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Alqashqri HS, Siddiqi A, Albar HT, Alfalogy EH, Hariri NH, Alhindi YZ, Alshanberi AM, Alsanosi SM, Falemban AH. Prescribing Renally Inappropriate Medication to Hospitalized Geriatric Patients in Makkah, Saudi Arabia. Int J Gen Med 2024; 17:1755-1764. [PMID: 38706746 PMCID: PMC11070154 DOI: 10.2147/ijgm.s462135] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction As a result of the physiological decline in renal function that comes with age and the common failure to recognise renal insufficiency, older adults aged 65 and above are at increased risk of receiving medications that are inappropriate for their level of renal function which in turn lead to increased risk of adverse effects. Little is known about how many older adults receive medications that are inappropriate for their level of renal function. This study aimed to determine the prevalence of renally inappropriate medications in elderly adults by reviewing patient files and evaluating the appropriateness of medication doses relative to renal function in patients aged ≥ 65 years at inpatient healthcare departments. Methods A retrospective cross-sectional study of patients aged ≥ 65 years was conducted, covering cases from 2015 to 2021. Patient's medical records were reviewed, their renal function and medications lists were evaluated, determined whether they had been prescribed at least one renally inappropriate medication based on drug-dosing recommendations for different degrees of renal function. Results A total of 317 elderly inpatients were included, 10% of whom had received inappropriate doses relative to their renal function. Glomerular filtration rate was associated with inappropriate dosing in this study. Of the patients CKD stage 5, 36.8% had at least one drug administered at an inappropriate dose, while this figure was 6.5% among the patients at CKD stage 1; this difference was statistically significant (p = 0.001). Conclusion A notable portion of older adults may be at risk of adverse effects due to inappropriate medication dosing related to their renal function. Further studies with large samples, drug use analyses based on comprehensive geriatric references and a prioritisation of actual outcomes over potential outcomes are needed to further determine elderly adults' exposure to inappropriate drugs.
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Affiliation(s)
- Hamsah S Alqashqri
- Department of Community Medicine and Pilgrims Health Care, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Ahmed Siddiqi
- Department of Internal Medicine, National Guard Hospital, Jeddah, Saudi Arabia
| | - Halah T Albar
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Enas H Alfalogy
- Department of Community Medicine and Pilgrims Health Care, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
- Family Medicine, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt
| | - Nahla H Hariri
- Department of Community Medicine and Pilgrims Health Care, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Yosra Z Alhindi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Asim M Alshanberi
- Department of Community Medicine and Pilgrims Health Care, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Safaa M Alsanosi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Alaa H Falemban
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
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Prabahar K, Alhawiti MS, Yosef AM, Alqarni RS, Sayd FY, Alsharif MO, Subramani V, Alshareef H, Hamdan AME, Alqifari S, Alqarni GS, Yousuf SM. Potentially Inappropriate Medications in Hospitalized Older Patients in Tabuk, Saudi Arabia Using 2023 Beers Criteria: A Retrospective Multi-Centric Study. J Multidiscip Healthc 2024; 17:1971-1979. [PMID: 38706504 PMCID: PMC11070160 DOI: 10.2147/jmdh.s461180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Older persons are frequently prescribed several medications; therefore, inappropriate medication prescriptions are common. Prescribing potentially inappropriate medications (PIMs) poses a serious risk and hence, we aimed to assess the PIMs in older patients in Tabuk, using the 2023 Beers criteria. Patients and Methods A retrospective cross-sectional study was carried out, including older persons ≥65 years of age admitted in two government hospitals from June 2022 to May 2023, and prescribed with five or more medications. PIMs were assessed using the 2023 Beers criteria. Descriptive analysis was performed for the categorical and continuous variables. Logistic regression was used to assess the influence of age, gender, number of medications and comorbidities on PIMs using SPSS version 27. Results The study included 420 patients. The mean age of the participants was 75.52 ± 8.70 years (range, 65-105 years). There was a slightly higher proportion of females (52%). The prevalence of PIMs was 81.43%, where 35.41% were prescribed one PIM, 26.48% were prescribed two PIMs, and 17.32% were prescribed three PIMs. The proportion of medications considered potentially inappropriate among older patients was 70.11%, and proton pump inhibitors were the most commonly prescribed medication (52.99%). The proportion of medications to be used with caution was 19.55%, with diuretics being the most frequently administered medication (91.43%). Gender and comorbidity did not influence PIMs, but age and number of medications significantly influenced the likelihood of PIMs. Conclusion PIMs are prevalent among older people and are significantly associated with age and multiple medications. Caution should be exercised while prescribing medications to older persons. Frequent audits should be performed to assess PIMs, and clinicians should be informed of the same to avoid serious outcomes associated with PIMs. Interventions designed to reduce PIM need to be initiated.
