral did not affect ICI prescribing at the end of life (P = 0.38). ICI use in the last 30 days of life was not associated with increased ED presentations or hospitalisations at the end of life. Patients who received ICI in the last month had a higher likelihood of in-hospital death (43% vs. 16%, P = 0.02). Conclusions: ICI within 30 days of death was associated with dying in hospital but did not lead to more hospitalisations and emergency department presentations. Early palliative care did not affect ICI use but reduced hospitalisations at the end of life.
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Affiliation(s)
- H M O'Sullivan
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - M Conroy
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D G Power
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D O'Mahony
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D C Collins
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - M J O'Leary
- Department of Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
- Department of Palliative Medicine, Cork University Hospital, Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
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29
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Aubert CE, Rodondi N, Netzer S, Dalleur O, Spinewine A, Maanen CD, Knol W, O'Mahony D, Aujesky D, Donzé J. Predictors of 1‐year drug‐related admissions in older multimorbid hospitalized adults. J Am Geriatr Soc 2022; 70:1510-1516. [PMID: 35064571 PMCID: PMC9305949 DOI: 10.1111/jgs.17667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/20/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Carole E. Aubert
- Department of General Internal Medicine Bern University Hospital, Inselspital, University of Bern Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine Bern University Hospital, Inselspital, University of Bern Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Seraina Netzer
- Department of General Internal Medicine Bern University Hospital, Inselspital, University of Bern Bern Switzerland
- Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group Université Catholique de Louvain, Louvain Drug Research Institute Brussels Belgium
- Pharmacy Department Université Catholique de Louvain, Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group Université Catholique de Louvain, Louvain Drug Research Institute Brussels Belgium
- Pharmacy Department Université Catholique de Louvain, CHU UCL Namur Yvoir Belgium
| | - Clara Drenth‐van Maanen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons University Medical Centre Utrecht, University of Utrecht Utrecht The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons University Medical Centre Utrecht, University of Utrecht Utrecht The Netherlands
| | - Denis O'Mahony
- Department of Medicine (Geriatrics) University College Cork Cork Ireland
- Department of Geriatric Medicine Cork University Hospital Cork Ireland
| | - Drahomir Aujesky
- Department of General Internal Medicine Bern University Hospital, Inselspital, University of Bern Bern Switzerland
| | - Jacques Donzé
- Department of Internal Medicine Hôpital neuchâtelois Neuchâtel Switzerland
- Harvard Medical School Harvard University Boston Massachusetts USA
- Division of General Internal Medicine and Primary Care Brigham and Women's Hospital Boston Massachusetts USA
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30
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Naughton C, Cummins H, de Foubert M, Barry F, McCullagh R, Wills T, Skelton DA, Dahly D, Palmer B, Murphy A, McHugh S, O'Mahony D, Tedesco S, O Sullivan B. Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13473.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.
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Randles M, Gallagher P, O'Mahony D. 243 MEASURED FRAILTY AND POTENTIALLY INAPPROPRIATE PRESCRIBING IN ACUTELY HOSPITALISED OLDER ADULTS: A PROSPECTIVE OBSERVATIONAL STUDY. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of adverse outcomes from PIP, compared with their non-frail counterparts of the same age. This study aims to examine the relationship between measured frailty and potentially inappropriate prescribing in older adults presenting acutely to hospital.
Methods
A prospective observational study was conducted. Participants were acutely hospitalised older adults. Inclusion Criteria: Age ≥ 65 years old, acute admission <72 hours, expected length of stay >24 hrs. Exclusion Criteria: <65 years of age, actively dying, direct admission to ICU, inability to provide informed consent and next of kin declined consent, patients in isolation for infection control purposes. Medical chart review was carried out, followed by a short interview using a standardised data collection proforma. Frailty was measured using the Clinical Frailty Scale and the Frail-VIG frailty index. Potentially Inappropriate Prescribing was identified using the STOPP/START criteria. Results are presented for the first 200 participants.
Results
The mean (±standard deviation [SD]) age of study participants was 79.25[±7.14], 56.5% were female. The prevalence of frailty measured using the CFS and Frail-VIG were 61.5% and 50.5% respectively. Applying the CFS, the mean number of STOPP criteria in non-frail patients was 1.03 and 1.87 for frail patients (p = 0.001 CI 95%) and 1.14 and 2.10 (p = 0.001 CI 95%) using the Frail-Vig Index.
Conclusion
Frailty is associated with functional decline, falls, hospitalisation and death. Frail patients had a higher mean number of STOPP criteria. As medication side effects are themselves included as part of the frailty syndrome, in-hospital medication review and patient centred medication optimisation should be guided by patient’s frailty status to reduce adverse outcomes.
