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Alageel NA, Hughes CM, Alwhaibi M, Alkeridy W, Barry HE. Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study. BMC Geriatr 2024; 24:328. [PMID: 38600444 PMCID: PMC11008018 DOI: 10.1186/s12877-024-04949-8] [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: 05/25/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia. Therefore, we aimed to estimate the prevalence of PIP and investigate associations between PIP and other patient characteristics among PwD in an ambulatory care setting. METHODS A cross-sectional, retrospective analysis was conducted at a tertiary hospital in Saudi Arabia. Patients who were ≥ 65 years old, had dementia, and visited ambulatory care clinics between 01/01/2019 and 31/12/2021 were included. Prescribing appropriateness was evaluated by applying the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria. Descriptive analyses were used to describe the study population. Prevalence of PIP and the prevalence per each STOPP criterion were calculated as a percentage of all eligible patients. Logistic regression analysis was used to investigate associations between PIP, polypharmacy, age and sex; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Analyses were conducted using SPSS v27. RESULTS A total of 287 PwD were identified; 56.0% (n = 161) were female. The mean number of medications prescribed was 9.0 [standard deviation (SD) ± 4.2]. The prevalence of PIP was 61.0% (n = 175). Common instances of PIP were drugs prescribed beyond the recommended duration (n = 90, 31.4%), drugs prescribed without an evidence-based clinical indication (n = 78, 27.2%), proton pump inhibitors (PPIs) for > 8 weeks (n = 75, 26.0%), and acetylcholinesterase inhibitors with concurrent drugs that reduce heart rate (n = 60, 21.0%). Polypharmacy was observed in 82.6% (n = 237) of patients and was strongly associated with PIP (adjusted OR 24.1, 95% CI 9.0-64.5). CONCLUSIONS Findings have revealed a high prevalence of PIP among PwD in Saudi Arabia that is strongly associated with polypharmacy. Future research should aim to explore key stakeholders' experiences and perspectives of medicines management to optimise medication use for this vulnerable patient population.
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Affiliation(s)
- Nahla A Alageel
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, Belfast, UK
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, Belfast, UK
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Walid Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada
- General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, Belfast, UK.
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Cross AJ, Hawthorne D, Kouladjian O'Donnell L, Lee K, Page AT. Pharmacists working in residential aged care: a survey of pharmacist interest and perceived preparedness. Int J Clin Pharm 2024; 46:506-514. [PMID: 38315305 PMCID: PMC10960889 DOI: 10.1007/s11096-023-01686-7] [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: 08/22/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pharmacists involvement in residential aged care facilities has traditionally been limited to that of an external contractor providing medication reviews, or medication supply. AIM To explore Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in residential aged care. METHOD National cross-sectional anonymous online survey open for two weeks (September 17th to October 1st 2022) consisting of Likert-type, multiple choice and multiple selection questions. Australian pharmacists were recruited using a broad advertising strategy which included social and traditional media platforms, and snowball sampling. Data were collected on pharmacist self-reported interest and perceived preparedness to work as on-site aged care pharmacists in residential aged care. Data were analysed using descriptive statistics. RESULTS Responses were received from 720 participants, 643 were eligible. Most participants were female (n = 466, 73%) and mean (SD) age was 43.5 (SD 12.5) years. Over half the participants were interested or extremely interested in working as an on-site aged care pharmacist (56%, n = 360), and agreed or strongly agreed (n = 475, 76%) that they felt prepared to work as an on-site aged care pharmacist. Most pharmacists felt prepared to engage in a variety of roles within the facilities (> 73% for each role), including resident and system level roles, and the majority agreed they felt prepared to engage with stakeholders, including general practitioners (93%) and medical specialists (86%). CONCLUSION Pharmacists reported they are interested and feel prepared to work as on-site aged care pharmacists. These findings will inform the roll-out of this new model of care to enhance multidisciplinary collaboration in residential aged care.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| | - Deborah Hawthorne
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Lisa Kouladjian O'Donnell
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
| | - Kenneth Lee
- Centre for Optimisation of Medicines, School of Allied Health, University of Western Australia, Crawley, Australia
| | - Amy Theresa Page
- Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
- Centre for Optimisation of Medicines, School of Allied Health, University of Western Australia, Crawley, Australia
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Zuleta M, San-José A, Gozalo I, Sánchez-Arcilla M, Carrizo G, Alvarado M, Pérez-Bocanegra C. Patterns of inappropriate prescribing and clinical characteristics in patients at admission to an acute care of the elderly unit. Eur J Clin Pharmacol 2024; 80:553-561. [PMID: 38265499 DOI: 10.1007/s00228-024-03627-3] [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: 08/09/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Inappropriate prescribing (IP) is common among the elderly and is associated with adverse health outcomes. The role of different patterns of IP in clinical practice remains unclear. The aim of this study is to analyse the characteristics of different patterns of IP in hospitalized older adults. METHODS This is a prospective observational study conducted in the acute care of elderly (ACE) unit of an acute hospital in Barcelona between June and August 2021. Epidemiological and demographic data were collected, and a comprehensive geriatric assessment (CGA) was performed on admitted patients. Four patterns of inappropriate prescribing were identified: extreme polypharmacy (10 or more drugs), potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs) and anticholinergic burden. RESULTS Among 93 admitted patients (51.6% male, mean age of 82.83), the main diagnosis was heart failure (36.6%). Overprescribing patterns (extreme polypharmacy, PIMs, PPOs and anticholinergic burden) were associated with higher comorbidity, increased dependence on instrumental activities of daily living (IADL) and greater prevalence of dementia. Underprescribing (omissions) was associated with important comorbidity, residence in nursing homes, an increased risk of malnutrition, higher social risk and greater frailty. Comparing different patterns of IP, patients with high anticholinergic burden exhibited more extreme polypharmacy and PIMs. In the case of omissions, no association was identified with other IP patterns. CONCLUSIONS We found statistically significant association between patterns of inappropriate prescribing and clinical and CGA variables such as comorbidity, dependency, dementia or frailty. There is a statistically significant association between patterns of overprescribing among patients admitted to the ACE unit.
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Affiliation(s)
- Mónica Zuleta
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain.
| | - Antonio San-José
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Inés Gozalo
- Pharmacy Department, Sant Rafael Hospital, Barcelona, Spain
| | | | - Gabriela Carrizo
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Marcelo Alvarado
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Carmen Pérez-Bocanegra
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
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4
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Talkhan H, Stewart D, McIntosh T, Ziglam H, Abdulrouf PV, Al-Hail M, Diab M, Cunningham S. Exploring determinants of antimicrobial prescribing behaviour using the Theoretical Domains Framework. Res Social Adm Pharm 2024; 20:401-410. [PMID: 38320948 DOI: 10.1016/j.sapharm.2023.12.009] [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: 05/21/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Few theoretically-based, qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals. Understanding these can promote successful development and implementation of behaviour change interventions (BCIs). OBJECTIVE (s): To use the Theoretical Domains Framework (TDF) to explore determinants of clinicians' antimicrobial prescribing behaviour, identifying barriers (i.e., impediments) and facilitators to appropriate antimicrobial practice. METHODS Semi-structured interviews with purposively-sampled doctors and pharmacists with a wide range of specialties and expertise in Hamad Medical Corporation hospitals in Qatar. Interviews based on previous quantitative research and the TDF were audio-recorded, transcribed and independently analysed by two researchers using the TDF as an initial coding framework. RESULTS Data saturation was achieved after interviewing eight doctors and eight pharmacists. Inter-related determinants of antimicrobial prescribing behaviour linked to ten TDF domains were identified as barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. The main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources); knowledge gaps relating to guidelines and appropriate prescribing (knowledge); restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity); challenging antimicrobial prescribing decisions (memory, attention and decision processes); and professional hierarchies and poor multidisciplinary teamworking (social influences). Key facilitators included guidelines compliance (goals and intentions), and participants' beliefs about the consequences of appropriate or inappropriate prescribing. Further education and training, and some changes to guidelines including their accessibility were also considered essential. CONCLUSIONS Antimicrobial prescribing behaviour in hospitals is a complex process influenced by a broad range of determinants including specific barriers and facilitators. The in-depth understanding of this complexity provided by this work may support the development of an effective BCI to promote appropriate antimicrobial stewardship.
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Affiliation(s)
- Hend Talkhan
- School of Pharmacy and Life Sciences, Robert Gordon University, UK.
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Trudi McIntosh
- School of Pharmacy and Life Sciences, Robert Gordon University, UK.
| | - Hisham Ziglam
- Infectious Diseases Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | | | - Moza Al-Hail
- Pharmacy Department, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Mohammad Diab
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, UK.
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Bell JS, La Caze A, Steeper M, Haines TP, Hilmer SN, Troeung L, Quirke L, Wesson J, Pond CD, Buys L, Ghahreman-Falconer N, Lawless MT, Shrestha S, Martini A, Ochieng N, Glamorgan F, Lagasca C, Walton R, Cenin D, Kitson A, Jung M, Bennett A, Cross AJ. Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial. Implement Sci 2024; 19:24. [PMID: 38438918 PMCID: PMC10913248 DOI: 10.1186/s13012-024-01353-z] [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: 12/29/2023] [Accepted: 02/13/2024] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care. METHODS AND ANALYSIS The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level. DISCUSSION The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 - retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .
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Affiliation(s)
- J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Dutton Park, QLD, Australia
| | - Michelle Steeper
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia
| | - Terry P Haines
- Faculty of Medicine Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Clayton, VIC, Australia
- National Centre for Healthy Ageing, Frankston, VIC, Australia
| | - Sarah N Hilmer
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
- New South Wales Therapeutic Advisory Group, Sydney, NSW, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | | | - Jacqueline Wesson
- Ageing and Health Research Unit, Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Constance Dimity Pond
- Wicking Dementia Research and Teaching Centre, University of Tasmania, Hobart, TAS, Australia
| | - Laurie Buys
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Nazanin Ghahreman-Falconer
- School of Pharmacy, The University of Queensland, Dutton Park, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Shakti Shrestha
- School of Pharmacy, The University of Queensland, Dutton Park, QLD, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Nancy Ochieng
- Lifeview Corporate Lifeview Pty Ltd., Carnegie, VIC, Australia
| | | | - Carmela Lagasca
- Anglicare Southern Queensland, Fortitude Valley, QLD, Australia
| | - Rebecca Walton
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Dayna Cenin
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Monica Jung
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia
| | | | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, VIC, 3052, Australia.
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de Andrade FK, Ignacio Nunes RP, Barboza Zanetti MO, Barboza Zanetti AC, Dos Santos M, de Oliveira AM, Carson-Stevens A, Leira Pereira LR, Rossi Varallo F. Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review. Farm Hosp 2024; 48:T83-T89. [PMID: 38016841 DOI: 10.1016/j.farma.2023.08.010] [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: 01/19/2023] [Accepted: 08/01/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
| | | | | | | | - Márcia Dos Santos
- Biblioteca Central, Universidad de São Paulo (USP), Ribeirão Preto, São Paulo, Brasil
| | - Alan Maicon de Oliveira
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil.
| | - Andrew Carson-Stevens
- Centro PRIME de Gales, División de Medicina de la Población, Facultad de Medicina, Universidad de Cardiff, Cardiff, Reino Unido
| | | | - Fabiana Rossi Varallo
- Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil
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de Andrade FK, Nunes RPI, Zanetti MOB, Zanetti ACB, Dos Santos M, de Oliveira AM, Carson-Stevens A, Pereira LRL, Varallo FR. Validated medication deprescribing instruments for patients with palliative care needs: a systematic review. Farm Hosp 2024; 48:83-89. [PMID: 37770284 DOI: 10.1016/j.farma.2023.08.004] [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: 01/19/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.