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Affiliation(s)
- Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | | | | | - Fai Yahya Sayd
- Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Vikashini Subramani
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Nilgiris, TN, India
| | - Hanan Alshareef
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Ahmed M E Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Saleh Alqifari
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
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Faquetti ML, Frey G, Stämpfli D, Weiler S, Burden AM. Prevalence of potentially inappropriate medications among newly treated patients with type 2 diabetes in UK primary care. Br J Clin Pharmacol 2024. [PMID: 38408767 DOI: 10.1111/bcp.16018] [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: 09/25/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
AIMS The aim of this study was to estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first noninsulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. METHODS A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society Beers criteria 2015 was used for older (≥65 years) patients and the Prescribing Optimally in Middle-age People's Treatments criteria was used for middle-aged (45-64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymized electronic health records in the UK. RESULTS Among 28 604 patients initiating NIADs, 18 494 (64.7%) received polypharmacy. In older and middle-aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIP. At the individual PIP level, long-term proton pump inhibitors (PPI) use was the most frequent PIP among older adults, and strong opioid without laxatives was the most frequent PIP in middle-aged patients with polypharmacy (11.1% and 4.1%, respectively). CONCLUSIONS This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimization.
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Affiliation(s)
- Maria Luisa Faquetti
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Zurich, Switzerland
| | - Géraldine Frey
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Zurich, Switzerland
| | - Dominik Stämpfli
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Zurich, Switzerland
- Hospital Pharmacy, Kantonsspital Baden, Baden, Switzerland
| | - Stefan Weiler
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Zurich, Switzerland
| | - Andrea M Burden
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Zurich, Switzerland
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Li C, Cui Z, Wei D, Zhang Q, Yang J, Wang W, Luo X, Chang Y. Trends and Patterns of Antibiotic Prescriptions in Primary Care Institutions in Southwest China, 2017-2022. Infect Drug Resist 2023; 16:5833-5854. [PMID: 37692470 PMCID: PMC10492579 DOI: 10.2147/idr.s425787] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To explore the prescription patterns and usage trends of antibiotics within primary care institutions located in underdeveloped regions of China from 2017 to 2022. Methods A retrospective analysis of antibiotic prescriptions was conducted from 25 primary care institutions in Guizhou Province during the period of 2017-2022. Antibiotic prescriptions were categorized into appropriate and inappropriate use. Appropriate use is further categorized into preferred medication, and antibiotics can be used or substituted. Inappropriate use is further categorized into unnecessary use, incorrect spectrum of antibiotics and combined use of antibiotics. Factors associated with inappropriate use were investigated using generalized estimation equations. Holt-Winters and SARIMA models were employed to predict the number of inappropriate antibiotic prescriptions as the alternative model. Results A total of 941,924 prescriptions were included, revealing a decreasing trend in both the number and inappropriate rates of antibiotic prescriptions from 2017 to 2022. Diseases of the respiratory system (70.66%) was the most frequent target of antibiotic use, with acute upper respiratory infections of multiple and unspecified sites representing 52.04% of these cases. The most commonly used antibiotics were penicillins (64.44%). Among all prescriptions, inappropriate antibiotic prescriptions reached 66.19%. Physicians aged over 35, holding the title of associate chief physician and possessing more than 11 years of experience were more likely to prescribe antibiotics inappropriately. The phenomenon of inappropriate antibiotic use was commoner among children aged five or younger. By comparing model parameters, it was determined that the SARIMA model outperforms the Holt-Winters model in predicting the number of inappropriate antibiotic prescriptions among primary care institutions. Conclusion The number and inappropriate rates of antibiotic prescriptions in southwest China exhibited a downward trend from 2017 to 2022, but inappropriate prescription remains a serious problem in primary care institutions. Therefore, future efforts should focus on strengthening physician education, training, and clinical practice. Additionally, physicians' awareness of common misconceptions about inappropriate antibiotic use must be improved, and the prescribing behavior of physicians who fulfill patients' expectations by prescribing antibiotics needs to be modified.
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Affiliation(s)
- Changlan Li
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Zhezhe Cui
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi Province, People’s Republic of China
| | - Du Wei
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Quan Zhang
- Department of Infectious Diseases, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Junli Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Wenju Wang
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Xiaobo Luo
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
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Falemban AH. Medication-Related Problems and Their Intervention in the Geriatric Population: A Review of the Literature. Cureus 2023; 15:e44594. [PMID: 37795072 PMCID: PMC10545972 DOI: 10.7759/cureus.44594] [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] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
In order to implement the principles of providing clinically and economically effective care, the current state of healthcare must be evaluated, and challenges must be addressed. As part of a physician's role in such a context, one tool consists of identifying medication-related problems (MRPs) and accordingly implementing best practices and innovative strategies to improve patient healthcare outcomes. The geriatric population is expected to have passed through the natural ageing process and experienced several physiological and biological changes that impact their bodies and lives. In the presence of geriatric syndromes and the increased number of medications consumed, the risk of MRPs such as polypharmacy, potentially inappropriate medication (PIM), adverse events, drug-drug interactions, and risk of non-adherence increases. Different interventions that focus on practical and perceptual barriers have been studied, and different tools to define clinically important prescribing problems relating to PIM have been established. The Beers Criteria and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria are the most widely used sets of explicit PIM criteria; however, they are still limited in Saudi Arabia. These tools should be considered in clinical settings to improve healthcare outcomes in the geriatric population, and the clinical relevance of enhancing medication should also be explored from the point of view of both the patient and healthcare practitioners.
