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Truong M, Van C, Sud K, Tesfaye W, Croker N, Seth S, Castelino RL. Drug-Related Problems and Recommendations Made during Home Medicines Reviews for Sick Day Medication Management in Australia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:798. [PMID: 38792982 PMCID: PMC11123247 DOI: 10.3390/medicina60050798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Backgrounds and Objectives: Using certain medications during an intercurrent illness can increase the risk of drug related problems (DRP) occurring such as acute kidney injury (AKI). Medications that increase this risk include sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, metformin, angiotensin receptor blockers, non-steroidal anti-inflammatories drugs, and sodium glucose co-transporter 2 inhibitors (SADMANS). Sick day medication guidance (SDMG) recommends withholding SADMANS medications during an intercurrent illness where adequate fluid intake cannot be maintained. But uptake of these recommendations is poor, and it is not known whether Australian pharmacists currently provide these recommendations during home medicine reviews (HMR) as per SDMG. We aimed to gain an understanding of the characteristics of DRP identified by pharmacists during HMR, especially those relating to SADMANS medications. Materials and Methods: We conducted a retrospective audit of 201 randomly selected HMR reports, conducted by accredited pharmacists from 2020 to 2022, that were analysed in 2023. All DRP and recommendations were categorised using a modified DOCUMENT system. Results: Overall, over 98% of participants experienced a DRP and a total of 710 DRP were found, where participants experienced an average of 4.0 ± 2.0 DRP each. Non-SADMANS medications accounted for 83.1% of all DRPs, with nervous system medications contributing the most. Common problems seen in non-SADMANS medications were related to toxicity, over/underdosing and undertreating. Diuretics contributed most to DRP in SADMANS medications. Problems with SADMANS were mainly related to toxicity and contraindications. No pharmacists provided SDMG despite 71.1% of participants using at least one SADMANS medication. Conclusions: We conclude that DRP remain prevalent in community pharmacy settings. Sick day recommendations were not provided in the HMRs included in our study, possibly due to lack of pharmacist knowledge and awareness. To ensure best practice, more research should be conducted to determine pharmacists' knowledge of and barriers to provision of sick day recommendations.
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Affiliation(s)
- Mimi Truong
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Connie Van
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Kamal Sud
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Kingswood 2747, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Wubshet Tesfaye
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4072, Australia
| | | | - Shrey Seth
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Ronald Lynel Castelino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Pharmacy Department, Blacktown Hospital, Western Sydney Local Health District, Blacktown 2148, Australia
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Zuleta M, San-José A, Gozalo I, Sánchez-Arcilla M, Carrizo G, Alvarado M, Pérez-Bocanegra C. Patterns of inappropriate prescribing and clinical characteristics in patients at admission to an acute care of the elderly unit. Eur J Clin Pharmacol 2024; 80:553-561. [PMID: 38265499 DOI: 10.1007/s00228-024-03627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Inappropriate prescribing (IP) is common among the elderly and is associated with adverse health outcomes. The role of different patterns of IP in clinical practice remains unclear. The aim of this study is to analyse the characteristics of different patterns of IP in hospitalized older adults. METHODS This is a prospective observational study conducted in the acute care of elderly (ACE) unit of an acute hospital in Barcelona between June and August 2021. Epidemiological and demographic data were collected, and a comprehensive geriatric assessment (CGA) was performed on admitted patients. Four patterns of inappropriate prescribing were identified: extreme polypharmacy (10 or more drugs), potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs) and anticholinergic burden. RESULTS Among 93 admitted patients (51.6% male, mean age of 82.83), the main diagnosis was heart failure (36.6%). Overprescribing patterns (extreme polypharmacy, PIMs, PPOs and anticholinergic burden) were associated with higher comorbidity, increased dependence on instrumental activities of daily living (IADL) and greater prevalence of dementia. Underprescribing (omissions) was associated with important comorbidity, residence in nursing homes, an increased risk of malnutrition, higher social risk and greater frailty. Comparing different patterns of IP, patients with high anticholinergic burden exhibited more extreme polypharmacy and PIMs. In the case of omissions, no association was identified with other IP patterns. CONCLUSIONS We found statistically significant association between patterns of inappropriate prescribing and clinical and CGA variables such as comorbidity, dependency, dementia or frailty. There is a statistically significant association between patterns of overprescribing among patients admitted to the ACE unit.