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Affiliation(s)
- Frangie Kallas de Andrade
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Raziel Prado Ignacio Nunes
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Márcia Dos Santos
- University of São Paulo (USP), Central Library, Ribeirão Preto, Brazil
| | - Alan Maicon de Oliveira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Leonardo Régis Leira Pereira
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Rossi Varallo
- University of São Paulo (USP), School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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Herrero Domínguez-Berrueta M, Muñoz-García M, Delgado-Silveira E, Martín-Aragón S, Gangoso Fermoso A. Primary care pharmacist-led medication review in older adult patients in coordination with general practitioners: an observational retrospective cohorts study. Explor Res Clin Soc Pharm 2024; 13:100390. [PMID: 38169950 PMCID: PMC10758959 DOI: 10.1016/j.rcsop.2023.100390] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Background Polypharmacy and risk of potentially inappropriate prescribing (PIP) in older adult are being continuously increased. Including a primary care pharmacist (PCP) in the healthcare team is associated with lower rates of medication-related problems (MRPs). Objectives To determine the impact (in terms of variation of PIP, MRPs and polymedication) of treatment reviews (TR) carried out by the PCP by comparing two cohorts: standard TR vs coordinated TR with prescribing General Practitioners (GP). To assess possible health outcomes in both groups 6 months post-TR. Methods This is an observational study of two retrospective cohorts (2018 to 2020). All patients who met the inclusion/exclusion criteria were analyzed. Patients ≥65 years, who underwent complete TR by the PCP were included. Patients in a situation of exitus at the time of TR and those who underwent a partial TR were excluded. Control group cohort consisted of patients who underwent standard TR, and intervention group cohort consisted of those who underwent TR coordinated with GP. Sociodemographic, clinical and pharmacological variables were analyzed. Results 181 patients were enrolled. Mean age 84.4 ± 7.2 years, 78.5% women. Variables (GP-coordinated vs standard TRs) pre-post: decrease in drugs/patient 1.9 (95%CI: 1.4-2.4) vs 0.6 (95%CI: 0.2-1.3), p < 0.05; decrease in MRPs/patient 3.1 (95%CI: 2.8-3.4) vs 1.0 (95%CI: 0.6-1.4), p < 0.05; decrease in PIP/patient 2.0 (95% CI: 1.6-2.2) vs 0.6 (95% CI: 0.2-0.9), p < 0.05. Health outcomes: there was significant difference in average primary-care visits/patient 1.3 ± 0.5 vs 2.2 ± 1.8, p < 0.05. Conclusions Multidisciplinary interventions between PCP and GP, together with a systematic approach to TR can improve the quality of pharmacotherapy in the elderly. Prospective large follow-up studies are needed to demonstrate a positive trend in health outcomes.
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Affiliation(s)
| | - M. Muñoz-García
- Pharmacy Service, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | | | - S. Martín-Aragón
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - A. Gangoso Fermoso
- Pharmacy Service of Northwest Healthcare Directorate, Primary Care Assistance Management of Madrid, Spain
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Steinsdóttir HR, Sigurðsson MI, Björnsson ES, Jónsdóttir F. The incidence and prevalence of proton pump inhibitor usage among internal medicine patients after hospital admission: A retrospective cohort study. Eur J Clin Pharmacol 2024; 80:273-281. [PMID: 38105298 DOI: 10.1007/s00228-023-03607-z] [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: 03/16/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The use of proton pump inhibitors (PPIs) has increased over the past decades. One potential gateway into new PPI use is following a hospital admission. The study aimed to examine the incidence of new PPI usage following admission to internal medicine services and the ratio of new persistent users. METHODS A retrospective descriptive study was conducted among all adults who had been admitted to internal medicine wards at the National University Hospital of Iceland from 2010-2020. Data was obtained from the Icelandic Internal Medicine Database. The proportion of patients who started treatment with PPI within 3 months of discharge (new users) and the proportion of patients who continued to use it after 3 months (persistent users) were examined. RESULTS Among 85.942 admissions during the study period, 7238 (15.6%) became new users, and of those 4942 (68%) were new persistent users. The incidence of new PPI use was highest for patients discharged from gastroenterology (32.2%), hematology (31.8%), and oncology (29.2%). Patients with new PPI use more commonly had a history of malignancy (19.5%) and liver disease (22.7%) and more commonly were admitted to the ICU during their hospitalization. The highest ratio of persistent usage was among patients discharged from geriatric medicine (84%). CONCLUSION One in every six patients admitted to internal medicine wards filled out a prescription for PPI within 3 months from discharge, and a large proportion of them became persistent users. The high rate of new PPI users from oncology and hematology is noteworthy and requires further research.
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Affiliation(s)
- Helga Rut Steinsdóttir
- Clinical Pharmacy Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Martin I Sigurðsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Anesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Einar Stefán Björnsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Internal Medicine, Division of Gastroenterology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Freyja Jónsdóttir
- Clinical Pharmacy Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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10
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Nazar Z, Al Hail M, Al-Shaibi S, Hussain TA, Abdelkader NN, Pallivalapila A, Thomas B, Kassem WE, Hanssens Y, Mahfouz A, Ryan C, Stewart D. Investigating physicians' views on non-formulary prescribing: a qualitative study using the theoretical domains framework. Int J Clin Pharm 2023; 45:1424-1433. [PMID: 37454024 PMCID: PMC10682051 DOI: 10.1007/s11096-023-01616-7] [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: 04/03/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Well-designed and well-maintained drug formularies serve as a reliable resource to guide prescribing decisions; they are associated with improved medicine safety and increased efficiency, while also serving as a cost-effective tool to help manage and predict medicine expenditure. Multiple studies have investigated the inappropriate prescribing of non-formulary drugs (NFDs) with statistics indicating that up to 70% of NFD usage being inappropriate or not following the ascribed NFD policies. AIM To explore physicians' views and influences on their prescribing of non-formulary drugs. METHOD Data collection and analysis were underpinned using the Theoretical Domains Framework (TDF). Thirteen semi-structured interviews were conducted within Hamad Medical Corporation, the main provider of secondary and tertiary healthcare in Qatar, with physicians who had submitted a NFD request in the preceding 12 months. RESULTS Three overarching themes were identified: providing evidence-based care for individual patients; influences of others; and formulary management issues. Subthemes were mapped to specific TDF domains: environmental context and resources; social influences; professional role and identity; beliefs about consequences; goals; intentions. CONCLUSION The behavioral influences identified in this study can be mapped to behavior change strategies facilitating the development of an intervention to promote appropriate prescribing of NFDs with implications for medicine safety and healthcare efficiency.
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Affiliation(s)
- Zachariah Nazar
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Moza Al Hail
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Samaher Al-Shaibi
- Pharmacy department, Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | | | | | | | - Binny Thomas
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Wessam El Kassem
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Cristin Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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11
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Ramos KA, Colosimo EA, Duarte YADO, Bof de Andrade F. Effect of polypharmacy and Fall-Risk-Increasing Drugs (FRIDs) on falls among Brazilian older adults: The SABE cohort study. Arch Gerontol Geriatr 2023; 115:105127. [PMID: 37480721 DOI: 10.1016/j.archger.2023.105127] [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: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
Polypharmacy, considered as the use of multiple medications, has been one of the factors associated with a higher risk of falls among older adults. However, the association of this factor regardless of the use of Fall-Risk-Increasing Drugs (FRIDs) has not been extensively explored. OBJECTIVES This study aimed to evaluate the longitudinal association of polypharmacy with falls and verify whether this association is independent of FRID use. METHODS A longitudinal study was conducted with a representative sample of the urban population aged 60 years and over in the city of São Paulo, Brazil, from 2000 to 2006. The analysis of the association among polypharmacy, the use of FRIDs, and the occurrence of falls over the years was performed using Generalized Estimating Equation (GEE) models adjusted for covariates. RESULTS The association between polypharmacy and falls was significantly attenuated after the adjustment for covariates and FRIDs. Users of two or more FRIDs had higher odds of falls (OR = 1.51; CI [1.16; 1.96]). CONCLUSION FRID use was associated with the occurrence of falls among older adults. The number of medications must be kept to the minimum necessary, and FRIDs should be avoided in approaches to preventing falls among older adults.
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Affiliation(s)
- Karina Alves Ramos
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
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12
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Higgins H, Freeman R, Doble A, Hood G, Islam J, Gerver S, Henderson KL, Demirjian A, Hopkins S, Ashiru-Oredope D. Appropriateness of acute-care antibiotic prescriptions for community-acquired infections and surgical antibiotic prophylaxis in England: analysis of 2016 national point prevalence survey data. J Hosp Infect 2023; 142:115-129. [PMID: 37858806 DOI: 10.1016/j.jhin.2023.10.006] [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: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Estimates of inappropriate prescribing can highlight key target areas for antimicrobial stewardship (AMS) and inform national targets. OBJECTIVES To (1) define and (2) produce estimates of inappropriate antibiotic prescribing levels within acute hospital trusts in England. METHODS The 2016 national Healthcare-Associated Infections (HAI), Antimicrobial Use (AMU) and AMS point prevalence survey (PPS) was used to derive estimates of inappropriate prescribing, focusing on the four most reported community-acquired antibiotic indications (CAIs) in the PPS and surgical prophylaxis. Definitions of appropriate antibiotic therapy for each indication were developed through the compilation of national treatment guidelines. A Likert-scale system of appropriateness coding was validated and refined through a two-stage expert review process. RESULTS Antimicrobial usage prevalence data were collected for 25,741 individual antibiotic prescriptions, representing 17,884 patients and 213 hospitals in England. 30.4% of prescriptions for the four CAIs of interest were estimated to be inappropriate (2054 prescriptions). The highest percentage of inappropriate prescribing occurred in uncomplicated cystitis prescriptions (62.5%), followed by bronchitis (48%). For surgical prophylaxis, 30.8% of prescriptions were inappropriate in terms of dose number, and 21.3% in terms of excess prophylaxis duration. CONCLUSIONS The 2016 prevalence of inappropriate antibiotic prescribing in hospitals in England was approximated to be 30.4%; this establishes a baseline prevalence and provided indication of where AMS interventions should be prioritized. Our definitions appraised antibiotic choice, treatment duration and dose number (surgical prophylaxis only); however, they did not consider other aspects of appropriateness, such as combination therapy - this is an important area for future work.
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Affiliation(s)
- H Higgins
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK.
| | - R Freeman
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; IQVIA, London, UK
| | - A Doble
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; Health Education England North West, Manchester, UK
| | - G Hood
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; NHS England (Midlands), Birmingham, UK
| | - J Islam
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK
| | - S Gerver
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK
| | - K L Henderson
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK
| | - A Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - S Hopkins
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK
| | - D Ashiru-Oredope
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK
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13
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Hermes VC, Loureiro AP, Assis MP, Balbinot F, Frighetto I, Ziembowicz H, Menezes RM, Carneiro M. Pharmacoeconomic and antimicrobial stewardship analysis in waste management: Beyond switching drug administration route. Am J Infect Control 2023; 51:1334-1338. [PMID: 37295674 DOI: 10.1016/j.ajic.2023.06.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of switch therapy of antimicrobials on cost reduction (pharmacoeconomic analysis) and hospital waste generation by switching from intravenous to oral therapy. This is a cross-sectional, observational, and retrospective study. METHODS Data from 2019, 2020, and 2021, provided by the clinical pharmacy service of a teaching hospital in the interior of Rio Grande do Sul, were analyzed. The variables analyzed were intravenous and oral antimicrobials, frequency, duration of use, and total treatment time according to the institutional protocols. An estimate of the amount of waste not generated from the change of administration route was calculated by weighing the kits using a precision balance in grams. RESULTS During the analyzed period, 275 switch therapy of antimicrobials were performed, resulting in US$ 55,256.00 of savings. The main antimicrobial classes that underwent changes were cephalosporins (25.1%), penicillins (22.55%), and quinolones (17.45%). Changing from intravenous to oral therapy avoided the generation of 170,631 g of waste, including needles, syringes, infusion bags, equipment, reconstituted solution bottles, and medication. CONCLUSIONS The change from intravenous to the oral route of antimicrobials is safe for the patient, economically effective, and significantly reduces waste generation.