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Affiliation(s)
- Alaa H Falemban
- Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, SAU
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Dreischulte T, Sanftenberg L, Hennigs P, Zöllinger I, Schwaiger R, Floto C, Sebastiao M, Kühlein T, Hindenburg D, Gagyor I, Wildgruber D, Hausen A, Janke C, Hölscher M, Teupser D, Gensichen J. Detecting Medication Risks among People in Need of Care: Performance of Six Instruments. Int J Environ Res Public Health 2023; 20:2327. [PMID: 36767705 PMCID: PMC9915255 DOI: 10.3390/ijerph20032327] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting. OBJECTIVES This cross sectional study compares six validated tools in terms of PIM and PPO detection. METHODS We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa. RESULTS We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95% CI, 87.2-94.9)% and the overall PPO prevalence was 63.7 (57.1-69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added. CONCLUSION Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.
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Affiliation(s)
- Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Philipp Hennigs
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Isabel Zöllinger
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Rita Schwaiger
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Caroline Floto
- Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Maria Sebastiao
- Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Dagmar Hindenburg
- Institute of General Practice, University Hospital of Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
| | - Ildikó Gagyor
- Institute of General Practice, University Hospital of Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
| | - Domenika Wildgruber
- Katholische Stiftungshochschule München/University of Applied Sciences, 81667 Munich, Germany
| | - Anita Hausen
- Katholische Stiftungshochschule München/University of Applied Sciences, 81667 Munich, Germany
| | - Christian Janke
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of LMU Munich, 80802 Munich, Germany
| | - Michael Hölscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of LMU Munich, 80802 Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital of LMU Munich, 81377 Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
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Mekonnen AB, Redley B, de Courten B, Manias E. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4150-4172. [PMID: 34008195 PMCID: PMC8597090 DOI: 10.1111/bcp.14870] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/17/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS To synthesise associations of potentially inappropriate prescribing (PIP) with health-related and system-related outcomes in inpatient hospital settings. METHODS Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health-related and system-related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates. RESULTS Overall, 63 studies were included. Pooled risk estimates did not show a significant association with all-cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90-1.36; adjusted hazard ratio 1.02, 83% CI 0.90-1.16), and hospital readmission (AOR 1.11, 95% CI 0.76-1.63; adjusted hazard ratio 1.02, 95% CI 0.89-1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event-related hospital admissions (AOR 1.91, 95% CI 1.21-3.01), functional decline (AOR 1.60, 95% CI 1.28-2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11-1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health-related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods. CONCLUSIONS PIP was significantly associated with a range of health-related and system-related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.
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Affiliation(s)
- Alemayehu B Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia
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Scott S, May H, Patel M, Wright DJ, Bhattacharya D. A practitioner behaviour change intervention for deprescribing in the hospital setting. Age Ageing 2021; 50:581-586. [PMID: 32875321 PMCID: PMC7936025 DOI: 10.1093/ageing/afaa169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 11/14/2022] Open
Abstract
Background hospital deprescribing trials have demonstrated marginal increases in deprescribing activity that are not sustained beyond the trial period. The hospital deprescribing implementation framework (hDIF) links barriers and enablers of deprescribing in hospital with 44 potential intervention components. This study aimed to support geriatricians and pharmacists to select and characterise hDIF components according to affordability, practicability, effectiveness, acceptability, safety and equity (APEASE) to design a deprescribing intervention in the English hospital setting. Methods we convened a modified Nominal Group Technique with a panel of nine geriatricians and pharmacists representing five English hospitals. Panel members selected and characterised intervention components from the hDIF based on the APEASE criteria. We set a consensus threshold of 80% agreement per APEASE criterion in order for the intervention component to be included. Results the panel selected five intervention components supporting engagement with deprescribing: an organisational action plan to prioritise deprescribing, two training activities to address pharmacists’ beliefs about negative deprescribing consequences, restructuring pharmacists’ working patterns to facilitate their contribution to deprescribing decisions, and sharing experiences of successfully engaging patients/family in deprescribing conversations to support others to do the same. A sixth component was selected to sustain engagement with deprescribing through measuring and sharing deprescribing activity achieved between teams. Conclusions deprescribing interventions targeting geriatricians’ and pharmacists’ behaviour in the English hospital context should include the six characterised components. A component to sustain deprescribing activity is a notable omission from previously reported deprescribing interventions and may explain their failure to maintain efficacy beyond the short-term trial period.
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Affiliation(s)
- Sion Scott
- School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Helen May
- Older People’s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, , Norwich, NR4 7UY, UK
| | - Martyn Patel
- Older People’s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, , Norwich, NR4 7UY, UK
| | - David J Wright
- School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK
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Abstract
Aim: The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard.Methods: Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted.Results: About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician's application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician's implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription.Conclusions: Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP v2 identified potentially inappropriate-prescriptions by implicit evaluation in a significant percent of geriatric patients signifying need for comprehensive geriatric evaluation in practice.