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Affiliation(s)
- Mónica Zuleta
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain.
| | - Antonio San-José
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Inés Gozalo
- Pharmacy Department, Sant Rafael Hospital, Barcelona, Spain
| | | | - Gabriela Carrizo
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Marcelo Alvarado
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Carmen Pérez-Bocanegra
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
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Anderssen-Nordahl E, Sánchez-Arcilla Rosanas M, Bosch Ferrer M, Sabaté Gallego M, Fernández-Liz E, San-José A, Barceló-Colomer ME. Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach. Front Pharmacol 2024; 15:1320490. [PMID: 38529187 PMCID: PMC10961593 DOI: 10.3389/fphar.2024.1320490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 03/27/2024] Open
Abstract
Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs. Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug-drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs. Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%. Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.
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Affiliation(s)
- Emilie Anderssen-Nordahl
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margarita Sánchez-Arcilla Rosanas
- Geriatric Unit, Internal Medicine Service, Vall d'Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bosch Ferrer
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mònica Sabaté Gallego
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Clinical Pharmacology Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eladio Fernández-Liz
- Primary Healthcare Barcelona, Management of Primary Care and the Community of Barcelona City, Catalan Institute of Health, Barcelona, Spain
- Foundation University Institute for Research in Primary Healthcare Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Antonio San-José
- Geriatric Unit, Internal Medicine Service, Vall d'Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Estrella Barceló-Colomer
- Primary Healthcare Barcelona, Management of Primary Care and the Community of Barcelona City, Catalan Institute of Health, Barcelona, Spain
- Foundation University Institute for Research in Primary Healthcare Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Chang CT, Teoh SL, Rajan P, Lee SWH. Explicit potentially inappropriate medications criteria for older population in Asian countries: A systematic review. Res Social Adm Pharm 2023:S1551-7411(23)00281-4. [PMID: 37277240 DOI: 10.1016/j.sapharm.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Explicit potentially inappropriate medications (PIM) criteria are commonly used to identify and deprescribe potentially inappropriate prescriptions among older patients. Most of these criteria were developed specifically for the Western population, which might not be applicable in an Asian setting. The current study summarizes the methods and drug lists to identify PIM in older Asian people. METHODS A systematic review of published and unpublished studies were carried out. Included studies described the development of explicit criteria for PIM use in older adults and provided a list of medications that should be considered inappropriate. PubMed, Medline, EMBASE, Cochrane CENTRAL, CINAHL, PsycINFO, and Scopus searches were conducted. The PIMs were analyzed according to the general conditions, disease-specific conditions, and drug-drug interaction classes. The qualities of the included studies were assessed using a nine-point evaluation tool. The kappa agreement index was used to evaluate the level of agreement between the identified explicit PIM tools. RESULTS The search yielded 1206 articles, and 15 studies were included in our analysis. Thirteen criteria were identified in East Asia and two in South Asia. Twelve out of the 15 criteria were developed using the Delphi method. We identified 283 PIMs independent of medical conditions and 465 disease-specific PIMs. Antipsychotics were included in most of the criteria (14/15), followed by tricyclic antidepressants (TCAs) (13/15), antihistamines (13/15), sulfonylureas (12/15), benzodiazepines (11/15), and nonsteroidal anti-inflammatory drug (NSAIDs) (11/15). Only one study fulfilled all the quality components. There was a low kappa agreement (k = 0.230) between the included studies. CONCLUSION This review included 15 explicit PIM criteria, which most listed antipsychotics, antidepressants, and antihistamines as potentially inappropriate. Healthcare professionals should exercise more caution when dealing with these medications among older patients. These results may help healthcare professionals in Asian nations to create regional standards for the discontinuation of potentially harmful drugs for elderly patients.