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Affiliation(s)
- Vanessa C Hermes
- Núcleo de Gerenciamento de Antimicrobianos - Hospital Santa Cruz, Brasil
| | - Adália P Loureiro
- Núcleo de Gerenciamento de Antimicrobianos - Hospital Santa Cruz, Brasil
| | - Mariana P Assis
- Núcleo de Gerenciamento de Antimicrobianos - Hospital Santa Cruz, Brasil
| | - Fábio Balbinot
- Department Ciência da Vida - Universidade de Santa Cruz, Brasil
| | | | | | - Rochele M Menezes
- Núcleo de Gerenciamento de Antimicrobianos - Hospital Santa Cruz, Brasil
| | - Marcelo Carneiro
- Núcleo de Gerenciamento de Antimicrobianos - Hospital Santa Cruz, Brasil.
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Rudelle K, Kazmierczak C, Grimbert D, Dumoitier N, Pfender E. [Evaluation of professional practices concerning proton pump inhibitors in general medicine]. Therapie 2023; 78:772-775. [PMID: 36841651 DOI: 10.1016/j.therap.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Karen Rudelle
- Département universitaire de médecine générale, faculté de médecine, 87025 Limoges, France; LaboVieSanté, faculté de médecine, 87025 Limoges, France.
| | - Camille Kazmierczak
- Département universitaire de médecine générale, faculté de médecine, 87025 Limoges, France
| | - Dimitri Grimbert
- Département universitaire de médecine générale, faculté de médecine, 87025 Limoges, France
| | - Nathalie Dumoitier
- Département universitaire de médecine générale, faculté de médecine, 87025 Limoges, France; LaboVieSanté, faculté de médecine, 87025 Limoges, France
| | - Elodie Pfender
- Centre d'investigation clinique Inserm 1435, CHU de Limoges, 87042 Limoges, France
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15
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van der Horst SFB, van Rein N, van Mens TE, Huisman MV, Klok FA. Inappropriate prescriptions of direct oral anticoagulants (DOACs) in hospitalized patients: A narrative review. Thromb Res 2023; 231:135-140. [PMID: 37005194 DOI: 10.1016/j.thromres.2023.03.007] [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: 02/03/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Direct oral anticoagulants (DOACs) have become the cornerstone for prevention of thromboembolic events in patients with atrial fibrillation and patients with a history of venous thromboembolism. However, studies show that DOAC prescriptions are commonly inconsistent with guideline recommendations. DOAC dosing in the acutely ill patient could impose an even greater challenge. In this review, we describe the prevalence of inappropriate inpatient prescribing of DOACs and the associated rationales, predictors and clinical consequences. With the aim of promoting appropriate prescriptions of DOACs to hospitalized patients, we further outline DOAC dose reduction criteria justified by various guidelines, illustrating the complexities of appropriate dosing, especially in acutely ill patients. Moreover, we will discuss the impact of anticoagulant stewardship programs and the vital role that pharmacists may play in optimizing inpatient DOAC treatment.
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Affiliation(s)
- S F B van der Horst
- Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, Netherlands.
| | - N van Rein
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - T E van Mens
- Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, Netherlands; Amsterdam UMC, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Reproduction and Development, University of Amsterdam, Amsterdam, Netherlands
| | - M V Huisman
- Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, Netherlands
| | - F A Klok
- Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, Netherlands
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16
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Wang SY, Larrain N, Groene O. Can peer effects explain prescribing appropriateness? a social network analysis. BMC Med Res Methodol 2023; 23:252. [PMID: 37898770 PMCID: PMC10613382 DOI: 10.1186/s12874-023-02048-7] [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: 05/17/2022] [Accepted: 09/25/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Optimizing prescribing practices is important due to the substantial clinical and financial costs of polypharmacy and an increasingly aging population. Prior research shows the importance of social relationships in driving prescribing behaviour. Using social network analysis, we examine the relationship between a physician practices' connectedness to peers and their prescribing performance in two German regions. METHODS We first mapped physician practice networks using links established between two practices that share 8 or more patients; we calculated network-level (density, average path length) and node-level measures (degree, betweenness, eigenvector). We defined prescribing performance as the total number of inappropriate medications prescribed or appropriate medications not prescribed (PIMs) to senior patients (over the age of 65) during the calendar year 2016. We used FORTA (Fit fOR The Aged) algorithm to classify medication appropriateness. Negative binomial regression models estimate the association between node-level measures and prescribing performance of physician practices controlling for patient comorbidity, provider specialization, percentage of seniors in practice, and region. We conducted two sensitivity analyses to test the robustness of our findings - i) limiting the network mapping to patients younger than 65; ii) limiting the network ties to practices that share more than 25 patients. RESULTS We mapped two patient-sharing networks including 436 and 270 physician practices involving 28,508 and 20,935 patients and consisting of 217,126 and 154,274 claims in the two regions respectively. Regression analyses showed a practice's network connectedness as represented by degree, betweenness, and eigenvector centrality, is significantly negatively associated with prescribing performance (degree-bottom vs. top quartile aRR = 0.04, 95%CI: 0.035,0.045; betweenness-bottom vs. top quartile aRR = 0.063 95%CI: 0.052,0.077; eigenvector-bottom vs. top quartile aRR = 0.039, 95%CI: 0.034,0.044). CONCLUSIONS Our study provides evidence that physician practice prescribing performance is associated with their peer connections and position within their network. We conclude that practices occupying strategic positions at the edge of networks with advantageous access to novel information are associated with better prescribing outcomes, whereas highly connected practices embedded in insulated information environments are associated with poor prescribing performance.
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Affiliation(s)
- Sophie Y Wang
- Hamburg Center for Health Economics, Esplanade 36, 20354, Hamburg, Germany.
- OptiMedis AG, Buchardstraße 17, 20095, Hamburg, Germany.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Nicolas Larrain
- Hamburg Center for Health Economics, Esplanade 36, 20354, Hamburg, Germany
- Employment, Labour and Social Affairs, Health Division, OECD, 2 Rue André Pascal, Cedex 16, 75775, Paris, France
| | - Oliver Groene
- OptiMedis AG, Buchardstraße 17, 20095, Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten, Alfred-Herrhausen-Straße 50, 58455, HerdeckeWitten, Germany
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17
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Teoh L, Park JS, Moses G, McCullough M, Page A. To prescribe or not to prescribe? A review of the Prescribing Competencies Framework for dentistry. J Dent 2023; 137:104654. [PMID: 37574106 DOI: 10.1016/j.jdent.2023.104654] [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: 07/05/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES Dentists in Australia are the second largest prescriber group, and are generally not formally taught how to prescribe. The objective of this review is to describe the Prescribing Competencies Framework and its relevance to dentistry. DATA The four-model stage of prescribing by Coombes and colleagues, and the seven competencies within the Prescribing Competencies Framework devised by the Australian National Prescribing Service MedicineWise, are discussed and applied to dentistry. SOURCES AND STUDY SELECTION Each of the seven competencies are analysed and detailed in the context of clinical dental practice. Competencies 1-5 describe the skillset and tasks required by dentists to safely prescribe, whereas Competencies 6 and 7 describe the clinical environment and recommended resources to support dentists to prescribe safely and effectively. CONCLUSIONS The Prescribing Competencies Framework provides an overview of safe and effective prescribing. Prescribing is a process, and a separate skillset to clinical dentistry. The process involves information gathering, clinical assessment, effective communication and review of the patient. Access to timely and appropriate resources and relevant electronic sources of health information for clinicians are important to provide the support required for better informed prescribing decisions. The framework describes a patient-centered prescribing process, and ultimately prescribing should be a shared decision between the dentist and the patient. CLINICAL SIGNIFICANCE Safe and effective prescribing is an integral part of dentistry and dentists are the second largest prescriber group. However, dentists display high rates of inappropriate and unnecessary prescribing, and to minimise errors, the Prescribing Competencies Framework has been established. This article details how the Framework applies to clinical practice dentistry.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia.
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Geraldine Moses
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Western Australia, Australia
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Meurant A, Lescure P, Lafont C, Pommier W, Delmas C, Descatoire P, Baudon M, Muzard A, Villain C, Jourdan JP. Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults. Eur J Clin Pharmacol 2023; 79:1391-1400. [PMID: 37597081 DOI: 10.1007/s00228-023-03551-y] [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: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients. METHODS A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores. RESULTS There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = - 0.13 [- 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = - 0.39 [- 0.72; - 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03). CONCLUSION Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction.
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Affiliation(s)
- Alexandre Meurant
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France.
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France.
| | - Pascale Lescure
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Claire Lafont
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Wilhelm Pommier
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Claire Delmas
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
| | - Pablo Descatoire
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
- Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France
| | - Marie Baudon
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France
| | - Alexandra Muzard
- Department of Pharmacy, University Hospital of Caen Normandie, Caen, France
| | - Cédric Villain
- Department of Geriatrics, University Hospital of Caen Normandie, Caen, France
- Normandie University, Unicaen, INSERM U1075, COMETE, Caen, France
| | - Jean-Pierre Jourdan
- Department of Pharmacy, Vire Hospital, Vire, France
- Normandie University, UNICAEN, CERMN (Centre d'Etudes et de Recherche sur le Médicament de Normandie), F-14032, Caen, France
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Tampaki M, Livada A, Fourka MN, Lazaridou E, Kotsani M, Benetos A, Sfikakis PP, Kravvariti E. Inappropriate prescribing in geriatric rural primary care: impact on adverse outcomes and relevant risk factors in a prospective observational cohort study. Aging Clin Exp Res 2023; 35:1901-1907. [PMID: 37428424 PMCID: PMC10460359 DOI: 10.1007/s40520-023-02475-y] [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: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Several tools have revealed an association between potentially inappropriate medications (PIM) and adverse outcomes, but the one most fitted for the rural population has not been determined. AIMS We investigated the performance of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) in identifying inappropriate prescribing and its association with adverse outcomes among older rural primary health care users. METHODS A cohort of consenting outpatients aged ≥ 65 years in a rural Greek primary care center was assessed for PIM and potential prescribing omissions (PPO) using the START/STOPP version 2 criteria. Medications, comorbidities, functional status, and laboratory data were recorded along with 6-month incidence of emergency department visits, hospitalization, and death prospectively. RESULTS Among 104 participants (median age 78 years, 49.1% women, receiving a median of 6 drugs), PPO was found in 78% and PIMs in 61%. PIM was multivariately correlated with multimorbidity (p = 0.029) and polypharmacy (p < 0,001), while drug-PPO was only associated with multimorbidity (p = 0.039). The number of PIM predicted emergency department visits and hospitalizations at 6-month follow-up (p value 0.011), independent of age, sex, frailty, comorbidities, and total medication number. DISCUSSION The START/STOPP tool is useful in identifying inappropriate prescribing patterns leading to increased utilization of acute care services in older adults followed at a rural primary care setting. CONCLUSION Inappropriate prescribing as identified by the START/STOPP criteria is prevalent among older adults with multimorbidity in rural primary care, and independently associated with future acute care visits.
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Affiliation(s)
- Maria Tampaki
- Postgraduate Medical Studies in Geriatric Syndromes and Physiology of Aging, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Livada
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Maria-Niki Fourka
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Elli Lazaridou
- Primary Medical Care Unit of Marmari, S. Evia, General Hospital of Karystos, Karystos, Greece
| | - Marina Kotsani
- Pôle « Maladies du Vieillissement, Gérontologie Et Soins Palliatifs », Université de Lorraine, CHRU-Nancy, Nancy, France
- Hellenic Society for the Study and Research of Aging, Athens, Greece
| | - Athanase Benetos
- Pôle « Maladies du Vieillissement, Gérontologie Et Soins Palliatifs », and INSERM DCAC u1116, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias St., Goudi, 11527, Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic and Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias St., Goudi, 11527, Athens, Greece.