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Affiliation(s)
- Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Division of Geriatrics, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Ilker Bay
- Istanbul Medical School, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Cihan Kilic
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Pinar Kucukdagli
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Meryem Merve Oren
- Erzurum Provincial Health Directorate, Public Health Services Presidency, Erzurum, Turkey
| | - Mehmet Akif Karan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey
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Vidoni ED, Kamat A, Gahan WP, Ourso V, Woodard K, Kerwin DR, Binder EF, Burns JM, Cullum M, Hynan LS, Vongpatanasin W, Zhu DC, Zhang R, Keller JN. Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer's Disease Study (rrAD). J Alzheimers Dis 2020; 77:175-182. [PMID: 32716358 PMCID: PMC8108402 DOI: 10.3233/jad-200122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about the prevalence of polypharmacy, the taking of five or more medications a day, in older adults with specific dementia risk factors. OBJECTIVE To examine the prevalence of polypharmacy in participants at baseline in a vascular risk reduction focused Alzheimer's disease (rrAD) trial targeting older patients with hypertension and elevated dementia risk. METHODS We conducted a detailed review of medications in a cross-sectional study of community-dwelling older adults with hypertension and elevated dementia risk. Medications were identified in a structured interview process with an onsite pharmacist or qualified designee. Polypharmacy was defined as use of five or more medications on a regular basis. Descriptive analyses were conducted on the sample as well as direct comparisons of subgroups of individuals with hypertension, diabetes, and hyperlipidemia. RESULTS The 514 rrAD participants, mean age 68.8 (standard deviation [sd] 6), reported taking different combinations of 472 unique medications at their baseline visit. The median number of medications taken by participants was eight [Range 0-21], with 79.2% exhibiting polypharmacy (n = 407). Sites differed in their prevalence of polypharmacy, χ2(3) = 56.0, p < 0.001. A nearly identical percentage of the 2,077 prescribed (51.8%) and over the counter (48.2%) medications were present in the overall medication profile. The presence of diabetes (87.5%), hyperlipidemia (88.2%), or both (97.7%) was associated with a higher prevalence of polypharmacy than participants who exhibited hypertension in the absence of either of these conditions (63.2%), χ2(3) = 35.8, p < 0.001. CONCLUSION Participants in a dementia risk study had high levels of polypharmacy, with the co-existence of diabetes or hyperlipidemia associated with a greater prevalence of polypharmacy as compared to having hypertension alone.
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Affiliation(s)
- Eric D Vidoni
- KU Alzheimer's Disease Center, Fairway KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Victoria Ourso
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kaylee Woodard
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Diana R Kerwin
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ellen F Binder
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey M Burns
- KU Alzheimer's Disease Center, Fairway KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Munro Cullum
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Wanpen Vongpatanasin
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, USA
| | - Rong Zhang
- Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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11
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Scott S, Twigg MJ, Clark A, Farrow C, May H, Patel M, Taylor J, Wright DJ, Bhattacharya D. Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists. Age Ageing 2019; 49:102-110. [PMID: 31711097 PMCID: PMC6939289 DOI: 10.1093/ageing/afz133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/29/2019] [Accepted: 09/05/2019] [Indexed: 01/21/2023] Open
Abstract
Background over 50% of older people in hospital are prescribed a pre-admission medicine that is potentially inappropriate; however, deprescribing by geriatricians and pharmacists is limited. This study aimed to characterise geriatricians’ and pharmacists’ barriers and enablers to deprescribing in hospital. It also intended to develop a framework of intervention components to facilitate implementation of hospital deprescribing. Methods fifty-four geriatricians and pharmacists representing four UK hospitals attended eight focus groups. We designed a topic guide to invite discussions about barriers and enablers to deprescribing. After thematic analysis, themes were mapped to the theoretical domains framework (TDF), enabling prioritisation of domains for behaviour change. We then identified evidence-based intervention components for changing behaviour within prioritised TDF domains. Results geriatricians and pharmacists described several deprescribing enablers in the hospital setting including alignment with their role and generalist knowledge, and routine patient monitoring. Five prioritised TDF domains represent the key barriers and enabler: patient and caregiver attachment to medication (social influence); perceptions that deprescribing is riskier than continuing to prescribe (beliefs about consequences); pharmacists’ working patterns limiting capacity to support deprescribing (environmental context and resources); deprescribing being a low hospital priority (goals) and incentives to deprescribe (reinforcement). Prioritised TDF domains aligned with 44 evidence-based intervention components to address the barriers and enabler to hospital deprescribing. Conclusion the behavioural determinants and their associated intervention components provide a hospital deprescribing implementation framework (hDIF). Intervention components should be selected from the hDIF to provide a theory and evidence-based intervention tailored to hospital contexts.