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Affiliation(s)
- M Randles
- University College Cork , Cork, Ireland
- Cork University Hospital , Cork, Ireland
| | - P Gallagher
- University College Cork , Cork, Ireland
- Bon Secours Hospital , Cork, Ireland
| | - D O'Mahony
- University College Cork , Cork, Ireland
- Cork University Hospital , Cork, Ireland
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O'Mahony D, Gudmundsson A, Soiza RL, Petrovic M, Jose Cruz-Jentoft A, Cherubini A, Fordham R, Byrne S, Dahly D, Gallagher P, Lavan A, Curtin D, Dalton K, Cullinan S, Flanagan E, Shiely F, Samuelsson O, Sverrisdottir A, Subbarayan S, Vandaele L, Meireson E, Montero-Errasquin B, Rexach-Cano A, Correa Perez A, Lozano-Montoya I, Vélez-Díaz-Pallarés M, Cerenzia A, Corradi S, Soledad Cotorruelo Ferreiro M, Dimitri F, Marinelli P, Martelli G, Fong Soe Khioe R, Eustace J. Corrigendum to: Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing 2021; 50:e10-e11. [PMID: 34166483 DOI: 10.1093/ageing/afab120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Denis O'Mahony
- University College Cork School of Medicine-Medicine Cork Ireland, Cork University Hospital Group, Cork, Ireland
| | | | - Roy L Soiza
- NHS Grampian, University of Aberdeen Institute of Applied Health Sciences-Ageing Clinical and Experimental Research, Aberdeen, UK
| | - Mirko Petrovic
- University of Ghent-Medicine, University Hospital Ghent, Ghent, Belgium
| | | | - Antonio Cherubini
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Richard Fordham
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Paul Gallagher
- Cork University Hospital-Geriatric Medicine, Cork, Ireland
| | - Amanda Lavan
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Denis Curtin
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Kieran Dalton
- University College Cork, National University of Ireland, Pharmaceutical Care Research Group, School of Pharmacy, Cork Ireland
| | - Shane Cullinan
- Royal College of Surgeons, School of Pharmacy, Dublin, Ireland
| | - Evelyn Flanagan
- University College Cork, Clinical Research Facility, Cork, Ireland
| | - Frances Shiely
- University College Cork, School of Epidemiology and Public Health, Cork, Ireland
| | - Olafur Samuelsson
- Landspitali University Hospital, Geriatric Medicine Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Annarita Cerenzia
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Samanta Corradi
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Federica Dimitri
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Paolo Marinelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Gaia Martelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Joseph Eustace
- University College Cork, National University of Ireland-Clinical Research Facility, Cork, Ireland
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Zerah L, Henrard S, Wilting I, O'Mahony D, Rodondi N, Dalleur O, Dalton K, Knol W, Haschke M, Spinewine A. Prevalence of drug-drug interactions in older people before and after hospital admission: analysis from the OPERAM trial. BMC Geriatr 2021; 21:571. [PMID: 34663238 PMCID: PMC8524798 DOI: 10.1186/s12877-021-02532-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Drug-drug interactions (DDIs) are highly prevalent in older patients but little is known about prevalence of DDIs over time. Our main objective was to assess changes in the prevalence and characteristics of drug-drug interactions (DDIs) during a one-year period after hospital admission in older people, and associated risk factors. Methods We conducted a sub-study of the European OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people), which assessed the effects of a structured medication review (experimental arm) compared to usual care (control arm) on reducing drug-related hospital readmissions. All OPERAM patients (≥70 years, with multimorbidity and polypharmacy, hospitalized in four centers in Bern, Brussels, Cork and Utrecht between December 2016 and October 2018, followed over 1 year) who were alive at hospital discharge and had full medication data during the index hospitalization (at baseline i.e., enrolment at admission, and at discharge) were included. DDIs were assessed using an international consensus list of potentially clinically significant DDIs in older people. The point-prevalence of DDIs was evaluated at baseline, discharge, and at 2, 6 and 12 months after hospitalization. Logistic regression models were performed to assess independent variables associated with changes in DDIs 2 months after baseline. Results Of the 1950 patients (median age 79 years) included, 1045 (54%) had at least one potentially clinically significant DDI at baseline; point-prevalence rates were 58, 57, 56 and 57% at discharge, and 2, 6 and 12 months, respectively. The prevalence increased significantly from baseline to discharge (P < .001 [significant only in the control group]), then remained stable over time (P for trend .31). The five most common DDIs –all pharmacodynamic in nature– accounted for 80% of all DDIs and involved drugs that affect potassium concentrations, centrally-acting drugs and antithrombotics. At 2 months, DDIs had increased in 459 (27%) patients and decreased in 331 (19%). The main factor predictive of a change in the prevalence of DDIs was hyperpolypharmacy (≥10 medications). Conclusions DDIs were very common; their prevalence increased during hospitalization and tended to remain stable thereafter. Medication review may help control this increase and minimize the risk of adverse drug events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02532-z.