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Jenghua K, Wutthi K, Wannakrachang C, Chathongyos S, Ngamsom P. Assessing medication use quality in older outpatients using the Beers criteria: findings from a single-center retrospective study. Ann Geriatr Med Res 2023:agmr.23.0036. [PMID: 37305900 DOI: 10.4235/agmr.23.0036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/21/2023] [Indexed: 06/13/2023] Open
Abstract
Background No comprehensive assessment of the quality of medications used in older outpatients has been conducted in Thailand. This study aimed to ascertain the prevalence of and factors contributing to older outpatients' use of potentially inappropriate medications (PIMs). Methods This cross-sectional study retrospectively assessed the prescriptions of older (60 years) outpatients at a secondary-care hospital. For PIM identification, the 2019 American Geriatric Society (AGS) Beers criteria were applied, considering all five PIM categories: PIM category I (medications that are potentially inappropriate in most older adults), II (disease-/syndrome-exacerbating drugs), III (medications that should be used with caution), IV (clinically important drug-drug interactions), and V (medications that should be avoided or have their dosage reduced based on renal function). Results This study included 22,099 patients (mean age = 68.86 ± 7.64 years). Nearly three-fourths of patients were prescribed PIMs, with 68.90%, 7.68%, 44.23%, 15.66%, and 3.05%, respectively, receiving category I-V medications. The positive factors associated with PIM use included female sex (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.01-1.16), age 75 years (OR = 1.10, 95% CI = 1.01-1.21), polypharmacy (OR = 10.21, 95% CI = 9.31-11.21), 3 diagnostic categories (OR = 2.31, 95% CI = 2.14-2.50), and 3 chronic morbidities (OR = 1.46, 95% CI = 1.26-1.68). The negative factor associated with PIM use was a comorbidity score of 1 (OR = 0.78, 95% CI = 0.71-0.86). Conclusion PIM use among older outpatients remains highly prevalent in clinical practice. The results of this study identified polypharmacy as the strongest factor affecting PIM use.
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Affiliation(s)
- Kittipak Jenghua
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical care, School of Pharmaceutical Sciences, University of Phayao, Phayao Province, Thailand
- Pharmacoepidemiology, Social and Administrative Pharmacy (PSAP) Research Unit, School of Pharmaceutical Sciences, University of Phayao, Phayao Province, Thailand
| | - Kanchira Wutthi
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical care, School of Pharmaceutical Sciences, University of Phayao, Phayao Province, Thailand
| | - Chanisorn Wannakrachang
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical care, School of Pharmaceutical Sciences, University of Phayao, Phayao Province, Thailand
| | - Sitanan Chathongyos
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical care, School of Pharmaceutical Sciences, University of Phayao, Phayao Province, Thailand
| | - Panadda Ngamsom
- Pharmacy Department, Chiangkham Hospital, Phayao Province, Thailand
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González-Munguía S, Munguía-López O, Sánchez Sánchez E. Pharmacist comprehensive review of fall-risk-increasing drugs and polypharmacy in elderly Spanish community patients using RStudio®. Heliyon 2023; 9:e17079. [PMID: 37383189 PMCID: PMC10293665 DOI: 10.1016/j.heliyon.2023.e17079] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
Objective The aim of this study is to identify and analyze adults aged ≥65 years living in the Canary Islands, Spain, who are prescribed medications that increase the risk of falls and are polymedicated. To do so we have made use of the electronic prescription and the RStudio®. Method For the detection of Fall-Risk-Increasing Drugs (FRIDs), outpatient electronic prescription dispensing data were used in two pharmacies. A total of 118,890 dispensations grouped into 15,601 treatment plans for 2,312 patients were analyzed. The FRIDs analyzed were antipsychotics (APSI), benzodiazepines (BZPN), antidepressants (DEPR), opioids (OPIO) and Z-hypnotics (ZHIP). For the development of the algorithms for the construction of tables and data screening, the statistical programming language RStudio® was used. Results Of the total number of patients and prescriptions analyzed, 46.6% were polymedicated and 44.3% had prescribed an FRID. 28.7% of the patients presented both factors, had a dispensation from an FRID and were polymedicated. Of the 14,278 dispensations with FRID, 49% had a benzodiazepine, 22.7% opioids, 18% antidepressants, 5.6% hypnotics, and finally 4.4% antipsychotics. At least 32% of the patients had been dispensed a benzodiazepine together with another FRID and 23% an opioid together with another FRID. Conclusions The method of analysis developed and applied in RStudio® allows to detect and determine in a simple and fast way polymedicated patients, as well as the number and therapeutic class of drugs in their treatment plan and identify prescriptions that can increase the risk of falls. Our results show a high number of prescriptions for benzodiazepines and opioids.
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Affiliation(s)
- Silvia González-Munguía
- Hospital Universitario Nuestra Señora de la Candelaria. Servicio de Farmacia. Carretera General del Rosario, 145 Santa Cruz de Tenerife, 38010 Tenerife, Spain
- Programa de Doctorado en Ciencias de la Salud. Universidad de La Laguna, 38200 San Cristóbal de La Laguna. Tenerife, Spain
| | - Obdulia Munguía-López
- Departamento de Ingeniería Química y Tecnología Farmacéutica, UD Farmacia y Tecnologia Farmacéutica. Facultad de Farmacia, Universidad de La Laguna, 38200 San Cristóbal de La Laguna. Tenerife, Spain
| | - Esther Sánchez Sánchez
- Departamento de Ingeniería Química y Tecnología Farmacéutica, UD Farmacia y Tecnologia Farmacéutica. Facultad de Farmacia, Universidad de La Laguna, 38200 San Cristóbal de La Laguna. Tenerife, Spain
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22
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Magallón Martínez A, Pinilla Rello A, Casajús Lagranja P, García Aranda A, Bueno Castel MDC, Caballero Asensio R, Sevil Puras M, Abad Sazatornil MR. Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. Farm Hosp 2023; 47:106-112. [PMID: 36842862 DOI: 10.1016/j.farma.2023.01.004] [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: 06/28/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE To assess the pharmacist's contributions by analyzing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019-June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and Priscus criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge. 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favored deprescription.
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Affiliation(s)
| | | | | | | | | | | | - María Sevil Puras
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
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23
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Magallón Martínez A, Pinilla Rello A, Casajús Lagranja P, García Aranda A, Bueno Castel MDC, Caballero Asensio R, Sevil Puras M, Abad Sazatornil MR. Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. Farm Hosp 2023; 47:T106-T112. [PMID: 37032197 DOI: 10.1016/j.farma.2023.03.005] [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: 06/28/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To assess the pharmacist's contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.
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Affiliation(s)
| | | | | | - Alfonso García Aranda
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - María Sevil Puras
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
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Okeowo DA, Zaidi STR, Fylan B, Alldred DP. Barriers and facilitators of implementing proactive deprescribing within primary care: a systematic review. Int J Pharm Pract 2023; 31:126-152. [PMID: 36860190 DOI: 10.1093/ijpp/riad001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 06/03/2022] [Accepted: 01/05/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Proactive deprescribing - identifying and discontinuing medicines where harms outweigh benefits - can minimise problematic polypharmacy, but has yet to be implemented into routine practice. Normalisation process theory (NPT) can provide a theory-informed understanding of the evidence base on what impedes or facilitates the normalisation of routine and safe deprescribing in primary care. This study systematically reviews the literature to identify barriers and facilitators to implementing routine safe deprescribing in primary care and their effect on normalisation potential using NPT.PubMed, MEDLINE, Embase, Web of Science, International Pharmaceutical Abstracts, CINAHL, PsycINFO and The Cochrane Library were searched (1996-2022). Studies of any design investigating the implementation of deprescribing in primary care were included. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used to appraise quality. Barriers and facilitators from included studies were extracted and mapped to the constructs of NPT. KEY FINDINGS A total of 12,027 articles were identified, 56 articles included. In total, 178 barriers and 178 facilitators were extracted and condensed into 14 barriers and 16 facilitators. Common barriers were negative deprescribing perceptions and suboptimal deprescribing environments, while common facilitators were structured education and training on proactive deprescribing and utilising patient-centred approaches. Very few barriers and facilitators were associated with reflexive monitoring, highlighting a paucity of evidence on how deprescribing interventions are appraised. SUMMARY Through NPT, multiple barriers and facilitators were identified that impede or facilitate the implementation and normalisation of deprescribing in primary care. However, more research is needed into the appraisal of deprescribing post-implementation.
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Affiliation(s)
- Daniel A Okeowo
- School of Healthcare, University of Leeds, Leeds, Yorkshire, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Syed Tabish R Zaidi
- School of Healthcare, University of Leeds, Leeds, Yorkshire, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Beth Fylan
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, Yorkshire, UK.,Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, Yorkshire, UK
| | - David P Alldred
- School of Healthcare, University of Leeds, Leeds, Yorkshire, UK.,NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
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Lee K, Kouladjian O'Donnell L, Cross AJ, Hawthorne D, Page AT. Clinical pharmacists' reported approaches and processes for undertaking Home Medicines Review services: A national survey. Arch Gerontol Geriatr 2023; 109:104965. [PMID: 36821873 DOI: 10.1016/j.archger.2023.104965] [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: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Comprehensive medicines reviews are a strategy to reduce medicines-related harm. In Australia, Home Medicines Review services (HMRs) are provided by consultant pharmacists to community-dwelling consumers, on referral from the consumer's medical practitioner. Limited research exists on the processes undertaken by consultant pharmacists when delivering HMRs, particularly as it relates to the information types received, collected, and reported. OBJECTIVE Describe the types of information consultant pharmacists report receiving in HMR referrals, collect before and during consumer consultations, and include in their written reports. MATERIALS AND METHODS We conducted a national online survey of Australian consultant pharmacists who deliver HMRs. Participants were recruited using a broad advertising strategy, including social and traditional media platforms, and snowballing. Data were analysed descriptively. RESULTS Of the 248 eligible participants, 179 (72%) completed the survey. The most commonly included information in the referral was medication list (97%), the least were details of hospitalisations (8%) and specialist letters (5%). Information pertaining to hospitalisation and specialist letters were collected by 20% of participants prior to the consultation. Details of, and history from, community pharmacy was the most sought information prior to consultations. Less than a quarter of participants 'most of the time' or 'always' formally assess adherence using a validated instrument during the consultation. Participants commonly (80%) report consumer concerns in the written report. CONCLUSIONS Consultant pharmacists collect a broad variety of information, beyond medicines-related content. Written HMR reports by consultant pharmacists were often reported to be consumer-centric.
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Affiliation(s)
- Kenneth Lee
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia.
| | - Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Sydney, Australia
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, Australia
| | - Deborah Hawthorne
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia; Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Amy Theresa Page
- Centre for Optimisation of Medicines, Discipline of Pharmacy, School of Allied Health, University of Western Australia, Perth, Australia; Western Australian Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
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Tang J, Wang K, Yang K, Jiang D, Fang X, Su S, Lin Y, Chen S, Gu H, Li P, Yan S. A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study. BMC Geriatr 2023; 23:44. [PMID: 36694126 PMCID: PMC9875512 DOI: 10.1186/s12877-023-03743-2] [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: 06/20/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Research on potentially inappropriate medications (PIM) and medication-related problems (MRP) among the Chinese population with chronic diseases and polypharmacy is insufficient. OBJECTIVES This study aimed to investigate the prevalence of PIM and MRP among older Chinese hospitalized patients with chronic diseases and polypharmacy and analyze the associated factors. METHODS A retrospective cross-sectional study was conducted in five tertiary hospitals in Beijing. Patients aged ≥ 65 years with at least one chronic disease and taking at least five or more medications were included. Data were extracted from the hospitals' electronic medical record systems. PIM was evaluated according to the 2015 Beers criteria and the 2014 Screening Tool of Older Persons' Prescriptions (STOPP) criteria. MRPs were assessed and classified according to the Helper-Strand classification system. The prevalence of PIM and MRP and related factors were analyzed. RESULTS A total of 852 cases were included. The prevalence of PIM was 85.3% and 59.7% based on the Beers criteria and the STOPP criteria. A total of 456 MRPs occurred in 247 patients. The most prevalent MRP categories were dosages that were too low and unnecessary medication therapies. Hyperpolypharmacy (taking ≥ 10 drugs) (odds ratio OR 3.736, 95% confidence interval CI 1.541-9.058, P = 0.004) and suffering from coronary heart disease (OR 2.620, 95%CI 1.090-6.297, P = 0.031) were the influencing factors of inappropriate prescribing (the presence of either PIM or MRP in a patient). CONCLUSION PIM and MRP were prevalent in older patients with chronic disease and polypharmacy in Chinese hospitals. More interventions are urgently needed to reduce PIM use and improve the quality of drug therapies.