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Affiliation(s)
- Sion Scott
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK
- Pharmacy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Carol Farrow
- Pharmacy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Helen May
- Older People’s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Martyn Patel
- Older People’s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - David J Wright
- School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK
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12
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Lee SWH, Mak VSL, Tang YW. Pharmacist services in nursing homes: A systematic review and meta-analysis. Br J Clin Pharmacol 2019; 85:2668-2688. [PMID: 31465121 DOI: 10.1111/bcp.14101] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/02/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022] Open
Abstract
AIMS Pharmacists have been contributing to the care of residents in nursing homes and play a significant role in ensuring quality use of medicine. However, the changing role of pharmacist in nursing homes and their impact on residents is relatively unknown. METHODS Six electronic databases were searched from inception until November 2018 for articles published in English examining the services offered by pharmacists in nursing homes. Studies were included if it examined the impact of interventions by pharmacists to improve the quality use of medicine in nursing homes. RESULTS Fifty-two studies (30 376 residents) were included in the current review. Thirteen studies were randomised controlled studies, while the remainder were either pre-post, retrospective or case-control studies where pharmacists provided services such as clinical medication review in collaboration with other healthcare professionals as well as staff education. Pooled analysis found that pharmacist-led services reduced the mean number of falls (-0.50; 95% confidence interval: -0.79 to -0.21) among residents in nursing homes. Mixed results were noted on the impact of pharmacists' services on mortality, hospitalisation and admission rates among residents. The potential financial savings of such services have not been formally evaluated by any studies thus far. The strength of evidence was moderate for the outcomes of mortality and number of fallers. CONCLUSION Pharmacists contribute substantially to patient care in nursing homes, ensuring quality use of medication, resulting in reduced fall rates. Further studies with rigorous design are needed to measure the impact of pharmacist services on the economic benefits and other patient health outcomes.
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Affiliation(s)
- Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia.,Gerentology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, Subang Jaya, Selangor, Malaysia
| | - Vivienne Sook Li Mak
- Center of Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Yee Woon Tang
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Selangor, Malaysia
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13
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Isik AT, Soysal P. Dementia-Related Results of "Costs of Medication in Older Patients: Before and After Comprehensive Geriatric Assessment". Am J Alzheimers Dis Other Demen 2018; 33:497-499. [PMID: 30249114 PMCID: PMC10852474 DOI: 10.1177/1533317518802434] [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] [Indexed: 04/03/2024]
Abstract
Changes in the pharmacokinetics and pharmacodynamics of drugs in the presence of certain comorbidities and geriatric syndromes and reduced tolerability of potential drug side effects due to physiological changes with aging lead to difficulties in planning treatments in elderly adults, especially patients with dementia. The Comprehensive Geriatric Assessment has an important role in assessing polypharmacy and optimizing potentially inappropriate medications and potentially prescribing omissions in these patients. For this reason, we intend to reexamine our new study titled " Costs of medication in older patients: before and after comprehensive geriatric assessment," because most of these results are also very important for dementia practice.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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14
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Abstract
The use of multiple drugs is often referred to as polypharmacy, although this term has not been precisely defined. Frequently, drugs are used unwisely in multiple combinations increasing the risk of adverse reactions, or for the long-term prevention of diseases in patients with a short life expectancy who, therefore, will not benefit from them. The reflection on this has led to the introduction of the concept of deprescription. There are many reasons for the inappropriate drug prescription and barriers to reduce medications. Tools were developed to help prescribers to limit the number of prescribed drugs that patients are taking. Several studies have shown that deprescription of some drugs is possible and safe and can even have a positive influence on wellbeing, cognitive function, falls, and admission to a hospital. Deprescription should be individualized and carried out, as far as possible, in agreement with patients and their families. A six-step method for deprescription is proposed.
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Affiliation(s)
- Ferraz Gonçalves
- Palliative Care Service, Instituto Português de Oncologia, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
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15
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Chiapella LC, Menna JM, Mamprin ME. Potentially Inappropriate Medications in Elderly Ambulatory Patients: A Comparative Study between a Primary Health Care Center and a Community Pharmacy. Value Health Reg Issues 2018; 17:119-125. [PMID: 29933229 DOI: 10.1016/j.vhri.2017.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to compare, both qualitatively and quantitatively, the medication dispensed to elderly patients in a primary health care center (PHC) and a community pharmacy (CP) in Argentina and to identify the prescription of potentially inappropriate medications (PIMs). METHODS A cross-sectional observational study. Data were acquired from 886 prescriptions in the PHC and 2368 in the CP between February and April 2015. Dispensed medications were coded according to the Anatomical, Therapeutic, and Chemical (ATC) classification system. The frequency of prescriptions for each of them was determined. The number and monthly average of drugs dispensed were calculated for each patient. The use of PIMs was identified using Beers Criteria. RESULTS In both institutions, the means of medications dispensed per individual and month were similar: 3.69 ± 1.93 in the PHC and 3.46 ± 2.18 in the CP. Most of the medications corresponded to cardiovascular system agents. In the CP, 111 prescriptions (4.69%) dispensed to 51 patients (19.39%) were identified as PIMs. In the PHC, 72 prescriptions (8.13%) dispensed to 27 patients (28.42%) were identified as PIMs. In patients with major polymedication the possibility of consuming these drugs was 2.55 times higher in the CP and 2.60 times higher in the PHC. The percentage of PIM prescriptions was significantly higher in the PHC, although the percentage of patients receiving them did not differ significantly. CONCLUSIONS The prevalence of PIMs found in this population is relevant enough to implement measures that address the problem in an integral way, to improve the quality of prescriptions and the health outcomes of patients.