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Affiliation(s)
- Lorène Zerah
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- School of Medicine, Geriatric Medicine, University College Cork, Cork, Ireland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Pharmacy, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Avenue Mounier, 73 bte B1.73.06, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.,Pharmacy Department, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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Pazan F, Petrovic M, Cherubini A, Onder G, Cruz-Jentoft AJ, Denkinger M, van der Cammen TJM, Stevenson JM, Ibrahim K, Rajkumar C, Bakken MS, Baeyens JP, Crome P, Frühwald T, Gallaghar P, Guðmundsson A, Knol W, O'Mahony D, Pilotto A, Rönnemaa E, Serra-Rexach JA, Soulis G, van Marum RJ, Ziere G, Mair A, Burkhardt H, Neumann-Podczaska A, Wieczorowska-Tobis K, Fernandes MA, Gruner H, Dallmeier D, Beuscart JB, van der Velde N, Wehling M. Correction to: Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials. Eur J Clin Pharmacol 2021; 77:1593-1594. [PMID: 34363520 PMCID: PMC8440242 DOI: 10.1007/s00228-021-03166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-UniversityofHeidelberg, Theodor-Kutzer-Ufer1-3, 68167, Mannheim, Germany
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Antonio Cherubini
- Department of Geriatric Medicine, INRCA Istituto Nazionale Di Ricovero E Cura Per Anziani, Ancona, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Michael Denkinger
- Department of Geriatrics, Alb-Donau, University of Ulm and Geriatric Center Ulm/Alb-DonauAgaplesion Bethesda Hospital, Ulm, Germany
| | | | | | - Kinda Ibrahim
- Faculty of Medicine, Academic Geriatric Medicine, Southampton University, Southampton, UK
| | | | | | - Jean-Pierre Baeyens
- AZ Alma, Eeklo, Belgium
- University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Thomas Frühwald
- Department of Acute Geriatrics, Social Medical Center East, Vienna, Austria
| | - Paul Gallaghar
- School of Medicine, University College Cork, Cambridge, UK
| | | | - Wilma Knol
- Geriatrics, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- DepartmentofMedicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Elina Rönnemaa
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala, Sweden
| | - José Antonio Serra-Rexach
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Consorcio de Investigación Biomédica en Red: Fragilidad y Envejecimiento Saludable, CIBERFES, Madrid, Spain
- Medicine Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Rob J van Marum
- Department of General Medicine and Geriatric Medicine, Free University, Amsterdam, The Netherlands
| | - Gijsbertus Ziere
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Scottish Government, Edinburgh, EH1 3DG, UK
| | - Heinrich Burkhardt
- IV. Medical Department, University Hospital Mannheim, Heidelberg University, GeriatricsMannheim, Germany
| | | | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
- Palliative Medicine Unit, University Hospital of Lord's Transfiguration, Poznan, Poland
| | - Marilia Andreia Fernandes
- Department of Internal Medicine, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Heidi Gruner
- Internal Medicine Department 7.2, Hospital Curry Cabral - Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
- Dept.ofEpidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jean-Baptiste Beuscart
- Évaluation Des Technologies de Santé Et Des Pratiques Médicales, CHULille, ULR2694-METRICS, Univ. Lille, 59000, Lille, France
| | | | - Martin Wehling
- Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-UniversityofHeidelberg, Theodor-Kutzer-Ufer1-3, 68167, Mannheim, Germany.
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Dalton K, Fleming A, O'Mahony D, Byrne S. Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults. Br J Clin Pharmacol 2021; 88:628-654. [PMID: 34270111 DOI: 10.1111/bcp.14987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. METHODS Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. RESULTS Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication-recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity-the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships-personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment-organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. CONCLUSION This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Aoife Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.,Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Denis O'Mahony
- Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Blum MR, Sallevelt BTGM, Spinewine A, O'Mahony D, Moutzouri E, Feller M, Baumgartner C, Roumet M, Jungo KT, Schwab N, Bretagne L, Beglinger S, Aubert CE, Wilting I, Thevelin S, Murphy K, Huibers CJA, Drenth-van Maanen AC, Boland B, Crowley E, Eichenberger A, Meulendijk M, Jennings E, Adam L, Roos MJ, Gleeson L, Shen Z, Marien S, Meinders AJ, Baretella O, Netzer S, de Montmollin M, Fournier A, Mouzon A, O'Mahony C, Aujesky D, Mavridis D, Byrne S, Jansen PAF, Schwenkglenks M, Spruit M, Dalleur O, Knol W, Trelle S, Rodondi N. Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial. BMJ 2021; 374:n1585. [PMID: 34257088 PMCID: PMC8276068 DOI: 10.1136/bmj.n1585] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. DESIGN Cluster randomised controlled trial. SETTING 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. PARTICIPANTS 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). INTERVENTION Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. MAIN OUTCOME MEASURE Primary outcome was first drug related hospital admission within 12 months. RESULTS 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths). CONCLUSIONS Inappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02986425.