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Affiliation(s)
- Jing Tang
- grid.413259.80000 0004 0632 3337Department of Pharmacy, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District 100053 Beijing, China ,National Clinical Research Center for Geriatric Disorders, Beijing, 100053 China
| | - Ke Wang
- grid.413259.80000 0004 0632 3337Department of Pharmacy, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District 100053 Beijing, China ,National Clinical Research Center for Geriatric Disorders, Beijing, 100053 China
| | - Kun Yang
- grid.413259.80000 0004 0632 3337Department of Evidence-Based Medicine, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, Beijing, 100053 China
| | - Dechun Jiang
- grid.413259.80000 0004 0632 3337Department of Pharmacy, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District 100053 Beijing, China ,National Clinical Research Center for Geriatric Disorders, Beijing, 100053 China
| | - Xianghua Fang
- grid.413259.80000 0004 0632 3337Department of Evidence-Based Medicine, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, Beijing, 100053 China
| | - Su Su
- grid.413259.80000 0004 0632 3337Department of Pharmacy, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District 100053 Beijing, China ,National Clinical Research Center for Geriatric Disorders, Beijing, 100053 China
| | - Yang Lin
- grid.411606.40000 0004 1761 5917Department of Pharmacy, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029 China
| | - Shicai Chen
- grid.478016.c0000 0004 7664 6350Department of Pharmacy, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149 China
| | - Hongyan Gu
- grid.414367.3Department of Pharmacy, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038 China
| | - Pengmei Li
- grid.415954.80000 0004 1771 3349Department of Pharmacy, China-Japan Friendship Hospital, Beijing, 100029 China
| | - Suying Yan
- grid.413259.80000 0004 0632 3337Department of Pharmacy, Xuanwu Hospital, the First Clinical Medical College of Capital Medical University, No. 45, Changchun Street, Xicheng District 100053 Beijing, China ,National Clinical Research Center for Geriatric Disorders, Beijing, 100053 China
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Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, López-Caicedo DF, Ospina-Cano JA, Oyuela-Gutiérrez MC, Martínez-Pulgarín DF, Machado-Alba JE. Indication-prescription study for the management of conjunctivitis in a Colombian population. Int Ophthalmol 2023; 43:83-93. [PMID: 35776393 PMCID: PMC9247934 DOI: 10.1007/s10792-022-02390-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Conjunctivitis is one of the most common ocular pathologies. Its treatment depends on its etiology, but an excessive use of antibiotics and corticosteroids, which in many cases are contraindicated, has been described. The objective was to describe the prescription patterns of medications used to treat conjunctivitis in a Colombian population. METHODS This was a cross-sectional study on the pharmacological treatment of patients diagnosed with conjunctivitis between April 1, 2020, and March 31, 2021; based on a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian Health System. Some sociodemographic and pharmacological variables and comorbidities were considered. A descriptive analysis was performed. RESULTS A total of 8708 patients were identified; they had a median age of 44.7 years, and 59.3% were women. The most common causes of conjunctivitis were unspecified (53.1%) and allergic (37.4%). The most commonly used drug was olopatadine (26.1%), followed by dexamethasone with neomycin and polymyxin B (25.0%). A total of 97.0% of the patients received ophthalmic prescriptions, while 12.8% received systemic medications. Glucocorticoids (40.3%), antibiotics (37.7%) and antihistamines (31.7%) were the most commonly used groups of ophthalmic drugs. Glucocorticoids and ophthalmic antibiotics were the medications most frequently prescribed by general practitioners for the treatment of viral or bacterial conjunctivitis. CONCLUSIONS Many patients with conjunctivitis are not being managed according to the recommendations of clinical practice guidelines, which highlights that the widespread use of antibiotics with ophthalmic glucocorticoids could be considered potentially inappropriate prescriptions in many cases.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia ,grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia ,grid.441853.f0000 0004 0418 3510Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda Colombia
| | - Manuel Enrique Machado-Duque
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia ,grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia ,grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Diana Fiorella López-Caicedo
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia
| | - Juan Alberto Ospina-Cano
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia
| | - María Camila Oyuela-Gutiérrez
- grid.441853.f0000 0004 0418 3510Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda Colombia
| | - Dayron Fernando Martínez-Pulgarín
- grid.10689.360000 0001 0286 3748Grupo de Investigación en Oftalmología Básica y Clínica, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge Enrique Machado-Alba
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia
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Martínez-Ruiz MG, Corona-Ruiz F, Solís-Rivera AP, Sifuentes-Franco S, Sánchez-López VA, Guevara-Martínez SJ, Huerta-Olvera SG. Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico. GAC MED MEX 2023; 159:147-153. [PMID: 37094248 DOI: 10.24875/gmm.m23000763] [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: 04/26/2023] Open
Abstract
BACKGROUND Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. OBJECTIVE To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. MATERIAL AND METHODS Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. RESULTS A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. CONCLUSIONS A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.
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Affiliation(s)
- Ma Guadalupe Martínez-Ruiz
- Institute of Clinical and Experimental Therapeutics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara
| | - Felisardo Corona-Ruiz
- Institute of Clinical and Experimental Therapeutics, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara
| | - Adriana P Solís-Rivera
- Department of Medical and Life Sciences, Centro Universitario de la Ciénega, Universidad de Guadalajara, Ocotlán
| | - Sonia Sifuentes-Franco
- Laboratory of Biological Systems, Department of Life Sciences, Centro Universitario Los Valles, Universidad de Guadalajara, Ameca
| | | | - Santiago J Guevara-Martínez
- Department of Physics and Nanomaterials, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara. Jalisco, Mexico
| | - Selene G Huerta-Olvera
- Department of Medical and Life Sciences, Centro Universitario de la Ciénega, Universidad de Guadalajara, Ocotlán
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29
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Gendre P, Mocquard J, Artarit P, Chaslerie A, Caillet P, Huon JF. (De)Prescribing of proton pump inhibitors: what has changed in recent years? an observational regional study from the French health insurance database. BMC Prim Care 2022; 23:341. [PMID: 36582006 PMCID: PMC9800230 DOI: 10.1186/s12875-022-01941-2] [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] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. METHODS This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were included, defined as patients who has had PPI dispensed for 3 consecutive months with a temporal coverage of at least 80%. Patients under 18 years of age and patients who received parenteral PPIs only were excluded. RESULTS The percentage of chronic treatment discontinuation in 2017 was 12.5% and remained stable to reach 12.4% in 2020. The number of new chronic patients increased from year to year to reach 77,222 patients in 2020, with an increasing rate of 1.2 to 2% between 2017 and 2020. The prevalent patient population increased from year to year to reach 167 751 patients in 2020, with an increasing rate of 4.2 to 4.4% between 2017 and 2020. Regarding the initiation of PPI therapy, in 2020, 87.1% of treatment initiations were done by general practitioners. They renewed 2,402,263 prescriptions (89.3%) between 2017 and 2020. CONCLUSIONS This study shows a stagnation over the last 4 years in the deprescribing of chronic PPI treatments in a French region despite the information on their inappropriate use reported by national agencies and in the literature with increasing frequency. This reinforces the interest of setting up a deprescribing project.
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Affiliation(s)
- Pauline Gendre
- grid.277151.70000 0004 0472 0371Pharmacy, Nantes Université, CHU Nantes, 44000 Nantes, France
| | - Julie Mocquard
- grid.277151.70000 0004 0472 0371Pharmacy, Nantes Université, CHU Nantes, 44000 Nantes, France
| | - Pascal Artarit
- Medical Department, French National Health Insurance, DRSM, Nantes, France
| | - Anicet Chaslerie
- Medical Department, French National Health Insurance, DRSM, Nantes, France
| | - Pascal Caillet
- grid.277151.70000 0004 0472 0371Public Health Department, Nantes Université, CHU Nantes, 44000 Nantes, France
| | - Jean-François Huon
- grid.277151.70000 0004 0472 0371Pharmacy, Nantes Université, CHU Nantes, 44000 Nantes, France
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30
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Echeverría Gorriti A, Alzueta Istúriz N, García González P, Fernández González J, Sanz Álvarez L, Garjón Parra J. [Off-label use of gabapentinoid drugs: is it necessary a deprescription strategy?]. Gac Sanit 2022; 37:102283. [PMID: 36565565 DOI: 10.1016/j.gaceta.2022.102283] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate gabapentin and pregabalin treatment adequacy to label indications, to analyze off-label use and to identify patients at high risk of respiratory depression. METHOD An observational, retrospective study was performed. It included patients treated with pregabalin and gabapentin during 2020 in Navarre. RESULTS A total of 9778 patients were treated with gabapentin or pregabalin during the first two months of 2020. In 56% of the cases, gabapentinoids were prescribed for off-label uses. Sixty percent of patients were taking at least one central nervous system (CNS) depressant drug concomitantly, 33% of them opioids, 20% of them combined opioids with CNS depressants and 4% of them at least one systemic antihistamine. In addition, 11% of the patients had a diagnosis of asthma or COPD. Prevalences remained constant along the year. CONCLUSIONS It is necessary to implement a gabapentinoid deprescription strategy to improve its use and reduce safety problems.
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Affiliation(s)
- Amaya Echeverría Gorriti
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España.
| | - Natalia Alzueta Istúriz
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Patricia García González
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Julen Fernández González
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Lorea Sanz Álvarez
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Javier Garjón Parra
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
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31
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De Schutter H, Hias J, Hellemans L, Walgraeve K, Tournoy J, Verhamme P, Sinnaeve P, Willems R, Droogné W, Vandenbriele C, Van Aelst L, Vanassche T, Van der Linden L. Consensus validation of a screening tool for cardiovascular pharmacotherapy in geriatric patients: the RASP_CARDIO list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Eur Geriatr Med 2022; 13:1467-76. [PMID: 36229756 DOI: 10.1007/s41999-022-00701-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/26/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Cardiovascular agents commonly used in geriatric patients, are linked to potentially avoidable harm and might hence be a suitable substrate for medication review practices. Therefore, we sought to update and validate the content of the cardiovascular segment of the previously published Rationalization of Home Medication by an Adjusted STOPP list in Older Patients (RASP) List. METHODS A three-step study was conducted by the pharmacy department in collaboration with the geriatric medicine and cardiology department at the University Hospitals Leuven, Belgium. First, the cardiovascular segment of the RASP list version 2014 was updated taking into account published research, other screening tools and the input of end-users. Secondly, this draft was reviewed during three panel discussions with five expert cardiologists and three clinical pharmacists, all of whom had relevant expertise in geriatric pharmacotherapy. Thirdly, the content was validated using a modified Delphi Technique by a panel of European hospital pharmacists, cardiologists, geriatricians and an internal medicine physician. RESULTS After the first and second step, the RASP_CARDIO list comprised 94 statements. Consensus (≥ 80% agreement) of all statements and one new statement about gliflozins in heart failure was achieved by a panel of seventeen experts across four European countries after two validation rounds. The final construct comprised a list of 95 statements related to potentially inappropriate prescribing of cardiovascular agents. CONCLUSION The RASP_CARDIO list is an updated and validated explicit screening tool to optimize cardiovascular pharmacotherapy in geriatric patients.
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Stojadinovic M, Zivkovic Zaric R, Lausevic M, Jemcov T, Komadina L, Petrovic D, Djuric P, Bulatovic A, Jankovic S. Factors Associated with Potentially Inappropriate Prescribing in Patients on Peritoneal Dialysis. Pharmacology 2022; 108:1-7. [PMID: 36446348 DOI: 10.1159/000527263] [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: 08/18/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Inappropriate prescribing is common in patients with end-stage kidney disease, especially in those over 65 years of age. Our study aimed to reveal potentially inappropriate drug prescribing in patients on peritoneal dialysis (PD) and explore factors associated with this phenomenon. METHODS The research was designed as an observational, cross-sectional study on a convenient sample of 145 consecutive patients with PD who attended the four tertiary-care hospitals in Serbia. The main outcome was the extent of inappropriate prescribing, as assessed by the medication appropriateness index, and potential predictors were tested by multiple linear regression. RESULTS Inappropriate prescribing was a widespread phenomenon among patients on PD. The main factors that promote inappropriate prescribing in this subgroup of patients on kidney replacement therapy are comorbidities (p = 0.000), increased body weight (p = 0.022), a number of prescribed drugs (p = 0.000), and arterial hypertension on examination (p = 0.030). On the other hand, drinking alcohol and higher systolic blood pressure were associated with a lower inappropriate prescribing. CONCLUSION In order to prevent the occurrence of inappropriate prescribing and its severe health or economic consequences, clinicians should pay special attention when prescribing new drugs to high-risk patients.