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Affiliation(s)
- Luciana C Chiapella
- Área Farmacología, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, CONICET, Rosario, Santa Fe, Argentina
| | - Jorgelina Montemarani Menna
- Atención Primaria de la Salud, Nodo Rosario, Ministerio de Salud de la Provincia de Santa Fe, Rosario, Santa Fe, Argentina
| | - María Eugenia Mamprin
- Área Farmacología, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, CONICET, Rosario, Santa Fe, Argentina.
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16
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Reichert AR, Stroka MA. Nursing home prices and quality of care - Evidence from administrative data. Health Econ 2018; 27:129-140. [PMID: 28512768 DOI: 10.1002/hec.3518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/20/2015] [Revised: 03/12/2017] [Accepted: 03/24/2017] [Indexed: 06/07/2023]
Abstract
There is widespread concern about the quality of care in nursing homes. On the basis of administrative data of a large health insurance fund, we investigate whether nursing home prices are associated with relevant quality of care indicators at the resident level. Our results indicate negative associations between price and both inappropriate and psychotropic medication. In contrast, we do not find any relationship between the price and impairments of physical health.
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Affiliation(s)
| | - Magdalena A Stroka
- RWI - Leibniz-Institut für Wirtschaftsforschung, Essen, Germany
- Hochschule des Bundes für öffentliche Verwaltung, Brühl, Germany
- Wissenschaftlichen Instituts der TK für Nutzen und Effizienz im Gesundheitswesen, Hamburg, Germany
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17
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Mestres C, Agustí A, Hernandez M, Puerta L, Llagostera B. Pharmacist Intervention Program at Different Rent Levels of Geriatric Healthcare. Pharmacy (Basel) 2017; 5:E27. [PMID: 28970439 PMCID: PMC5597152 DOI: 10.3390/pharmacy5020027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/07/2017] [Revised: 04/22/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
As a pharmacy service giving pharmaceutical care at different levels of health care for elderly people, we needed a standardization procedure for recording and evaluating pharmacists' interventions. Our objective was to homogenize pharmacist interventions; to know physicians' acceptance of our recommendations, as well as the most prevalent drug related problems (DRP); and the impact of the pharmacists' interventions. To achieve this goal we conducted a one year prospective study at two levels of health care: 176 nursing homes (EAR) (8828 patients) and 2 long-term and subacute care hospitals (HSS) (268 beds). Pharmacists' interventions were recorded using the American Society of Health-System Pharmacists classification as the basis. Frequency of the different DRP and the level of response and acceptance on the part of physicians was determined. The Medication Appropriateness Index (MAI) was used to evaluate the impact of the interventions on the prescription quality. Patients' mean age was 84.2 (EAR) and 80.7 (HSS), and in both cases, polypharmacy ≥ 9 drugs was around 63-69%. There were 4073 interventions done in EAR and 2560 in HSS. Level of response: 44% (EAR), 79% (HSS); degree of acceptance of the recommendations: 84% (EAR), 72% (HSS). Most frequent DRP: inappropriate dose, length of therapy, omissions, and financial impact. Drugs for the nervous system are those with the most DRP. MAI values/medication improved from 4.4 to 2.7 (EAR) and 3.8 to 1.7 (HSS). A normalized way of managing pharmacists' interventions for different health care levels has been established. We are on the way to increasing collaborative work with physicians and we know which DRPs are most prevalent.
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Affiliation(s)
- Conxita Mestres
- School of Health Sciences Blanquerna, University Ramon Llull, Padilla 326, 08025 Barcelona, Spain.
| | - Anna Agustí
- Pharmacy Service, HSS Mutuam Girona, Avinguda de França 64, 17007 Girona, Spain.
| | - Marta Hernandez
- Pharmacy Service, EAR Grup Mutuam, Ausias March 39, 08010 Barcelona, Spain.
| | - Laura Puerta
- Pharmacy Service, HSS Mutuam Güell, Mare de Deu de la Salut 49, 08024 Barcelona, Spain.
| | - Blanca Llagostera
- Pharmacy Service, EAR Grup Mutuam, Ausias March 39, 08010 Barcelona, Spain.