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Affiliation(s)
- Chee Tao Chang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia; Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia; School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
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Song Y, Chen L, Liu Y, Xia X, Hou L, Wu J, Cao L, Mo L. Geriatrician-led multidisciplinary team management improving polypharmacy among older inpatients in China. Front Pharmacol 2023; 14:1167306. [PMID: 37188273 PMCID: PMC10177397 DOI: 10.3389/fphar.2023.1167306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Background/Aim: Polypharmacy is prevalent among older inpatients and associated with adverse outcomes. To determine whether a geriatrician-led multidisciplinary team (MDT) management mode could reduce medications use among older inpatients. Methods: A retrospective cohort study was conducted in a geriatric department of a tertiary hospital in China with 369 older inpatients, including 190 patients received MDT management (MDT cohort), and 179 patients received usual treatment (non-MDT cohort). The primary outcome was to compare the changes of the amount of medications before and after hospitalization in two cohorts. Results: We reported that MDT management significantly reduced the number of medications used in older inpatients at discharge (at home: n = 7 [IQR: 4, 11] vs at discharge: n = 6 [IQR: 4, 8], p < 0.05). Hospitalization with the MDT management had a significant effect on the change in the amount of medications (F = 7.813, partial-η2 = 0.011, p = 0.005). The discontinuance of medications was associated with polypharmacy at home (OR: 96.52 [95% CI: 12.53-743.48], p < 0.001), and the addition of medications was associated with a diagnosis of chronic obstructive pulmonary disease (COPD) (OR: 2.36 [95% CI: 1.02-5.49], p = 0.046). Conclusion: The results indicated that the geriatrician-led MDT mode during hospitalization could reduce the number of medications used by older patients. The patients with polypharmacy were more likely to "deprescription" after MDT management, while the patients with COPD were more likely to be under-prescription at home, polypharmacy which could be made up for after MDT management.
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Affiliation(s)
- Yi Song
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Lihua Chen
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Liu
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Xia
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lisha Hou
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinhui Wu
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Cao
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Mo
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Li Mo,
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ÇAVUŞOĞLU Ç. Inappropriate drug use determined by TIME criteria and the relation with frailty. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1136024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Çalışmamızın amacı kırılganlık ile çoklu ilaç kullanımı, Potansiyel Uygunsuz İlaç Kullanımı (PUİK) ve Potansiyel Reçete İhmali (PRİ) ilişkisini değerlendirmektedir.
Gereç ve Yöntem: Geriatri polikliniğine 1 Ekim 2021 ve 1 Nisan 2022 ayaktan başvuran 65 yaş ve üzeri hastalar retrospektif değerlendirildi. Hastaların demografik verileri, kullandıkları ilaçların etken maddeleri, komorbid hastalıkları ve Klinik Kırılganlık Skalası (KKS) skoru kayıt edildi. KKS skoruna göre hastalar kırılgan ve kırılgan olmayan olarak ikiye ayrıldı. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP kriterleri PUİK değerlendirmek için, TIME to START ise PRİ’yi belirlemek için kullanıldı.
Bulgular: Hastaların ortalama yaşı 75,9±8,7 olup, hastaların %63,1 kadın idi. Hastaların kullandığı ortanca ilaç sayısı 7 (0-17) iken, katılımcıların %79,6’sında polifarmasi mevcuttu. Kırılgan hastaların %69,5 (n=42)’ inde polifarmasi mevcut olup, kırılgan olmayan hastalarda bu oran %22,5 (n=18) idi. Kırılgan hastalarda oral beslenme ürünü, 3-hidroksi-3-metil-glutaril-KoA reduktaz inhibitörleri ve demans tedavisi reçete ihmali oranı anlamlı olarak normal popülasyondan daha fazla idi. Proton pompa inhibitörleri, antipsikotikler, asetilsalisilik asit ve betahistinin uygunsuz kullanım oranı kırılgan hastalarda, kırılgan olmayan hastalardan daha fazla idi.
Sonuç: Polifarmasi, PRİ ve PUİK hastalarda değerlendirilirken kırılganlık göz önünde bulundurulmalıdır ve her ülkenin farklı reçeteleme alışkanlığı olmasından dolayı ülkemize özel olan TIME kriterlerinin kullanımı önemli bir avantaj sağlayabilir.