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Affiliation(s)
- Milorad Stojadinovic
- University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Mirjana Lausevic
- University Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Tamara Jemcov
- Medical Faculty, University of Belgrade, Belgrade, Serbia.,Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Ljiljana Komadina
- Medical Faculty, University of Belgrade, Belgrade, Serbia.,Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Dejan Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Petar Djuric
- Medical Faculty, University of Belgrade, Belgrade, Serbia.,Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Ana Bulatovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia.,Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,University Clinical Center of Kragujevac, Kragujevac, Serbia
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33
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Beck A, Persaud N, Tessier LA, Grad R, Kidd MR, Klarenbach S, Korownyk C, Moore A, Thombs BD, Mangin D, McCracken RK, McDonald EG, Sirois C, Kanji S, Molnar F, Nicholls SG, Thavorn K, Bennett A, Shaver N, Skidmore B, Mitchelmore BR, Avey M, Rolland-Harris E, Little J, Moher D. Interventions to address potentially inappropriate prescriptions and over-the-counter medication use among adults 65 years and older in primary care settings: protocol for a systematic review. Syst Rev 2022; 11:225. [PMID: 36266708 PMCID: PMC9585747 DOI: 10.1186/s13643-022-02044-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To inform recommendations by the Canadian Task Force on Preventive Health Care on potentially inappropriate prescribing and over-the-counter (OTC) medication use among adults aged 65 years and older in primary care settings. This protocol outlines the planned scope and methods for a systematic review of the benefits and harms and acceptability of interventions to reduce potentially inappropriate prescriptions and OTC medication use. METHODS De novo systematic reviews will be conducted to synthesize the available evidence on (a) the benefits and harms of interventions to reduce potentially inappropriate prescriptions and OTC medications compared to no intervention, usual care, or non- or minimally active intervention among adults aged 65 years and older and (b) the acceptability of these interventions or attributes among patients. Outcomes of interest for the benefits and harms review are all-cause mortality, hospitalization, non-serious adverse drug reactions, quality of life, emergency department visits, injurious falls, medical visits, and the number of medications (and number of pills). Outcomes for the acceptability review are the preference for and relative importance of different interventions or their attributes. For the benefits and harms review, we will search MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials. For the acceptability review, we will search MEDLINE, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database for experimental and observational studies with a comparator. Websites of relevant organizations, other grey literature sources, and reference lists of included studies and reviews will be searched. Title and abstract screening will be completed by two independent reviewers using the liberal accelerated approach. Full-text review, data extraction, risk of bias assessments, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers, with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE approach will be used to assess the certainty of the evidence for outcomes. DISCUSSION The results of this systematic review will be used by the Canadian Task Force on Preventive Health Care to inform their recommendation on potentially inappropriate prescribing and OTC medication use among adults aged 65 years and older. SYSTEMATIC REVIEW REGISTRATION PROSPERO (KQ1: CRD42022302313; KQ2: CRD42022302324); Open Science Framework ( https://osf.io/urj4b/ ).
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Affiliation(s)
- Andrew Beck
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Navindra Persaud
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laure A Tessier
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Michael R Kidd
- College of Health & Medicine, The Australian National University, Canberra, Australia.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott Klarenbach
- Department of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital and Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of General Practice, University of Otago, Dunedin, New Zealand
| | - Rita K McCracken
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily G McDonald
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Laval University; Centre d'excellence sur le vieillissement de Québec, VITAM research Centre, Québec, Québec, Canada
| | - Salmaan Kanji
- The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Frank Molnar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Geriatric Medicine, The Ottawa Hospital, The Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Alexandria Bennett
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Shaver
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Bradley R Mitchelmore
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Marc Avey
- Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Walsh KA, Byrne S, O'Riordan A, McSharry J, Browne J, Irving K, Hurley E, Timmons S. Rationalising Antipsychotic Prescribing in Dementia (RAPID) complex intervention: A mixed-methods feasibility intervention study. Explor Res Clin Soc Pharm 2022; 8:100190. [PMID: 36277309 PMCID: PMC9579044 DOI: 10.1016/j.rcsop.2022.100190] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To help address the issue of inappropriate antipsychotic prescribing to nursing home residents with dementia, the 'Rationalising Antipsychotic Prescribing in Dementia' (RAPID) complex intervention was developed, comprising staff education and training, academic detailing and a novel resident assessment tool. OBJECTIVES The primary objective was to assess the feasibility and acceptability of the RAPID complex intervention in a nursing home setting. The secondary objective was to describe associated trends in psychotropic prescribing, falls, and behavioural symptoms. METHODS A mixed-methods feasibility intervention study in one large nursing home in Ireland was undertaken between 07/2017 and 01/2018. Focus groups and semi-structured interviews were conducted with nursing home staff and GPs at the end of the 3-month follow up period to assess participants' experience of the intervention. Quantitative measurements included pre- and post-course evaluation and psychotropic prescribing rates. RESULTS Sixteen nursing home staff members attended the two education and training days (21% attendance rate), and four GPs participated in the academic detailing sessions (100% attendance rate). Participants of the focus groups and interviews (n = 18) found the education and training beneficial for their work and expressed a desire to continue educating new staff after the study's completion. However, there was limited usage of the resident assessment tool. Participants also offered recommendations to enhance the intervention.The proportion of dementia residents prescribed at least one regular antipsychotic was stable over the 3-months pre-intervention at 45% (n = 18), and at baseline at 44% (n = 19) but decreased slightly to 36% (n = 14) at 3-months post-intervention. At the same time the absolute number of 'PRN' psychotropics administered monthly to dementia residents decreased substantially from 90 at baseline to 69 at 3-months post-intervention. CONCLUSION The RAPID complex intervention was broadly feasible to conduct and may be acceptable to stakeholders. However, before it can be evaluated in larger scale studies, certain protocol modifications and further exploratory work are required to improve implementation.
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Key Words
- ABC, Antecedent-Behaviour-Consequence
- Antipsychotics
- BCW, behaviour change wheel
- BPSD, behavioural and psychological symptoms of dementia
- CNM, clinical nurse manager
- COS, core outcome set
- CPZ, chlorpromazine
- Dementia
- Feasibility study
- GP, general practitioner
- GRAMMS, Good Reporting of A Mixed-Methods Study
- HCA, healthcare assistant
- Inappropriate prescribing
- Long term care facility
- MRC, Medical Research Council
- NIHR, National Institute for Health Research
- NPI-NH, neuropsychiatric inventory - nursing home version
- Nursing home
- OD, occupational disruptiveness
- PINCH-ME, Pain, Infection, Nutrition, Constipation, Hydration, Medication and Environment
- PRN, pro re nata
- QUM-D, quality use of medicines in dementia
- RAPID, Rationalising Antipsychotic Prescribing in Dementia
- WHO-ATC, World Health Organization Anatomical Therapeutic Chemical
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Affiliation(s)
- Kieran A. Walsh
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
- Corresponding author at: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork T12YN60, Ireland.
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Alex O'Riordan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Eimir Hurley
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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35
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Mansbart F, Kienberger G, Sönnichsen A, Mann E. Efficacy and safety of adrenergic alpha-1 receptor antagonists in older adults: a systematic review and meta-analysis supporting the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr 2022; 22:771. [PMID: 36171560 PMCID: PMC9516834 DOI: 10.1186/s12877-022-03415-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/01/2021] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Adrenergic alpha-1 receptor antagonists (alpha-1 antagonists) are frequently used medications in the management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and in the management of therapy-resistant arterial hypertension, two conditions frequently found in older adults. This systematic review aims at presenting a complete overview of evidence over the benefits and risks of alpha-1 antagonist treatment in people ≥ 65 years, and at deriving recommendations for a safe application of alpha-1 antagonists in older adults from the evidence found. Methods A comprehensive literature search was performed (last update March 25th 2022) including multiple databases (Medline/Pubmed, Embase, the Cochrane Library) and using the PICOS framework to define search terms. The selection of the studies was done by two independent reviewers in a two-step approach, followed by a systematic data extraction. Quality appraisal was performed for each study included using standardised appraisal tools. The studies retrieved and additional literature were used for the development of recommendations, which were rated for strength and quality according to the GRADE methodology. Results Eighteen studies were included: 3 meta-analyses, 6 randomised controlled trials and 9 observational trials. Doxazosin in the management of arterial hypertension was associated with a higher risk of cardiovascular disease, particularly heart failure, than chlorthalidone. Regarding treatment of LUTS suggestive of BPH, alpha-1 antagonists appeared to be effective in the relief of urinary symptoms and improvement of quality of life. They seemed to be less effective in preventing disease progression. Analyses of the risk profile indicated an increase in vasodilation related adverse events and sexual adverse events for some agents. The risk of falls and fractures as well as the effects of long-term treatment remained unclear. All meta-analyses and 5 out of 6 interventional studies were downgraded in the quality appraisal. 7 out of 9 observational studies were of good quality. Conclusions It cannot be recommended to use doxazosin as first-line antihypertensive agent neither in older adults nor in younger patients. In the management of BPH alpha-1 antagonists promise to effectively relieve urinary symptoms with uncertainty regarding their efficacy in preventing long-term progression events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03415-7.
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Affiliation(s)
- Felix Mansbart
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Gerda Kienberger
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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Pazan F, Breunig H, Weiss C, Röhr S, Luppa M, Pentzek M, Bickel H, Weeg D, Weyerer S, Wiese B, König HH, Brettschneider C, Heser K, Maier W, Scherer M, Riedel-Heller S, Wagner M, Wehling M. Higher FORTA (Fit fOR The Aged) scores are associated with poor functional outcomes, dementia, and mortality in older people. Eur J Clin Pharmacol 2022. [PMID: 36167853 DOI: 10.1007/s00228-022-03389-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe-AgeQualiDe cohort of community-dwelling older people. In particular, the longitudinal relation between the FORTA score and mortality and the incidence of dementia was evaluated. METHODS Univariate and multivariate correlations between the FORTA score and activities of daily living (ADL) or instrumental activities of daily living (IADL) as well as comparisons between high vs. low FORTA scores were conducted. RESULTS The FORTA score was significantly correlated with ADL/IADL at baseline and at all follow-up visits (p < 0.0001). ADL/IADL results of participants with a low FORTA score were significantly better than in those with high FORTA scores (p < 0.0001). The FORTA score was also significantly (p < 0.0001) correlated with ADL/IADL in the multivariate analysis. Moreover, the mean FORTA scores of participants with dementia were significantly higher (p < 0.0001) than in those without dementia at follow-up visits 6 through 9. The mean FORTA scores of participants who died were significantly higher than those of survivors at follow-up visits 7 (p < 0.05), 8 (p < 0.001), and 9 (p < 0.001). CONCLUSION In this study, an association between higher FORTA scores and ADL as well as IADL was demonstrated in community-dwelling older adults. Besides, higher FORTA scores appear to be linked to a higher incidence of dementia and even mortality.