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Affiliation(s)
- Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Denis O'Mahony
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Nathalie Schwab
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lisa Bretagne
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shanthi Beglinger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ingeborg Wilting
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stefanie Thevelin
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Kevin Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Corlina J A Huibers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Clara Drenth-van Maanen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Benoit Boland
- Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Belgium
| | - Erin Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Anne Eichenberger
- Institute of Hospital Pharmacy, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michiel Meulendijk
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Emma Jennings
- School of Medicine, University College Cork, Cork, Republic of Ireland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marvin J Roos
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Laura Gleeson
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Zhengru Shen
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Sophie Marien
- Geriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Belgium
| | - Arend-Jan Meinders
- Department of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein and Utrecht, Netherlands
| | - Oliver Baretella
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Seraina Netzer
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Maria de Montmollin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Anne Fournier
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
| | - Ariane Mouzon
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
| | - Cian O'Mahony
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitris Mavridis
- Department of Primary School Education, University of Ioannina, Greece
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Paul A F Jansen
- Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Marco Spruit
- Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium
- Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sven Trelle
- CTU Bern, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Santarsieri A, Sturgess K, Brice P, Menne TF, Osborne W, Creasey T, Ardeshna KM, Behan S, Bhuller K, Booth S, Collins GP, Cwynarski K, Furtado M, Iyenga S, Jones SG, O'Mahony D, Martinez‐Calle N, McKay P, Nagumantry SK, Rudge JF, Shah N, Stafford G, Sternberg A, Uttenthal BJ, McMillan AK, Follows GA. MODIFICATION OF ESCALATED BEACOPP WITH DACARBAZINE SUBSTITUTION REDUCES TOXICITY WHILE MAINTAINING EFFICACY FOR THE TREATMENT OF ADVANCED STAGE HODGKIN LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.109_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Santarsieri
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - K. Sturgess
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - P. Brice
- Hôpital Saint‐Louis Hématologie‐Oncologie Paris France
| | - T. F. Menne
- Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust Haematology Newcastle UK
| | - W. Osborne
- Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust Haematology Newcastle UK
| | - T. Creasey
- Newcastle University Hospitals NHSFT Haematology Newcastle UK
| | - K. M. Ardeshna
- University College London Hospitals NHS Foundation Trust Haematology London UK
| | - S. Behan
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - K. Bhuller
- University Hospitals of Leicester NHS Trust Haematology Leicester UK
| | - S. Booth
- Oxford University Hospitals NHS Foundation Trust Haematology Oxford UK
| | - G. P. Collins
- Oxford University Hospitals NHS Foundation Trust Haematology Oxford UK
| | - K. Cwynarski
- University College London Hospitals NHS Foundation Trust Haematology London UK
| | - M. Furtado
- Royal Cornwall Hospitals NHS Trust Haematology Cornwall UK
| | - S. Iyenga
- The Royal Marsden NHS Foundation Trust Haematology London UK
| | - S. G. Jones
- Sherwood Forest Hospitals NHS Foundation Trust Haematology Nottinghamshire UK
| | - D. O'Mahony
- Cork University Hospital Oncology Cork Ireland
| | | | - P. McKay
- Beatson West of Scotland Cancer Centre Haematology Glasgow UK
| | - S. K. Nagumantry
- Peterborough City Hospital North West Anglia NHS Foundation Trust Haematology Peterborough UK
| | - J. F. Rudge
- Bullard Laboratories University of Cambridge Cambridge UK
| | - N. Shah
- Norfolk and Norwich University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - G. Stafford
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - A. Sternberg
- Great Western Hospitals NHS Foundation Trust Haematology Swindon UK
| | - B. J. Uttenthal
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - A. K. McMillan
- Nottingham University Hospitals NHS Trust Haematology Nottingham UK
| | - G. A. Follows
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
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Sternberg SA, Petrovic M, Onder G, Cherubini A, O'Mahony D, Gurwitz JH, Pegreffi F, Mason R, Akerman J, McCarthy L, Lawson A, Li J, Wu W, Rochon PA. Identifying key prescribing cascades in older people (iKASCADE): a transnational initiative on drug safety through a sex and gender lens-rationale and design. Eur Geriatr Med 2021; 12:475-483. [PMID: 33835427 DOI: 10.1007/s41999-021-00480-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the objectives, methods and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens. METHODS To create a comprehensive, internationally relevant inventory of prescribing cascades affecting older adults, the consortium has created a modified Delphi procedure where international experts in prescribing and managing pharmacotherapy for older adults will rank a list of prescribing cascades as to their clinical importance. We will use administrative and clinical data on older adults to evaluate the frequency of prescribing cascades by sex internationally, in the hospital, long-term care and community settings. Finally, we will use semi-structured interviews and realistic, country-specific vignettes, each incorporating a prescribing cascade with identified sex differences, to explore how socially constructed gender roles contribute to the experience, presentation and management of prescribing cascades. RESULTS The consortium will synthesize the quantitative and qualitative results to produce a position paper and products-aimed at knowledge users within and outside of academia-designed to elevate the importance of integrating a gender dimension in the identification and prevention of prescribing cascades. CONCLUSION Findings will improve our understanding of how adverse drug events are different between older women and men and inform the development and dissemination of tailored knowledge translation products to reduce the frequency and impact of prescribing cascades.
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Affiliation(s)
- Shelley A Sternberg
- Department of Geriatric Medicine, Maccabi Healthcare Services, Modiin, Israel
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, IstitutoSuperiore di Sanità, Rome, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento. IRCCS INRCA, Ancona, Italy
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
| | - Jerry H Gurwitz
- Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Francesco Pegreffi
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Robin Mason
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jennifer Akerman
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Lisa McCarthy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Andrea Lawson
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Joyce Li
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Paula A Rochon
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
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Gleeson LL, O'Brien GL, O'Mahony D, Byrne S. Thirst for change in a challenging environment: healthcare providers' perceptions of safety culture in a large Irish teaching hospital. Ir J Med Sci 2021; 191:607-613. [PMID: 33822314 DOI: 10.1007/s11845-021-02611-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Irish healthcare system is currently recognised as being understaffed and under-resourced due to historic underfunding and the aftermath of the 2008 global financial crisis. This descriptive study investigated healthcare providers' perceptions of the safety culture in a large Irish teaching hospital. AIM The aim of this study was to investigate healthcare workers' perceptions of the safety culture in a large Irish teaching hospital in a climate of national under-resourcing of healthcare. METHODS Seventeen semi-structured interviews were carried out with patient-attending staff between February and June 2019. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Two predominant themes emerged from the interviews: (1) challenging environment and (2) thirst for change. Study participants described the poor working conditions in the hospital, but also recognised the importance of teamwork and communication in maintaining patient safety and had a strong appetite for change regarding the safety culture in the hospital. CONCLUSION This study highlights the complex relationship between working conditions and safety culture. Hospital staff were committed to providing the best possible care for their patients but struggled to provide safe care in a challenging work environment. A clear appetite for change was identified amongst HCPs regarding patient safety culture in Irish healthcare.
