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Grigolo S, Bruschi B, Di Masi D, Bena C, Armando LG, Cena C. Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients. Healthcare (Basel) 2024; 12:231. [PMID: 38255118 PMCID: PMC10815688 DOI: 10.3390/healthcare12020231] [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: 11/25/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Combining therapeutic patient education (TPE) with a medication review service could foster the adoption of appropriate lifestyles by patients and support care-providers in identifying strategies to improve the quality of prescribed care. This study aimed to identify barriers experienced by patients in managing their diseases and medication-related problems. This was a monocentric, case series, observational study involving home-care patients from the Local Health Authority ASL TO4. Patients were enrolled for a TPE intervention where drug therapies and patient habits were collected through narrative interviews. Medication review was performed to identify potentially inappropriate prescriptions (PIPs). Twenty patients (13 females) with a mean age of 74.7 years were enrolled. Patients had an average of 4.3 diseases and 80.0% of them were treated with ≥5 daily medications. The main PIPs involved ibuprofen, furosemide and pantoprazole. The qualitative analysis of the interviews identified seven macro-themes relating to different aspects of medication management: therapy; diseases; patient; patient journey; professionals; family and caregivers; drug information. The results of this study revealed some critical aspects related to the treatment path and healthcare professionals. These results will be used to plan educational interventions for polypharmacy patients to improve medication adherence and the understanding and management of diseases.
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Affiliation(s)
- Sabrina Grigolo
- Department of Philosophy and Education Sciences, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy; (S.G.); (B.B.); (D.D.M.)
| | - Barbara Bruschi
- Department of Philosophy and Education Sciences, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy; (S.G.); (B.B.); (D.D.M.)
| | - Diego Di Masi
- Department of Philosophy and Education Sciences, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy; (S.G.); (B.B.); (D.D.M.)
| | - Carla Bena
- Struttura Semplice Cure Domiciliari di Chivasso, Settimo Torinese, San Mauro Torinese, Via Po 11, 10034 Chivasso, Italy
| | - Lucrezia Greta Armando
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 11, 10125 Turin, Italy;
| | - Clara Cena
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 11, 10125 Turin, Italy;
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Sanchez S, Chrusciel J, Ndiongue BM, Blochet C, Forget JF, Letty A, Hay PE, Novella JL. Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes. Int J Environ Res Public Health 2021; 19:ijerph19010423. [PMID: 35010682 PMCID: PMC8744764 DOI: 10.3390/ijerph19010423] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
AIM The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. METHODS Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. RESULTS In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. CONCLUSION This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.
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Affiliation(s)
- Stéphane Sanchez
- Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France;
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
- EA 3797, Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, Université Reims Champagne Ardennes, 51100 Reims, France;
- Correspondence: ; Tel.: +33-25-49-75-61
| | - Jan Chrusciel
- Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France;
| | - Biné Mariam Ndiongue
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | | | | | - Aude Letty
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | - Paul Emile Hay
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | - Jean Luc Novella
- EA 3797, Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, Université Reims Champagne Ardennes, 51100 Reims, France;
- Pole Autonomie Santé, Centre Hospitalier Universitaire de Reims, 92130 Issy les Moulineaux, France
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Quindroit P, Baclet N, Gerard E, Robert L, Lemaitre M, Gautier S, Delannoy-Rousselière C, Décaudin B, Vambergue A, Beuscart JB. Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol. Healthcare (Basel) 2021; 9:1539. [PMID: 34828585 DOI: 10.3390/healthcare9111539] [Citation(s) in RCA: 3] [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: 10/06/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/21/2022] Open
Abstract
In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs.