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Hias J, Hellemans L, Laenen A, Walgraeve K, Liesenborghs A, De Geest S, Luyten J, Spriet I, Flamaing J, Van der Linden L, Tournoy J. The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial. Contemp Clin Trials 2022; 119:106853. [PMID: 35842106 DOI: 10.1016/j.cct.2022.106853] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Unplanned rehospitalizations occur frequently in older patients. Drug-related problems constitute a major and largely preventable cause with inappropriate prescribing being a substantial culprit. Solutions are needed to reduce this risk by targeting pharmacotherapy both during and after hospital stay. Therefore, we aim to perform a randomized controlled trial in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health-related outcomes. METHODS/DESIGN The study concerns a monocenter, non-blinded, randomized controlled trial that will take place at the acute geriatric wards of a large academic hospital. Patients being in a palliative stage with active therapy withdrawal or patients discharged to another ward within the same hospital or another hospital are excluded. In total, 828 patients will be randomized (1:1) to the usual care or intervention group. The multifaceted clinical pharmacy intervention comprises medication reconciliation at admission and discharge, medication review, patient/caregiver education, intensified communication with primary care providers and post-discharge follow-up, which also includes a telepharmacology service. The primary endpoint is defined as the time to an all-cause, unplanned hospital revisit within six months after discharge. Other health-related outcomes such as drug-related readmissions, quality of life and number of potentially inappropriate medications will be analyzed as secondary endpoints. Patient inclusion started in February 2021. DISCUSSION This study will provide useful insights regarding the impact of clinical pharmacy interventions on geriatric wards with the goal to optimize health-related outcomes such as hospital revisits. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04617340.
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Affiliation(s)
- Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | | | | | - Sabina De Geest
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Jeroen Luyten
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Tamargo J, Kjeldsen KP, Delpón E, Semb AG, Cerbai E, Dobrev D, Savarese G, Sulzgruber P, Rosano G, Borghi C, Wassman S, Torp-Pedersen CT, Agewall S, Drexel H, Baumgartner I, Lewis B, Ceconi C, Kaski JC, Niessner A. Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Cardiovasc Pharmacother 2022; 8:406-419. [PMID: 35092425 DOI: 10.1093/ehjcvp/pvac005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022]
Abstract
Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVDs) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently underrepresented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity, and polypharmacy. Our goal is to provide information that can contribute to improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, and Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid,Spain
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemme Hospital, Oslo, Norway
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Hospital, Rome, Italy
| | - Claudio Borghi
- Medicine and Surgery Science Department, University of Bologna, Bologna, Italy
| | - Seven Wassman
- Cardiology Pasing, Munich, and Faculty of Medicine, University of the Saarland, Homburg/Saar, Germany
| | - Christian Tobias Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Heinz Drexel
- Department of Internal Medicine and Cardiology, VIVIT Institute, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Basil Lewis
- Department of Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Claudio Ceconi
- UO Cardiologia, Ospedale di Desenzano del Garda, Desenzano del Garda, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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García Pliego RA, Baena Díez JM, Herreros Herreros Y, Acosta Benito MÁ. [Deprescription in old people: It's time to take action]. Aten Primaria 2022; 54:102367. [PMID: 35653980 DOI: 10.1016/j.aprim.2022.102367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
El uso de fármacos conlleva innegables beneficios en las personas mayores, pero no está exento de efectos indeseables. La deprescripción es el proceso de revisión sistemática de la medicación con el objetivo de lograr la mejor relación riesgo-beneficio en base a la mejor evidencia disponible. Este proceso es especialmente importante en mayores polimedicados, sobretratados, frágiles, con enfermedades terminales y en el final de la vida. La deprescripción debe hacerse de forma escalonada, estableciendo un seguimiento estrecho por si aparecen problemas tras la retirada. En la toma de decisiones es muy importante contar con la opinión del paciente y de los cuidadores, valorando los objetivos del tratamiento según la situación clínica, funcional y social del enfermo. Existen múltiples herramientas para facilitar a los clínicos la tarea de seleccionar qué fármacos deprescribir (criterios Beers, STOPP-START…). Los grupos farmacológicos más susceptibles de intervención son: antihipertensivos, antidiabéticos, estatinas, benzodiacepinas, antidepresivos, anticolinérgicos, anticolinesterásicos y neurolépticos.
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Tuti T, Aluvaala J, Malla L, Irimu G, Mbevi G, Wainaina J, Mumelo L, Wairoto K, Mochache D, Hagel C, Maina M, English M. Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol. Implement Sci 2022; 17:32. [PMID: 35578243 PMCID: PMC9109356 DOI: 10.1186/s13012-022-01203-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Medication errors are likely common in low- and middle-income countries (LMICs). In neonatal hospital care where the population with severe illness has a high mortality rate, around 14.9% of drug prescriptions have errors in LMICs settings. However, there is scant research on interventions to improve medication safety to mitigate such errors. Our objective is to improve routine neonatal care particularly focusing on effective prescribing practices with the aim of achieving reduced gentamicin medication errors. METHODS We propose to conduct an audit and feedback (A&F) study over 12 months in 20 hospitals with 12 months of baseline data. The medical and nursing leaders on their newborn units had been organised into a network that facilitates evaluating intervention approaches for improving quality of neonatal care in these hospitals and are receiving basic feedback generated from the baseline data. In this study, the network will (1) be expanded to include all hospital pharmacists, (2) include a pharmacist-only professional WhatsApp discussion group for discussing prescription practices, and (3) support all hospitals to facilitate pharmacist-led continuous medical education seminars on prescription practices at hospital level, i.e. default intervention package. A subset of these hospitals (n = 10) will additionally (1) have an additional hospital-specific WhatsApp group for the pharmacists to discuss local performance with their local clinical team, (2) receive detailed A&F prescription error reports delivered through mobile-based dashboard, and (3) receive a PDF infographic summarising prescribing performance circulated to the clinicians through the hospital-specific WhatsApp group, i.e. an extended package. Using interrupted time series analysis modelling changes in prescribing errors over time, coupled with process fidelity evaluation, and WhatsApp sentiment analysis, we will evaluate the success with which the A&F interventions are delivered, received, and acted upon to reduce prescribing error while exploring the extended package's success/failure relative to the default intervention package. DISCUSSION If effective, these theory-informed A&F strategies that carefully consider the challenges of LMICs settings will support the improvement of medication prescribing practices with the insights gained adapted for other clinical behavioural targets of a similar nature. TRIAL REGISTRATION PACTR, PACTR202203869312307 . Registered 17th March 2022.
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Affiliation(s)
- Timothy Tuti
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Jalemba Aluvaala
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Lucas Malla
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- London School of Hygiene and Tropical Medicine, London, UK
| | - Grace Irimu
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - George Mbevi
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - John Wainaina
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Kefa Wairoto
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Christiane Hagel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michuki Maina
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Bassetti S, Tschudin-Sutter S, Egli A, Osthoff M. Optimizing antibiotic therapies to reduce the risk of bacterial resistance. Eur J Intern Med 2022; 99:7-12. [PMID: 35074246 DOI: 10.1016/j.ejim.2022.01.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 01/02/2023]
Abstract
The incidence of infections caused by bacteria that are resistant to antibiotics is constantly increasing. In Europe alone, it has been estimated that each year about 33'000 deaths are attributable to such infections. One important driver of antimicrobial resistance is the use and abuse of antibiotics in human medicine. Inappropriate prescribing of antibiotics is still very frequent: up to 50% of all antimicrobials prescribed in humans might be unnecessary and several studies show that at least 50% of antibiotic treatments are inadequate, depending on the setting. Possible strategies to optimize antibiotic use in everyday clinical practice and to reduce the risk of inducing bacterial resistance include: the implementation of rapid microbiological diagnostics for identification and antimicrobial susceptibility testing, the use of inflammation markers to guide initiation and duration of therapies, the reduction of standard durations of antibiotic courses, the individualization of antibiotic therapies and dosing considering pharmacokinetics/pharmacodynamics targets, and avoiding antibiotic classes carrying a higher risk for induction of bacterial resistance. Importantly, measures to improve antibiotic prescribing and antibiotic stewardship programs should focus on facilitating clinical reasoning and improving prescribing environment in order to remove any barriers to good prescribing.
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Affiliation(s)
- Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland.
| | - Sarah Tschudin-Sutter
- Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel and University of Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland
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Fuertes Abardía C, Ballesta Juan P, Cruz Esteve I, Galindo Ortego G, Marsal Mora JR, Gómez-Arbonés X. [Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population]. Semergen 2022; 48:163-173. [PMID: 35151557 DOI: 10.1016/j.semerg.2021.09.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions). MATERIALS AND METHODS Design: Retrospective cross sectional population study. SETTINGS Primary Health Care, Catalonia, Spain. PARTICIPANTS The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients). MAIN ANALYSIS 55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres. CONCLUSIONS The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription.
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Affiliation(s)
- C Fuertes Abardía
- Centro de Atención Primaria Primer de Maig, Institut Català de la Salut, Lleida, España.
| | - P Ballesta Juan
- Centro de Salud Elx Carrús Este, Departamento de Salud del Vinalopó, Elche, España
| | - I Cruz Esteve
- Centro de Atención Primaria Primer de Maig, Institut Català de la Salut, Lleida, España
| | - G Galindo Ortego
- Centro de Atención Primaria Primer de Maig, Institut Català de la Salut, Lleida, España
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida-Pirineus, Institut d'Investigació en Atenció Primària J Gol (IDIAP J Gol), Lleida, España
| | - X Gómez-Arbonés
- Departamento de Medicina, Universitat de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida (IRB Lleida), Lleida, España
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Ailabouni NJ, Rebecca Weir K, Reeve E, Turner JT, Wilson Norton J, Gray SL. Barriers and enablers of older adults initiating a deprescribing conversation. Patient Educ Couns 2022; 105:615-624. [PMID: 34183219 DOI: 10.1016/j.pec.2021.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/26/2021] [Accepted: 06/18/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To examine older adults' perceptions and identify barriers and enablers to initiating a conversation about stopping medication(s) with their healthcare provider. METHODS We conducted one focus group (n = 3) and in-depth, face-to-face, individual interviews (n = 6) using an interview guide. Older adults aged ≥65 years in a retirement community who were taking ≥5 medications were recruited. Focus groups and interviews were audio-recorded and transcribed verbatim. Both a deductive analysis, informed by the Theoretical Domains Framework, and an inductive analysis were conducted. RESULTS Five themes and fourteen sub-themes were identified. Theme 1, 'older adult-related barriers', discusses limited or varying self-efficacy, past unsuccessful deprescribing experiences and limited familiarity with medications/deprescribing. Theme 2, 'provider-related barriers', discusses trust, short office visits, lack of communication and multiple providers. Theme 3, 'environmental/social-related barriers', involves limited availability of resources and access to telehealth/internet. The remaining themes (Themes 4-5) identified enablers including strategies to promote older adults' self-efficacy and improved healthcare communication. CONCLUSION Consumer-centric tools could improve older adults' self-efficacy to initiate deprescribing conversations. PRACTICE IMPLICATIONS Removing barriers and implementing enablers may empower older adults to initiate deprescribing conversations with providers to take fewer medications. Ultimately, this could be a catalyst for increased translation of deprescribing in practice.
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Affiliation(s)
- Nagham J Ailabouni
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, South Australia, Australia; School of Pharmacy, Plein Center for Geriatric Research, Education and Outreach, University of Washington, Seattle, WA, USA.
| | - Kristie Rebecca Weir
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, South Australia, Australia; University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Emily Reeve
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, South Australia, Australia; Dalhousie University and Nova Scotia Health Authority, Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Halifax, Canada
| | - Justin T Turner
- Institut Universitaire de Gériatrie de Montréal, Centre de Recherche, Montréal, Canada; University of Montreal, Faculty of Pharmacy, Montreal, Canada
| | - Jennifer Wilson Norton
- School of Pharmacy, Plein Center for Geriatric Research, Education and Outreach, University of Washington, Seattle, WA, USA
| | - Shelly L Gray
- School of Pharmacy, Plein Center for Geriatric Research, Education and Outreach, University of Washington, Seattle, WA, USA
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Peris-Campillo P, Trillo-Mata JL, Roca-Navarro MP, Usó-Talamantes R, Navarro-Pérez J. Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019). Rev Esp Geriatr Gerontol 2022; 57:90-94. [PMID: 35292158 DOI: 10.1016/j.regg.2022.01.006] [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: 06/15/2021] [Revised: 12/03/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). OBJECTIVE Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019. METHOD Descriptive population-based study. SETTING 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain. PERIOD 2015-2019. SUBJECTS Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. ANALYSES frequencies and time trends, both overall and by specific type. RESULTS Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). CONCLUSIONS IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.