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18
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Dörks M, Allers K, Schmiemann G, Herget-Rosenthal S, Hoffmann F. Inappropriate Medication in Non-Hospitalized Patients With Renal Insufficiency: A Systematic Review. J Am Geriatr Soc 2017; 65:853-862. [PMID: 28240771 DOI: 10.1111/jgs.14809] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 01/06/2023]
Abstract
OBJECTIVES Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency. DESIGN A systematic literature search was performed. Data were identified from three electronic databases: PubMed, CINAHL, and Scopus. Studies were included if they reported quantitative data on inappropriate drug use with respect to renal function in non-hospitalized patients. RESULTS Our search strategy resulted in 2,403 hits, of which 18 articles satisfied the criteria for inclusion. Mean estimated glomerular filtration rate ranged from 36.0 to 60.4 mL/min. Prevalence of renally inappropriate drug use ranged from 1% to 37% in outpatient settings other than nursing homes, and from 6% to 43% in nursing homes. Eight of the studies we included identified predictors for use of drugs inappropriate for kidney function. Most frequently determined risk factors were increasing age and a high number of prescribed drugs. CONCLUSION Lack of dose adjustment for renal impairment seems to be a common problem, even in outpatients. However, the differences in methodologies used in these studies hampered any direct comparison. Accepted and comparable standards regarding the drugs included in the studies as well as estimation of renal function would be beneficial.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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19
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Barnett KN, Bennie M, Treweek S, Robertson C, Petrie DJ, Ritchie LD, Guthrie B. Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705). Implement Sci 2014; 9:133. [PMID: 25304255 PMCID: PMC4201916 DOI: 10.1186/s13012-014-0133-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 03/17/2014] [Accepted: 09/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions have small/moderate effects on clinical practice, but few trials explicitly compare different forms of feedback. There is growing recognition that intervention development should be theory-informed, and that comprehensive reporting of intervention design is required by potential users of trial findings. The paper describes intervention development for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study, a pragmatic three-arm cluster randomised trial in 262 Scottish general practices. METHODS The NHS chose to implement a feedback intervention to utilise a new resource, new Prescribing Information System (newPIS). The development phase required selection of high-risk prescribing outcome measures and design of intervention components: (1) educational material (the usual care comparison), (2) feedback of practice rates of high-risk prescribing received by both intervention arms and (3) a theory-informed behaviour change component to be received by one intervention arm. Outcome measures, educational material and feedback design, were developed with a National Health Service Advisory Group. The behaviour change component was informed by the Theory of Planned Behaviour and the Health Action Process Approach. A focus group elicitation study and an email Delphi study with general practitioners (GPs) identified key attitudes and barriers of responding to the prescribing feedback. Behaviour change techniques were mapped to the psychological constructs, and the content was informed by the results of the elicitation and Delphi study. RESULTS Six high-risk prescribing measures were selected in a consensus process based on importance and feasibility. Educational material and feedback design were based on current NHS Scotland practice and Advisory Group recommendations. The behaviour change component was resource constrained in development, mirroring what is feasible in an NHS context. Four behaviour change interventions were developed and embedded in five quarterly rounds of feedback targeting attitudes, subjective norms, perceived behavioural control and action planning (2×). CONCLUSIONS The paper describes a process which is feasible to use in the resource-constrained environment of NHS-led intervention development and documents the intervention to make its design and implementation explicit to potential users of the trial findings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01602705.
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Affiliation(s)
- Karen N Barnett
- />Centre of Population Health Sciences, University of Edinburgh Medical Quad, Teviot Place, Edinburgh EH8 9AG UK
| | - Marion Bennie
- />Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, The John Arbuthnott Building, 161 Cathedral Street, Glasgow, G4 ORE UK
| | - Shaun Treweek
- />Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD UK
| | - Christopher Robertson
- />Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower 26 Richmond Street, Glasgow, G1 1XH UK
| | - Dennis J Petrie
- />Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010 Australia
| | - Lewis D Ritchie
- />Centre of Academic Primary Care, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD UK
| | - Bruce Guthrie
- />Quality, Safety and Informatics Research Group, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
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20
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Neuner-Jehle S, Krones T, Senn O. [Systematic elimination of prescribed medicines is acceptable and feasible among polymorbid family medicine patients]. Praxis (Bern 1994) 2014; 103:317-322. [PMID: 24618310 DOI: 10.1024/1661-8157/a001591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Polypharmacy increasingly is a problem in the care of polymorbid and elderly people, and affects morbidity and mortality. We adapted an algorithm for systematic deprescribing of medicaments (Good Palliative Geriatric Practice, developed for geriatric patients originally), and performed a practicability and acceptance study with 14 general practitioners and 63 patients with 523 medicaments totally. By the intervention 13% of all medicaments could be changed and 9% stopped, mostly (56%) due to an absence of indication. 75% of patients given a recommendation to change a medicament agreed. Acceptance and practicability of the tool were rated clearly positive by physicians. To study efficacy a randomized-controlled trial with clinical outcomes, long-term follow up and the exploration of patients' views is warranted.
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Affiliation(s)
| | - Tanja Krones
- Abteilung Klinische Ethik, Universitätsspital Zürich und Universität Zürich
| | - Oliver Senn
- Institut für Hausarztmedizin Zürich, Universität Zürich
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21
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Holmes HM, Luo R, Kuo YF, Baillargeon J, Goodwin JS. Association of potentially inappropriate medication use with patient and prescriber characteristics in Medicare Part D. Pharmacoepidemiol Drug Saf 2013; 22:728-34. [PMID: 23494811 DOI: 10.1002/pds.3431] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/23/2013] [Accepted: 02/11/2013] [Indexed: 01/10/2023]
Abstract
PURPOSE The use of potentially inappropriate medications (PIMs) in older people is associated with increased risk of adverse drug events and hospitalization. This study aimed to determine the contribution of primary prescribers to variation in PIM use. METHODS This was a retrospective cohort study using 2008 Medicare Part D event files and claims data for a 100% sample of Texas beneficiaries. PIM use was defined as receiving any of 48 medications on the Beers 2003 list of PIMs. Patient characteristics associated with PIM use were determined using a multivariable model. A multilevel model for the odds of PIM use was constructed to evaluate the amount of variation in PIM use at the level of primary care prescriber, controlling for patient characteristics. RESULTS Of 677,580 patients receiving prescriptions through Part D in 2008, 31.9% received a PIM. Sex, ethnicity, low-income subsidy eligibility, and hospitalization in 2007 were associated with PIM use. The strongest associations with higher PIM use were increasing number of prescribers and increasing number of medications. The odds ratio for PIM use was 1.50 (95%CI 1.47-1.53) for ≥4 prescribers versus only 1 prescriber. In the multilevel model, the adjusted average percent of patients prescribed a PIM ranged from 17.5% for the lowest decile to 28.9% for the highest decile of prescribers. CONCLUSIONS PIM use was prevalent in Part D beneficiaries and varied among individual primary care prescribers. The association of PIM use with increasing numbers of prescribers suggests the need to reduce fragmentation of care to reduce inappropriate prescribing.