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Roux B, Bezin J, Morival C, Noize P, Laroche ML. Prevalence and direct costs of potentially inappropriate prescriptions in France: a population-based study. Expert Rev Pharmacoecon Outcomes Res 2021; 22:627-636. [PMID: 34525899 DOI: 10.1080/14737167.2021.1981863] [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: 10/20/2022]
Abstract
BACKGROUND Potentially inappropriate prescriptions (PIPs) in the older population remain a growing public health concern due to the many associated adverse events increasing healthcare service use and health costs. This study aimed to assess the prevalence and direct costs of PIPs in older adults aged ≥65 years in France. METHODS A population-based cross-sectional study was conducted in 2017 using a representative sample of the French national healthcare reimbursement system database. PIPs were defined using the French REMEDI[e]S tool. Overall reimbursed direct costs and by PIP category were extrapolated to the French older population. RESULTS The overall PIP prevalence was estimated at 56.7% (95% CI: 56.4-57.0). Medications with an unfavorable benefit/risk ratio had the highest prevalence (34.0%, 95% CI: 33.7-34.3). Direct costs associated with PIPs represented 6.3% of the total reimbursed medication costs in 2017 (€507 million). Drug duplications were the main contributors to these costs (39.2% of the total reimbursed PIP costs, €199 million) and among all PIPs, proton pump inhibitors (>8 weeks) were the most expensive PIPs (€152 million). CONCLUSIONS PIP prevalence is still high among French older adults, with substantial direct costs. Large-scale interventions targeting the most prevalent and/or costly PIPs are needed to reduce their clinical and economic impacts.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France
| | - Julien Bezin
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1219, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France
| | - Camille Morival
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1219, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France
| | - Pernelle Noize
- Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France.,Univ. Bordeaux, INSERM UMR 1219, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.,INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.,Laboratoire Vie-Santé (Vieillissement Fragilité Prévention, e-Santé), IFR GEIST, Université de Limoges, Limoges, France
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Murphy C, Dyer AH, Lawlor B, Kennelly SP. Potentially inappropriate medication use in older adults with mild-moderate Alzheimer's disease: prevalence and associations with adverse events. Age Ageing 2020; 49:580-587. [PMID: 32474584 DOI: 10.1093/ageing/afaa067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Indexed: 11/14/2022] Open
Abstract
AIM Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group. DESIGN Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated. SETTING AND PARTICIPANTS 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. RESULTS Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13-1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17-1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03-1.30, P = 0.016) and GP visits (IRR 1.22, 1.15-1.28, P < 0.001). PIM use was not associated with dementia progression. CONCLUSIONS AND IMPLICATIONS PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted.
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Affiliation(s)
- Claire Murphy
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Brian Lawlor
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Research on Ageing, St James’s Hospital, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Stojanović M, Vuković M, Jovanović M, Dimitrijević S, Radenković M. GheOP 3 S tool and START/STOPP criteria version 2 for screening of potentially inappropriate medications and omissions in nursing home residents. J Eval Clin Pract 2020; 26:158-164. [PMID: 30722098 DOI: 10.1111/jep.13107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 01/25/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVE There is limited information about the comparative effectiveness of the START/STOPP (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment) criteria and the Ghent Older People's Prescriptions community Pharmacy Screening tool (GheOP3 S tool) for the screening of potentially inappropriate prescribing (PIP) in the geriatric population. Considering this, the aim of this study was to compare the ability of the START/STOPP criteria and GheOP3 S tool to identify the PIP and potential prescribing omissions (PPOs) among elderly patients visiting their primary care physician. METHODS This is a retrospective observational study where a total of 422 subjects were included. The Charlson Co-morbidity Index (CCI) and the Medicines Co-morbidity Index (MCI) for older people were used to determine the co-morbidity status. The user's diagnosis and medications prescribed were analysed with the START/STOPP criteria and GheOP3 S tool. The Wilcoxon signed rank test was used to compare these criteria. The statistical relationship between the occurrence of PIP and users' age, the number of medication prescribed, the number of diagnoses, CCI, and MCI was determined with one-tailed bivariate correlation. RESULTS The START/STOPP criteria detected 843 PIPs and 1067 PPOs, while the GheOP3 S tool detected 936 PIPs and 202 PPOs. The GheOP3 S tool detected significantly more PIPs than did the STOPP criteria (P = 0.003). A significantly higher number of PPOs were detected with the START criterion (P < 0.0001). The results obtained with the START/STOPP criteria positively correlated with mentioned variables. Oppositely, there is a negative correlation between the results obtained with the GheOP3 S tool and age. Still, the positive correlation could be found with the rest of the variables. CONCLUSION The results of this study indicate that both tested tools demonstrated efficiency to detect PIPs and PPOs. The GheOP3 S tool detected significantly more PIPs than did the STOPP criteria. On the other hand, the START criteria performed much better for the screening of PPOs.