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Affiliation(s)
- Paula Peris-Campillo
- Emergency Department, University Clinical Hospital, Health Department 'València - Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain.
| | - José Luis Trillo-Mata
- Direction of Pharmacy, Health Department 'València-Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain
| | - María Pilar Roca-Navarro
- Primary Care Physician, República Argentina Health Centre, Health Department 'València-Clinic-Malvarrosa', Valencia, C/ República Argentina n° 8, Valencia, Spain
| | - Ruth Usó-Talamantes
- Medical Direction, Valencia Quiron Hospital, Av. Blasco Ibáñez n° 14, 46010 Valencia, Spain
| | - Jorge Navarro-Pérez
- Medical Direction, Health Department 'València-Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain; INCLIVA Health Research Institute, University Clinical Hospital, Health Department 'València - Clinic-Malvarrosa', Valencia, Spain; CIBERESP Consortium for Biomedical Research in Epidemiology & Public Health, Spain
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Manias E, Soh CH, Kabir MZ, Reijnierse EM, Maier AB. Associations between inappropriate medication use and (instrumental) activities of daily living in geriatric rehabilitation inpatients: RESORT study. Aging Clin Exp Res 2022; 34:445-454. [PMID: 34370211 DOI: 10.1007/s40520-021-01946-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inappropriate medication use can affect functional independence in older adults. AIMS The aim of the study is to examine associations between potentially inappropriate medication use and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in geriatric rehabilitation inpatients. METHODS A longitudinal, prospective, observational study was undertaken at a teaching hospital. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation. Associations between PIM and PPO use and ADL and IADL scores were examined at admission to geriatric rehabilitation, discharge and 3-month post-discharge. RESULTS A total of 693 inpatients were included. At the 3-month post-discharge, PPOs were associated with lower IADL scores (incident rate ratio = 0.868, 95% CI 0.776-0.972). There were no significant associations between PIMs and PPOs use at admission to geriatric rehabilitation with longitudinal changes of ADLs and IADLs from geriatric rehabilitation admission to 3-month post-discharge Renal PIMs were associated with higher IADL scores at 3-month post-discharge (incidence rate ratio = 1.750, 95% CI 1.238-2.474). At 3-month post-discharge, PPOs involving vaccinations were associated with a lower IADL score (incident risk ratio = 0.844, 95% CI 0.754-0.944). CONCLUSIONS Inappropriate medication use involving PPOs was associated with lower IADL scores at 3-month post-discharge from geriatric rehabilitation but not with ADL scores. Greater attention is needed in reducing PPOs in geriatric rehabilitation inpatients that can potentially impact IADLs. In the community, health professionals need to be vigilant about assessing how older patients' physical functioning may be affected by inappropriate medication prescribing.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia.
| | - Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Md Zunayed Kabir
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia
- @AgeAmsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
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Scharner V, Hasieber L, Sönnichsen A, Mann E. Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr 2022; 22:87. [PMID: 35100976 PMCID: PMC9887772 DOI: 10.1186/s12877-022-02757-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/28/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Z-drugs are usually prescribed as first line pharmacological therapy for insomnia. However, the benefits and risks of Z-drugs may differ for older adults. This systematic review investigated the available evidence on the efficacy and safety of Z-drugs in the management of insomnia in older adults. METHODS The Cochrane database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE were searched for systematic reviews, meta-analyses, controlled interventional and observational studies using a pre-formulated search term. The target population was older adults (≥65 years old) with insomnia. Studies were included if they reported efficacy and/or safety outcomes of the use of Z-drugs for the management of insomnia compared to placebo, usual or no treatment, or other pharmacological agents. RESULTS Eighteen studies were included (8 interventional and 10 observational studies). In short-term interventional studies, Z-drugs were similarly or better efficacious in improving both sleep and daytime parameters than placebo or other pharmacological treatments, while showing good results on measures of safety. However, in longer-term observational studies, Z-drugs significantly increased the risk for falls and fractures in comparison to no treatment or melatonin agonists. CONCLUSIONS Analyzing the evidence from short-term interventional studies, Z-drugs appear effective and safe for treatment of insomnia in older adults, but they may have unfavorable side effects when used for longer periods of time. We, therefore, recommend discontinuing Z-drugs, principally because of the high risk for falls and fractures. Nonetheless, quality and quantity of evidence are low. Due to the scarcity of data, especially concerning drug dependence after longer periods of treatment and due to the significantly increased risk for falls and fractures, further studies are needed to evaluate the benefit-risk profile of Z-drugs use in older patients, particularly for long-term use.
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Affiliation(s)
- Vincenz Scharner
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Lukas Hasieber
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
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Cantudo-Cuenca MR, Jimenez-Morales A, la Plata JEMD. Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness. Eur Geriatr Med 2022; 13:1357-1364. [PMID: 36374428 PMCID: PMC9660210 DOI: 10.1007/s41999-022-00715-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
METHODS A prospective quasi-experimental study to implement an ASP in a LTCF. Antibiotic prescriptions for suspected infections initiated in any setting for LTCF residents were included. We assessed appropriateness and prospective audits and feedback of each inappropriate antimicrobial prescription were carried out. Associations of variables with appropriate antibiotic prescribing were estimated using logistic regression. RESULTS A total of 416 antibiotic prescriptions were included. The mean consumption of antibiotics was reduced from 63.2 defined daily doses per 1000 residents days (DRD) in the preintervention period to 22.8 in the intervention period (- 63.8%), with a significant drop in fluoroquinolones (81.4%). Overall, 46.6% of antibiotic prescriptions were judged inappropriate, mainly because of a use not recommended in treatment guidelines (63.2%). Multivariable analysis showed that empirical therapy, some classes of antibiotics (cephalosporins, fluoroquinolones, fosfomycin calcium, macrolides) and prescription initiation in the emergency department were independent predictors of antimicrobial inappropriateness. CONCLUSIONS Pharmacist-led ASP in a LTCF has being effective in reducing consumption of antibiotics by improving appropriateness of treatment decisions. However, ASP should include interventions in the emergency department because of the high inappropriate use in this setting.
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Affiliation(s)
- María Rosa Cantudo-Cuenca
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, Granada, Spain ,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain ,Pharmacy Doctoral Programme, University of Granada, Granada, Spain
| | - Alberto Jimenez-Morales
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, Granada, Spain ,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Juan Enrique Martínez-de la Plata
- Pharmacy Department, Hospital de Poniente, El Ejido, Spain ,Department of Biochemistry and Molecular Biology II, University of Granada, Granada, Spain
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Ayalew MB, Spark MJ, Quirk F, Dieberg G. Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review. Int J Clin Pharm 2022; 44:860-872. [PMID: 35776376 PMCID: PMC9393152 DOI: 10.1007/s11096-022-01414-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate prescribing is associated with poorer health outcomes. AIM The aim of this scoping review was to explore and map studies conducted on potentially inappropriate prescribing among adults living with diabetes and to identify gaps regarding identification and assessment of potentially inappropriate prescribing in this group. METHOD Studies that reported any type of potentially inappropriate prescribing were included. Studies conducted on people aged < 18 years or with a diagnosis of gestational diabetes or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases. RESULTS Of the 190 included studies, the majority (63.7%) were conducted in high-income countries. None of the studies used an explicit tool specifically designed to identify potentially inappropriate prescribing among people with diabetes. The most frequently studied potentially inappropriate prescribing in high-income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying drug-drug interactions. The specific events and conditions that were considered as inappropriate were inconsistent across studies. CONCLUSION Contraindications, prescribing omissions and dosing problems were the most commonly studied types of potentially inappropriate prescribing. Prescribers should carefully consider the individual prescribing recommendations of medications. Future studies focusing on the development of explicit tools to identify potentially inappropriate prescribing for adults living with diabetes are needed.
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Affiliation(s)
- Mohammed Biset Ayalew
- Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia ,Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - M. Joy Spark
- Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia
| | - Frances Quirk
- School of Rural Medicine, University of New England, Armidale, NSW 2351 Australia
| | - Gudrun Dieberg
- Biomedical Science, School of Science and Technology, University of New England, Armidale, NSW 2351, Australia.
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Mahlknecht A, Wiedermann CJ, Sandri M, Engl A, Valentini M, Vögele A, Schmid S, Deflorian F, Montalbano C, Koper D, Bellmann R, Sönnichsen A, Piccoliori G. Expert-based medication reviews to reduce polypharmacy in older patients in primary care: a northern-Italian cluster-randomised controlled trial. BMC Geriatr 2021; 21:659. [PMID: 34814835 PMCID: PMC8609829 DOI: 10.1186/s12877-021-02612-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [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: 08/17/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Evidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical benefits for older patients (aged 75+) by means of evidence-based reduction of polypharmacy (defined as ≥8 prescribed drugs) and inappropriate prescribing in general practice. METHODS The cluster-randomised controlled trial involved general practitioners and patients in a northern-Italian region. The intervention consisted of a review of patient's medication regimens by three experts who gave specific recommendations for drug discontinuation. Main outcome measures were non-elective hospital admissions or death within 24 months (composite primary endpoint). Secondary outcomes were drug numbers, hospital admissions, mortality, falls, fractures, quality of life, affective status, cognitive function. RESULTS Twenty-two GPs/307 patients participated in the intervention group, 21 GPs/272 patients in the control group. One hundred twenty-five patients (40.7%) experienced the primary outcome in the intervention group, 87 patients (32.0%) in the control group. The adjusted rates of occurrence of the primary outcome did not differ significantly between the study groups (intention-to-treat analysis: adjusted odds ratio 1.46, 95%CI 0.99-2.18, p = 0.06; per-protocol analysis: adjusted OR 1.33, 95%CI 0.87-2.04, p = 0.2). Hospitalisations as single endpoint occurred more frequently in the intervention group according to the unadjusted analysis (OR 1.61, 95%CI 1.03-2.51, p = 0.04) but not in the adjusted analysis (OR 1.39, 95%CI 0.95-2.03, p = 0.09). Falls occurred less frequently in the intervention group (adjusted OR 0.55, 95%CI 0.31-0.98; p = 0.04). No significant differences were found regarding the other outcomes. Definitive discontinuation was obtained for 67 (16.0%) of 419 drugs rated as inappropriate. About 6% of the prescribed drugs were PIMs. CONCLUSIONS No conclusive effects were found regarding mortality and non-elective hospitalisations as composite respectively single endpoints. Falls were significantly reduced in the intervention group, although definitive discontinuation was achieved for only one out of six inappropriate drugs. These results indicate that (1) even a modest reduction of inappropriate medications may entail positive clinical effects, and that (2) focusing on evidence-based new drug prescriptions and prevention of polypharmacy may be more effective than deprescribing. TRIAL REGISTRATION Current Controlled Trials (ID ISRCTN: 38449870), date: 11/09/2013.
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy. .,Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Christian J Wiedermann
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy.,UMIT - Private University for Health Sciences, Medical Informatics and Technology - Tyrol, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Marco Sandri
- Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy
| | - Martina Valentini
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Anna Vögele
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Sara Schmid
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Felix Deflorian
- South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy
| | - Carmelo Montalbano
- Genomedics S.r.L. Health Care Consultants, Via Sestese 61, 50141, Florence, Italy
| | - Dara Koper
- Salzburger Gesundheitsfonds, Sebastian Stief-Gasse 2, 5020, Salzburg, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Medical Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Peter-Anich- Street 35, 6020, Innsbruck, Austria
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy
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Abstract
The world population is aging due to increasing life expectancy. The rate of drug use increases, and inappropriate prescribing is frequently encountered with advancing age. In addition, misuse and abuse of prescription drugs is a serious problem in older adults. It is challenging to detect substance and drug abuse in older patients because it may have fewer consequences in social, legal, and occupational fields. However, there is not enough information about the screening, evaluation, diagnosis, and treatment of abuse. Therefore, the awareness of health care professionals and others involved in older patients' care should be raised about the misuse and abuse of drugs.
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Affiliation(s)
- Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Turan Isik
- Unit for Brain Aging and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, School of Medicine, 35340 Balcova, IZMIR, Turkey.
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