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Affiliation(s)
- Laura L Gleeson
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Gary L O'Brien
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, School of Medicine, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Affiliation(s)
- Denis O'Mahony
- Division of Geriatrics, Department of Medicine, School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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Lavan AH, O'Mahony D, O'Mahony D, Gallagher P. Potentially inappropriate medication (PIM) use and severe drug interactions (SDIs) in older adults with cancer. J Geriatr Oncol 2021; 12:872-880. [PMID: 33648904 DOI: 10.1016/j.jgo.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/29/2020] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Older adults with cancer frequently have other co-morbidities requiring prescription pharmacotherapy. The objectives of this study were to identify the prevalence of potentially inappropriate medications (PIMs), severe drug interactions (SDIs) and associated risk factors in these patients. MATERIALS AND METHODS This twelve-month prospective observation study was conducted at an Irish Hospital. PIMs were identified in older adults (≥65 years) using STOPP and OncPal criteria; potential SDIs using Stockley's interaction checker. RESULTS We enrolled 186 patients; mean age 72.5(SD5.7) years, 46.2% female, mean co-morbidities 7.5(SD3.4), median medications 7(IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. STOPP PIMs were observed in 73.1%; median 2(IQR1-3). The most common PIM identified was any drug prescribed beyond the recommended duration (46.5%). For each additional prescription, the odds of receiving a STOPP PIM increased by 79.2% (OR 1.792, 95% CI 1.459-2.02). Potential SDIs were identified in 50.5% participants. The most common were beta-blocker/alpha-blocker (6.5%), selective-serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (5.9%) and SSRI/Aspirin (4.8%). For each additional prescription, the odds of an SDI increased by 50.8% (OR 1.508, 95% CI 1.288-1.764). Seventy-seven (41.4%) participants died within six months of enrolment. OncPal PIMs were observed in 81.8% of this cohort, median 2(IQR1-3). The most common OncPal PIM was statin therapy (38%). For each additional prescription, the odds of receiving an OncPal PIM increased by 38.2%, (OR 1.382, 95% CI 1.080-1.767). CONCLUSIONS PIMs and SDIs are common in this population. Comprehensive specialist evaluation of medications by a geriatrician may identify PIMs thereby reducing related adverse outcomes such as SDIs.
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Affiliation(s)
- Amanda Hanora Lavan
- School of Medicine, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.
| | - Deirdre O'Mahony
- School of Medicine, University College Cork, Cork, Ireland; Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Denis O'Mahony
- School of Medicine, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Paul Gallagher
- School of Medicine, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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Bhadhuri A, Kind P, Salari P, Jungo KT, Boland B, Byrne S, Hossmann S, Dalleur O, Knol W, Moutzouri E, O'Mahony D, Murphy KD, Wisselink L, Rodondi N, Schwenkglenks M. Measurement properties of EQ-5D-3L and EQ-5D-5L in recording self-reported health status in older patients with substantial multimorbidity and polypharmacy. Health Qual Life Outcomes 2020; 18:317. [PMID: 32993637 PMCID: PMC7526382 DOI: 10.1186/s12955-020-01564-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The EQ-5D-3L and EQ-5D-5L are two generic health-related quality of life measures, which may be used in clinical and health economic research. They measure impairment in 5 aspects of health: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The aim of this study was to assess the performance of the EQ-5D-3L and EQ-5D-5L in measuring the self-reported health status of older patients with substantial multimorbidity and associated polypharmacy. METHODS Between 2017 and 2019, we administered EQ-5D-3L and EQ-5D-5L to a subset of patients participating in the OPERAM trial at 6 months and 12 months after enrolment. The OPERAM trial is a two-arm multinational cluster randomised controlled trial of structured medication review assisted by a software-based decision support system versus usual pharmaceutical care, for older people (aged ≥ 70 years) with multimorbidity and polypharmacy. In the psychometric analyses, we only included participants who completed the measures in full at 6 and 12 months. We assessed whether responses to the measures were consistent by assessing the proportion of EQ-5D-5L responses, which were 2 or more levels away from that person's EQ-5D-3L response. We also compared the measures in terms of informativity, and discriminant validity and responsiveness relative to the Barthel Index, which measures independence in activities of daily living. RESULTS 224 patients (mean age of 77 years; 56% male) were included in the psychometric analyses. Ceiling effects reported with the EQ-5D-5L (22%) were lower than with the EQ-5D-3L (29%). For the mobility item, the EQ-5D-5L demonstrated better informativity (Shannon's evenness index score of 0.86) than the EQ-5D-3L (Shannon's evenness index score of 0.69). Both the 3L and 5L versions of EQ-5D demonstrated good performance in terms of discriminant validity, i.e. (out of all items of the EQ-5D-3L and EQ-5D-5L, the pain/discomfort and anxiety/depression items had the weakest correlation with the Barthel Index. Both the 3L and 5L versions of EQ-5D demonstrated good responsiveness to changes in the Barthel Index. CONCLUSION Both EQ-5D-3L and EQ-5D-5L demonstrated validity and responsiveness when administered to older adults with substantial multimorbidity and polypharmacy who were able to complete the measures.