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Affiliation(s)
- Çağatay ÇAVUŞOĞLU
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ŞANLIURFA MEHMET AKİF İNAN SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Lisowska A, Czepielewska E, Rydz M, Dworakowska A, Makarewicz-Wujec M, Kozłowska-Wojciechowska M. Applicability of tools to identify potentially inappropriate prescribing in elderly during medication review: Comparison of STOPP/START version 2, Beers 2019, EU(7)-PIM list, PRISCUS list, and Amsterdam tool—A pilot study. PLoS One 2022; 17:e0275456. [PMID: 36173988 PMCID: PMC9521918 DOI: 10.1371/journal.pone.0275456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 09/17/2022] [Indexed: 11/20/2022] Open
Abstract
Potentially inappropriate prescribing (PIP) is one of the major risk factors of adverse drug events in elderly patients. Pharmacotherapy assessment criteria may help reduce the instances of PIP among geriatric patients. This study aimed to verify the applicability of selected tools designed to assess prescribing appropriateness in elderly and to identify PIP in the study population. Based on pharmacist-led medication reviews that were performed among patients attending senior day-care centers based in Poland, aged 65 years and over, the following tools were applied for assessing the appropriateness of pharmacotherapy: PILA (patient-in-focus listing approach): STOPP/START v.2 and Amsterdam tool, DOLA (drug-oriented listing approach): PRISCUS list, and DOLA+: Beers criteria v.2019 and the EU(7)-PIM list–the criteria oriented on medications requiring indications. Fifty patients participated in the study. The prevalence of prescribing issues in the study population was very high and ranged from 28% to 100%, depending on the criteria applied. The highest number of PIP cases was identified based on the PILA criteria: STOPP/START v.2 (171, a mean of 3.4 PIP cases per patient), and the Amsterdam criteria (124, a mean of 2.5 PIP cases per patient). The lack of protective vaccinations against pneumococci identified using the START criterion was found to be the most common PIP (identified in 96% of the patients). Proton-pump inhibitors (PPIs) were identified as the most problematic group of medications. The STOPP, EU(7)-PIM and Beers criteria revealed cases of inappropriate prolonged PPI use, whereas the Amsterdam tool identified cases where PPIs should have been prescribed but were not. The highest number of PIP cases in the study population were identified with the PILA tools, and on this basis the most comprehensive assessment of pharmacotherapy appropriateness in geriatric patients was conducted. Further studies should be designed, covering a larger group of patients across different healthcare settings (inpatient and outpatient), with access to comprehensive patient data.
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Affiliation(s)
- Agnieszka Lisowska
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Czepielewska
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
- * E-mail:
| | - Martyna Rydz
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
| | - Anna Dworakowska
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Makarewicz-Wujec
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
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Andersen AL, Houlind MB, Nielsen RL, Jørgensen LM, Treldal C, Damgaard M, Bengaard AK, Juul-Larsen HG, Laursen LB, Iversen E, Kruse M, Pedersen AML, Hornum M, Beck AM, Pedersen MM, Ankarfeldt MZ, Petersen J, Andersen O. Optimization of Nutrition And Medication (OptiNAM) for acutely admitted older patients: protocol for a randomized single-blinded controlled trial. Trials 2021; 22:616. [PMID: 34521465 PMCID: PMC8439057 DOI: 10.1186/s13063-021-05456-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/13/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Internationally, older patients (≥65 years) account for more than 40% of acute admissions. Older patients admitted to the emergency department (ED) are frequently malnourished and exposed to inappropriate medication prescribing, due in part to the inaccuracy of creatinine-based equations for estimated glomerular filtration rate (eGFR). The overall aims of this trial are to investigate: (1) the efficacy of a medication review (MED intervention) independent of nutritional status, (2) the accuracy of eGFR equations based on various biomarkers compared to measured GFR (mGFR) based on 99mTechnetium-diethylenetriaminepentaacetic acid plasma clearance, and (3) the efficacy of an individualized multimodal and transitional nutritional intervention (MULTI-NUT-MED intervention) in older patients with or at risk of malnutrition in the ED. METHODS The trial is a single-center block randomized, controlled, observer-blinded, superiority and explorative trial with two parallel groups. The population consists of 200 older patients admitted to the ED: 70 patients without malnutrition or risk of malnutrition and 130 patients with or at risk of malnutrition defined as a Mini Nutritional Assessment-Short Form score ≤11. All patients without the risk of malnutrition receive the MED intervention, which consists of a medication review by a pharmacist and geriatrician in the ED. Patients with or at risk of malnutrition receive the MULTI-NUT-MED intervention, which consists of the MED intervention in addition to, dietary counseling and individualized interventions based on the results of screening tests for dysphagia, problems with activities of daily living, low muscle strength in the lower extremities, depression, and problems with oral health. Baseline data are collected upon study inclusion, and follow-up data are collected at 8 and 16 weeks after discharge. The primary outcomes are (1) change in medication appropriateness index (MAI) score from baseline to 8 weeks after discharge, (2) accuracy of different eGFR equations compared to mGFR, and (3) change in health-related quality of life (measured with EuroQol-5D-5L) from baseline to 16 weeks after discharge. DISCUSSION The trial will provide new information on strategies to optimize the treatment of malnutrition and inappropriate medication prescribing among older patients admitted to the ED. TRAIL REGISTRATION ClinicalTrials.gov NTC03741283 . Retrospectively registered on 14 November 2018.