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Affiliation(s)
- Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Vuković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Jovanović
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Gerontology Center Belgrade, Belgrade, Serbia
| | | | - Miroslav Radenković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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López-Álvarez J, Sevilla-Llewellyn-Jones J, Agüera-Ortiz L. Anticholinergic Drugs in Geriatric Psychopharmacology. Front Neurosci 2019; 13:1309. [PMID: 31866817 PMCID: PMC6908498 DOI: 10.3389/fnins.2019.01309] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson's disease, cardiovascular conditions and urinary incontinence.
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Affiliation(s)
- Jorge López-Álvarez
- Servicio de Psiquiatría, Hospital 12 de Octubre (imas12), Madrid, Spain.,Instituto de Investigación, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Julia Sevilla-Llewellyn-Jones
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Hospital 12 de Octubre (imas12), Madrid, Spain.,Instituto de Investigación, Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain.,Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Hudhra K, Beçi E, Petrela E, Xhafaj D, García-Caballos M, Bueno-Cavanillas A. Prevalence and factors associated with potentially inappropriate prescriptions among older patients at hospital discharge. J Eval Clin Pract 2016; 22:707-13. [PMID: 27001470 DOI: 10.1111/jep.12521] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 01/28/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Explicit criteria have been used worldwide to identify suboptimal prescribing such as potentially inappropriate prescriptions (PIPs). The objective of our study was to determine prevalence, types and factors associated with PIPs in older people discharged from an Albanian hospital. METHOD Retrospective, cross-sectional study conducted among patients aged 60 years and more discharged from the Cardiology and Internal Medicine departments of the University Hospital Center 'Mother Theresa' Tirana during 2013. PIPs were identified by using Beers (2012 update) and STOPP criteria (2008 and 2014 versions). Chi-square analysis and Student Test were performed. Crude and adjusted odds ratios with their 95% confidence intervals were estimated by logistic regression analysis. RESULTS Medical files for 319 patients were assessed. The median number of drugs prescribed was 7.8 (SD 2.2). PIPs prevalence at hospital discharge was 34.5% (95% CI 27.5-42.2%; 110 patients) according to both Beers and STOPP version 1 criteria. STOPP version 2 identified 201 (63.0%) patients with at least one PIP (95% CI 55.2-70.2%; 312 PIPs). The drugs more frequently involved in PIPs were aspirin, spironolactone, benzodiazepines, digoxin and methyldopa. The odds of having a PIP were higher in patients discharged from Internal Medicine (P < 0.005). The PIP index was 0.056%, 0.054% and 0.125% respectively for Beers, STOPP 2008 and STOPP 2014 criteria. A significant positive correlation was found between the number of prescribed drugs and PIP occurrence. CONCLUSIONS Our study found that between one and two out of three older patients has at least one PIP among the treatment prescribed at hospital discharge, depending on the tool used for detection. The high frequency of PIPs suggests the urgent need for interventions to reduce them.