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Affiliation(s)
- Arjun Bhadhuri
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
| | - Paul Kind
- Academic Unit for Health Economics, Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Paola Salari
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | | | - Benoît Boland
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Olivia Dalleur
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
| | - Kevin D Murphy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Linda Wisselink
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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O'Mahony D, Gudmundsson A, Soiza RL, Petrovic M, Cruz-Jentoft AJ, Cherubini A, Fordham R, Byrne S, Dahly D, Gallagher P, Lavan A, Curtin D, Dalton K, Cullinan S, Flanagan E, Shiely F, Samuelsson O, Sverrisdottir A, Subbarayan S, Vandaele L, Meireson E, Montero-Errasquin B, Rexach-Cano A, Correa Perez A, Lozano-Montoya I, Vélez-Díaz-Pallarés M, Cerenzia A, Corradi S, Soledad Cotorruelo Ferreiro M, Dimitri F, Marinelli P, Martelli G, Fong Soe Khioe R, Eustace J. Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing 2020; 49:605-614. [PMID: 32484850 DOI: 10.1093/ageing/afaa072] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention. METHODS We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n = 772, mean number of daily medications = 9.34) or standard care alone (control, n = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life. RESULTS For the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77-1.24; P = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%). CONCLUSIONS In this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization.
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Affiliation(s)
- Denis O'Mahony
- University College Cork School of Medicine-Medicine Cork Ireland, Cork University Hospital Group, Cork, Ireland
| | | | - Roy L Soiza
- NHS Grampian, University of Aberdeen Institute of Applied Health Sciences-Ageing Clinical and Experimental Research, Aberdeen, UK
| | - Mirko Petrovic
- University of Ghent-Medicine, University Hospital Ghent, Ghent, Belgium
| | | | - Antonio Cherubini
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Richard Fordham
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
| | | | - Paul Gallagher
- Cork University Hospital-Geriatric Medicine, Cork, Ireland
| | - Amanda Lavan
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Denis Curtin
- University College Cork, School of Medicine-Geriatrics, Cork, Ireland
| | - Kieran Dalton
- University College Cork, National University of Ireland, Pharmaceutical Care Research Group, School of Pharmacy, Cork Ireland
| | - Shane Cullinan
- Royal College of Surgeons, School of Pharmacy, Dublin, Ireland
| | - Evelyn Flanagan
- University College Cork, Clinical Research Facility, Cork, Ireland
| | - Frances Shiely
- University College Cork, School of Epidemiology and Public Health, Cork, Ireland
| | - Olafur Samuelsson
- Landspitali University Hospital, Geriatric Medicine Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Annarita Cerenzia
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Samanta Corradi
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Federica Dimitri
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Paolo Marinelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | - Gaia Martelli
- Italian National Research Center on Aging (IRCCS-INRCA), Geriatrics and Geriatrics Emergency Care, Ancona, Italy
| | | | - Joseph Eustace
- University College Cork, National University of Ireland-Clinical Research Facility, Cork, Ireland
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Gleeson LL, Tobin L, O'Brien GL, Crowley EK, Delaney A, O'Mahony D, Byrne S. Safety culture in a major accredited Irish university teaching hospital: a mixed methods study using the safety attitudes questionnaire. Ir J Med Sci 2020; 189:1171-1178. [PMID: 32274618 DOI: 10.1007/s11845-020-02228-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The measurement of safety culture, the way in which members of an organisation think about and prioritise safety, in a hospital can provide valuable insight and inform quality improvement strategies. AIMS The aim of this study is to describe the safety culture of a university teaching hospital in the Republic of Ireland. METHODS This is a mixed methods survey study using the Safety Attitudes Questionnaire (SAQ). The SAQ was distributed to all staff in the study hospital. Staff attitudes towards six domains of patient safety culture were assessed over 32 Likert-scaled items. Thematic analysis was performed on qualitative data. RESULTS A total of 768 staff members completed and returned a copy of the SAQ. The hospital scored above the international benchmark in five out of six domains, indicating a positive safety culture, but scored below the international benchmark in the domain 'Working Conditions'. This positive safety culture was not mirrored in the qualitative data, from which five themes emerged; three major-Staffing Issues, Patient-Focused Care and Hospital Environment-and two minor-Safe Reporting Culture and Training and Education. CONCLUSIONS In this study, a mixed methods approach was successfully used to investigate the safety culture in a large Irish hospital. Although the SAQ results indicated a positive safety culture, the qualitative data revealed a number of issues that the hospital staff felt impacted negatively on patient safety. The results of this study will inform future work on the design of an intervention to improve patient safety in the hospital.