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Affiliation(s)
- Holly M Holmes
- Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, TX, USA.
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22
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Abstract
In the past, polypharmacy was referred to the mixing of many drugs in one prescription. Today polypharmacy implies to the prescription of too many medications for an individual patient, with an associated higher risk of adverse drug reactions (ADRs) and interactions. Situations certainly exist where the combination therapy or polytherapy is the used for single disease condition. Polypharmacy is a problem of substantial importance, in terms of both direct medication costs and indirect medication costs resulting from drug-related morbidity. Polypharmacy increases the risk of side effects and interactions. Moreover it is a preventable problem. A retrospective study was carried out at Bhopal district (Capital of Madhya Pradesh, India) in the year of September-November 2009 by collecting prescriptions of consultants at various levels of health care. The tendency of polypharmacy was studied and analyzed under the various heads in the survey. Available data suggests that polypharmacy is a widespread problem, and physician, clinical pharmacists and patients are all responsible. These risks can be minimized through identifying the prevalence of this potential problem in a high-risk population and by increasing awareness among patients and healthcare professionals. Physicians and clinical pharmacists have the potential to combating this problem through a variety of interventions such as reducing the number of medications taken, reducing the number of doses taken, increasing patient adherence, preventing ADRs, improving patient quality of life and decreasing facility and drug costs.
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Affiliation(s)
- Sujit Rambhade
- Department of Pharmacology, Peoples Institute of Pharmacy & Research Center, Peoples Group, Bhopal, Madhya Pradesh, India
| | - Anup Chakarborty
- Department of Pharmacology, Peoples Institute of Pharmacy & Research Center, Peoples Group, Bhopal, Madhya Pradesh, India
| | - Anand Shrivastava
- Department of Pharmacology, Peoples Institute of Pharmacy & Research Center, Peoples Group, Bhopal, Madhya Pradesh, India
| | - Umesh K. Patil
- Department of Pharmacology, Peoples Institute of Pharmacy & Research Center, Peoples Group, Bhopal, Madhya Pradesh, India
| | - Ashish Rambhade
- Sagar Institute of Research Technology and Science, Ayodhya Nagar, Bhopal, Madhya Pradesh, India
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Laroche ML, Charmes JP, Nouaille Y, Picard N, Merle L. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 2007; 63:177-86. [PMID: 17166186 PMCID: PMC2000580 DOI: 10.1111/j.1365-2125.2006.02831.x] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [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: 05/29/2006] [Accepted: 10/06/2006] [Indexed: 01/01/2023] Open
Abstract
AIM To study the occurrence of adverse drug reactions (ADRs) linked to inappropriate medication (IM) use in elderly people admitted to an acute medical geriatric unit. METHODS All the elderly people aged > or = 70 years admitted to the acute medical geriatric unit of Limoges University hospital (France) over a 49-month period were included, whatever their medical condition. For all the patients, clinical pharmacologists listed the medications given before admission and identified the possible ADRs. The appropriateness of these medications and the causal relationship between drugs (either appropriate or not) and ADRs were evaluated. RESULTS Two thousand and eighteen patients were included. The number of drugs taken was 7.3 +/- 3.0 in the patients with ADRs and 6.0 +/- 3.0 in those without ADRs (P < 0.0001). Sixty-six percent of the patients were given at least one IM prior to admission. ADR prevalence was 20.4% among the 1331 patients using IMs and 16.4% among those using only appropriate drugs (P < 0.03). In only 79 of the 1331 IM users (5.9%) were ADRs directly attributable to IMs. The IMs most often involved in patients with ADRs were: anticholinergic antidepressants, cerebral vasodilators, long-acting benzodiazepines and concomitant use of two or more psychotropic drugs from the same therapeutic class. Using multivariate analysis, after adjusting for confounding factors, IM use was not associated with a significant increased risk of ADRs (odds ratio 1.0, 95% confidence interval 0.8, 1.3). CONCLUSION Besides a reduction in the number of drugs given to the elderly, a good prescription should involve a reduction in the proportion of IMs and should take into consideration the frailty of these patients.
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Affiliation(s)
- Marie-Laure Laroche
- Department of Pharmacology-Toxicology, University Hospital Dupuytren and Department of Geriatrics, Hospital Rebeyrol, Limoges, France
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