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Affiliation(s)
- Klejda Hudhra
- Faculty of Pharmacy, University of Medicine Tirana, Tirana, Albania. , .,Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain. ,
| | - Eni Beçi
- Faculty of Pharmacy, University of Medicine Tirana, Tirana, Albania
| | - Elizana Petrela
- Service of Statistics, University Hospital Center Mother Teresa, Tirana, Albania
| | - Delina Xhafaj
- Faculty of Pharmacy, University of Medicine Tirana, Tirana, Albania
| | - Marta García-Caballos
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain.,Service of Preventive Medicine, University Hospital San Cecilio, Granada, Spain
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Cojutti P, Arnoldo L, Cattani G, Brusaferro S, Pea F. Polytherapy and the risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in three different settings (hospital, community, long-term care facilities) of the Friuli Venezia Giulia region, Italy: are the very elderly at higher risk of PIPs? Pharmacoepidemiol Drug Saf 2016; 25:1070-8. [PMID: 27184012 DOI: 10.1002/pds.4026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this point-prevalence study was to assess the occurrence of polypharmacy and hyperpolypharmacy and the risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in different health-care settings of the Friuli-Venezia Giulia region in the North-East of Italy. METHODS Prescription pattern of elderly (65-79 years) and very elderly (>79 years) patients in three different health-care settings [hospitals, general practitioners, and long-term care facilities (LTCFs)] was assessed in March 2014, and PIPs were assessed according to the Beers criteria. Other situations at potentially high risk were checked. RESULTS A total of 1582 patients (hospital, n = 528; outpatients, n = 527; nursing homes, n = 527) were included. Very elderly were more represented in hospitals (60.4%) and LTCFs (77.1%) than among general practitioners (37.6%). Polypharmacy and hyperpolypharmacy rates ranged 57.7-73.7% and 9.7-15.6%, respectively. The most frequently prescribed drugs were the proton pump inhibitors, whereas the most common PIPs resulted the benzodiazepines. Multinomial regression analysis showed that female sex, age > 79 years, hyperpolypharmacy, and chronic kidney disease were associated with the risk of having ≥2 PIPs. Two situations at high risk of PIPs not contemplated by the Beers criteria were recurrent in the study population and concerned the statins and metformin. CONCLUSIONS Polypharmacy and hyperpolypharmacy among elderly and very elderly are strictly associated with the risk of multiple PIPs. The findings offer the opportunity to remark that improvement of the knowledge of safe drug use is generally needed in aging societies and may become of utmost relevance among health-care workers operating in LTCFs. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Piergiorgio Cojutti
- Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy.,Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Luca Arnoldo
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Giovanni Cattani
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Silvio Brusaferro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Federico Pea
- Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy.,Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
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Hudhra K, García-Caballos M, Casado-Fernandez E, Jucja B, Shabani D, Bueno-Cavanillas A. Polypharmacy and potentially inappropriate prescriptions identified by Beers and STOPP criteria in co-morbid older patients at hospital discharge. J Eval Clin Pract 2016; 22:189-93. [PMID: 26399173 DOI: 10.1111/jep.12452] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 01/14/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES The objective of this study was to evaluate the prevalence of potentially inappropriate prescriptions (PIP) and the association with polypharmacy (more than six drugs prescribed) in co-morbid older patients in a critical moment of care transition such as hospital discharge by means of two explicit criteria (Beers 2012 and STOPP 2008). METHOD Cross-sectional study carried out in an older patients' population (≥65 years old) discharged from a university hospital in Spain. We recorded patients' information regarding demographics, diagnosis, drugs prescribed and associated pathological conditions and calculated the Charlson co-morbidity index. Data were obtained from the electronic medical records of hospital discharge. Beers (2012) and STOPP criteria (2008) were applied for PIP detection. The strength of association between polypharmacy and the presence of PIP was assessed by calculating the crude and adjusted odds ratio and its 95% confidence interval. RESULTS From 1004 patients of a 15% random sample, just 624 that fulfilled the inclusion criteria were included in the study. The number of prescribed drugs was a risk factor for PIP according to both criteria, even after adjusting for confounding variables. PIP frequency was higher in patients who received more than 12 medications (Beers: 34.8%, STOPP: 54.4%). Each additional medication increased the risk of PIP by 14 or 15% (Beers or STOPP). CONCLUSIONS Our results suggest that the strategies used for PIP reduction in co-morbid older patients should focus on the management of polypharmacy. Medication review at hospital discharge is highly recommended for patients taking more than six drugs.
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Affiliation(s)
- Klejda Hudhra
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain.,Faculty of Pharmacy, University of Medicine, Tirana, Albania
| | - Marta García-Caballos
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain.,Primary Care Health Center 'Peligros', Andalusian Health Service, Granada, Spain
| | | | - Besnik Jucja
- Faculty of Pharmacy, University of Medicine, Tirana, Albania
| | - Driton Shabani
- Faculty of Pharmacy, University of Medicine, Tirana, Albania.,Department of Pharmacy, Faculty of Medicine, University of Pristine, Pristina, Kosovo
| | - Aurora Bueno-Cavanillas
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Spain.,Service of Preventive Medicine, University Hospital San Cecilio, Granada, Spain
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