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Affiliation(s)
- Laura L Gleeson
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Leanne Tobin
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Gary L O'Brien
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Erin K Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Aoife Delaney
- Medication Safety, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, School of Medicine, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Kilpatrick KA, Paton P, Subbarayan S, Stewart C, Abraha I, Cruz-Jentoft AJ, O'Mahony D, Cherubini A, Soiza RL. Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series. Maturitas 2020; 133:42-48. [PMID: 32005422 DOI: 10.1016/j.maturitas.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. METHODS A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. RESULTS Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. CONCLUSIONS There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.
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Affiliation(s)
- Kirsty A Kilpatrick
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Pamela Paton
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Dept of Geriatric Medicine, NHS Grampian, Aberdeen, United Kingdom
| | - Selvarani Subbarayan
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Carrie Stewart
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom
| | - Iosief Abraha
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roy L Soiza
- Ageing Clinical & Experimental Research Group, School of Medicine & Dentistry, University of Aberdeen, United Kingdom; Dept of Geriatric Medicine, NHS Grampian, Aberdeen, United Kingdom.
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Curtin D, Jennings E, Daunt R, Curtin S, Randles M, Gallagher P, O'Mahony D. Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria. J Am Geriatr Soc 2019; 68:762-769. [PMID: 31868920 DOI: 10.1111/jgs.16278] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty. DESIGN Randomized controlled trial. SETTING Two acute hospitals in Ireland. PARTICIPANTS Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long-term nursing home care. INTERVENTION A STOPPFrail-guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes. MEASUREMENTS The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality. RESULTS Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (±3.0) and 10.9 (±3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was -2.6 (±2.73) in the intervention group and -.36 (±2.60) in the control group (mean difference = 2.25 ± .54; 95% confidence interval [CI] = 1.18-3.32; P < .001). The mean change in monthly medication cost was -$74.97 (±$148.32) in the intervention group and -$13.22 (±$110.40) in the control group (mean difference $61.74 ± $26.60; 95% CI = 8.95-114.53; P = .02). No significant differences were found between groups for any of the other secondary outcomes. CONCLUSION STOPPFrail-guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes. J Am Geriatr Soc 68:762-769, 2020.
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Affiliation(s)
- Denis Curtin
- Department of Medicine (Geriatrics), University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Emma Jennings
- Department of Medicine (Geriatrics), University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Ruth Daunt
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Sara Curtin
- Department of Occupational Therapy, University of Limerick, Limerick, Ireland
| | - Mary Randles
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Paul Gallagher
- Department of Medicine (Geriatrics), University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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O'Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress. Expert Rev Clin Pharmacol 2019; 13:15-22. [PMID: 31790317 DOI: 10.1080/17512433.2020.1697676] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) are explicit criteria that facilitate medication review in multi-morbid older people in most clinical settings. This review examines the clinical trial evidence pertaining to STOPP/START criteria as an intervention.Areas covered: The literature was searched for registered clinical trials that used STOPP/START criteria as an intervention. In single-center trials, applying STOPP/START criteria improved medication appropriateness, reduced polypharmacy, reduced adverse drug reactions (ADRs), led to fewer falls, and lower medication costs. Two large-scale multi-center trials (SENATOR and OPERAM) examined the impact of computer-generated STOPP/START criteria on incident ADRs (SENATOR) and drug-related hospitalizations (OPERAM) in multi-morbid older people. Results of these trials will be publicized in 2020.Expert opinion: Applying STOPP/START criteria improves clinical outcomes in multi-morbid older people. Electronic deployment of STOPP/START criteria is a substantial technical challenge; however, recent clinical trials of software prototypes demonstrate feasibility. Even with well-functioning software for the application of STOPP/START criteria, the need remains for face-to-face interaction between attending clinicians and appropriately trained personnel (likely pharmacists) to explain and qualify specific STOPP/START recommendations in individual multi-morbid older patients. Such interaction is essential for the implementation of relevant STOPP/START recommendations.
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Affiliation(s)
- Denis O'Mahony
- Department of Medicine, University College Cork, Ireland & consultant geriatrician, Cork University Hospital, Cork, Ireland
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48
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Curtin D, Jennings E, Daunt R, Randles M, Gallagher P, O'Mahony D. 206 Deprescribing in Frail Older People Transitioning to Long-term Care: a Randomized Controlled Trial Using STOPPFrail Criteria. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Older people with advanced frailty are among the highest consumers of prescription medications. When life expectancy is limited, the use of multiple medications may be unnecessary or burdensome. STOPPFrail criteria were recently developed to assist clinicians with deprescribing decisions in frail older people approaching end-of-life. The aim of this study was to examine whether long-term medications could be safely discontinued in frail older people using STOPPFrail criteria.
Methods
We recruited hospitalized adults aged ≥75 years with polypharmacy (≥5 long-term medications) that were transitioning to nursing home care. Participants were eligible if their Clinical Frailty Scale score was ≥7 and if their attending physician indicated that he/she “would not be surprised if the patient died in the next 12 months”. Patients were randomized to single time point pre-discharge STOPPFrail-guided deprescribing or routine pharmaceutical care. The primary outcome was change in the number of regular medications at 3 months. Secondary outcomes included emergency hospital transfers, incident falls, fractures and mortality.
Results
Results are presented for the first 100 enrolled patients. The mean (±standard deviation [SD]) age of study participants was 85.1 (±5.7) and 61% were female. Intervention (n = 49) and control group (n = 51) participants were prescribed a mean (±SD) of 11.5 (±3.0) and 10.9 (±3.5) regular medications, respectively, at baseline. The mean (±SD) change in the number of regular medications at 3 months was -2.7 (±2.8) in the intervention group and -0.6 (±2.6) in the control group (estimated difference 2.1 ±0.6, 95% confidence interval 0.8 -3.3, p=0.001). Ten intervention participants and 14 control participants died within 3 months of randomization (20.4% vs 27.4%, p=0.49). There was no significant difference between groups for emergency hospital transfers, incident falls or fractures.
Conclusion
STOPPFrail-guided deprescribing significantly reduced medication burden in frail older people without adversely affecting clinical outcomes in the prospective 3 months.
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Affiliation(s)
- Denis Curtin
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | | | | | | | - Paul Gallagher
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
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49
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Lavan A, O'Mahony D, Buckley M, O'Mahony D, Gallagher P. 150 Severe Drug Interactions (SDIs) and Potentially Inappropriate Prescriptions (PIPs) in Older Adults with Cancer. Age Ageing 2019. [DOI: 10.1093/ageing/afz102.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The objectives of this study were to identify the prevalence of severe drug interactions (SDIs) and potentially inappropriate prescriptions (PIPs) in older adults with cancer.
Methods
A 12-month prospective observational study of patients ≥65 years admitted to an oncology centre was conducted. SDIs were assessed using Stockley’s interaction checker; PIPs were identified using STOPP/START criteria. Logistic regression was applied to determine the influence of age, gender, co-morbidities and medication number on the likelihood of an SDI and a PIP.
Results
We enrolled 186 participants; mean age 72.5 (SD5.7) years, 46.2% female, mean co-morbidity number 7.5 (SD3.4), median medication number 7 (IQR4-9). Polypharmacy (≥6 medications) and major polypharmacy (≥11 medications) were identified in 60.8% and 17.7% respectively. Systemic anti-cancer therapies (SACTs) were concomitantly prescribed to 60.2%.
SDIs were identified in 50.5% participants; 7.5% ≥1 SACT-SACT SDI, 41.4% ≥1 drug-drug SDI and 10.2% ≥1 drug-SACT SDI. The most common SDIs were beta-blocker/alpha-blocker (n=12), Selective serotonin re-uptake inhibitor (SSRI)/proton pump inhibitor (PPI) (n=11) and SSRI/Aspirin (n=8). A strong correlation between medication and SDI number was identified (r2=0.61, p-value <0.001). For each additional prescription, the odds of an SDI increased by 50.8% (Odds ratio 1.508, 95% CI1.288–1.764, p<0.001).
PIPs were observed in 73.1%; median 2(IQR1-3). The most common PIPs were drugs prescribed beyond the recommended duration (46.8%), high-dose PPIs >8 weeks (34.9%) and regular opioids without laxatives (20.4%). Patients prescribed ≥1 PIP had more co-morbidities (8.4(SD3.4) vs 5.2(SD2.4), p< 0.001), a higher cumulative illness rating score (18(IQR12-20) vs 11(IQR10-14), p<0.001) and more prescribed medications (8(IQR6-10) vs 3(IQR1-4.25), p<0.001). For each additional prescription, the odds of receiving a PIP increased by 79.2% (Odds ratio 1.792, 95% CI1.459–2.02, p<0.001).
Conclusion
SDIs and PIPs are common in older adults with cancer and higher than previously reported. Comprehensive specialist medication evaluation, by a Geriatrician, may benefit patients.
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Affiliation(s)
- Amanda Lavan
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Deirdre O'Mahony
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Mary Buckley
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Paul Gallagher
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
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50
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Curtin D, Gallagher P, O'Mahony D. 209 Deprescribing in Frail Older People Approaching End-of-Life: Development and Validation of STOPPFrail Version 2. Age Ageing 2019. [DOI: 10.1093/ageing/afz102.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Older people with advanced frailty are commonly prescribed lengthy, burdensome medication regimens. When life expectancy is likely to be limited, many of the prescribed drugs may be inappropriate. STOPPFrail Criteria were developed in 2016 to assist clinicians with deprescribing decisions in frail older people with limited life expectancy. Due to an expanding evidence base, updating of the criteria was required.
Methods
A focused literature review was performed to reassess the original criteria and propose new criteria. Eight panelists, with expertise in geriatric medicine, general practice, palliative medicine, psychiatry and clinical pharmacology, reviewed and critiqued a new draft of STOPPFrail criteria. The revised list of criteria was then validated using Delphi consensus methodology.
Results
The expert panel agreed a final list of 27 criteria after two Delphi validation rounds. STOPPFrail version 2 proposes a method for identifying older people approaching end-of-life and emphasizes shared decision making in the deprescribing process. New criteria relating to the discontinuation of anti-hypertensive medications, anti-thrombotic therapies and vitamin D are included.
Conclusion
STOPPFrail version 2 has been expanded and updated for the purpose of assisting clinicians with deprescribing decisions in frail older adults approaching end-of-life. The criteria are based on an up-to-date literature review and consensus validation among a panel of experts.
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Affiliation(s)
- Denis Curtin
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Paul Gallagher
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
| | - Denis O'Mahony
- Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
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