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Affiliation(s)
- Aino L Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Morten B Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,The Capital Region Pharmacy, Marielundsvej 25, 2730, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen Ø, Denmark
| | - Rikke L Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Lillian M Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,The Capital Region Pharmacy, Marielundsvej 25, 2730, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen Ø, Denmark
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,The Capital Region Pharmacy, Marielundsvej 25, 2730, Herlev, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Louise Bolvig Laursen
- Department of Physio- and Occupational Therapy, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Marie Kruse
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Danish Centre for Health Economics, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Anne M L Pedersen
- Section of Oral Medicine and Pathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen Ø, Denmark
| | - Anne M Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200, Copenhagen N, Denmark.,Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
| | - Mette M Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Mikkel Z Ankarfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Copenhagen Phase IV unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.,Copenhagen Phase IV unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark. .,Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark.
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9
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Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study. Eur J Clin Pharmacol 2020; 77:777-785. [PMID: 33269418 PMCID: PMC8032616 DOI: 10.1007/s00228-020-03052-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/20/2020] [Indexed: 11/05/2022]
Abstract
Purpose To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients. Methods A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time. Results The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p = .95), whereas PPO prevalence increased (OR = 1.08, p < .001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p < .001) and PPO prevalence (aOR = 0.94, p < .001) decreased over the years. Conclusion We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-020-03052-2.
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10
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El Hadidi S, Rosano G, Tamargo J, Agewall S, Drexel H, Kaski JC, Niessner A, Lewis BS, Coats AJS. Potentially Inappropriate Prescriptions in Heart Failure with Reduced Ejection Fraction (PIP-HFrEF). EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 8:187-210. [PMID: 32941594 DOI: 10.1093/ehjcvp/pvaa108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a chronic debilitating and potentially life-threatening condition. Heart Failure patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of ESC guidelines, ESC position papers, scientific evidence, and experts' opinions.
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Affiliation(s)
- Seif El Hadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Egypt
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Heinz Drexel
- VIVIT Institute, Landeskrankenhaus Feldkirch, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Andrew J S Coats
- Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
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11
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Traina S, Armando LG, Diarassouba A, Baroetto Parisi R, Esiliato M, Rolando C, Remani E, de Cosmo P, Cena C. Proactive inter-disciplinary CME to improve medication management in the elderly population. Res Social Adm Pharm 2020; 17:1072-1078. [PMID: 32919917 DOI: 10.1016/j.sapharm.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The absence of collaboration between health professionals is known to influence prescriptions' quality, also disadvantaging elderly frail patients' polytherapies. OBJECTIVES This study aims to improve the adherence to medications of elderly patients suffering from multiple diseases through interpersonal continuing medical education (CME). The CME was organized for general practitioners (GPs) by hospital pharmacists (HPs) from a Territorial Pharmaceutical Centre of Piedmont, in collaboration with pharmacists from the Drug Science and Technology Department of the University of Turin, to enhance awareness on the management of chronic therapies and de-prescription. METHODS Pharmacists set face-to-face lessons for GPs between April 2018 and November 2018, while therapies' reconciliation and delivery of the Illustrated Therapy Schedules (ITS) lasted until September 2019. Polytherapies were evaluated by pharmacists and GPs in terms of appropriateness (number of potentially inappropriate prescriptions - PIPs according to 2019 Beers Criteria) and number of drug-drug interactions (DDIs), using a clinical decision support system (CDSS - NavFarma©) to help health professionals dealing with the process of review, reconciliation and individuation of possible adverse reactions. RESULTS From the CME organization it emerged that the collaboration between health professionals supported by a CDSS could improve the quality of elderly patients polytherapies. Two-hundred fifteen patients were enrolled by GPs; patients included were aged - results reported as average (sd) - 76.4 (6.3), mostly men (54.9%), number of daily medications per patient was 8.1 (2.4); 2.1 (1.8) DDIs per patient were individuated, 12.9% of which were solved thanks to the CME. Average number of PIPs found was 2.5 (1.4) per patient. CONCLUSIONS The CME represented a proactive approach by HPs to the management of elderly patients' polytherapies. Moreover, clinicians' engagement is a mean to enhance quality, safety, professionalism and communication in health processes.
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Affiliation(s)
- S Traina
- Drug Science and Technology Department, Università degli Studi di Torino, via Pietro Giuria 9, 10125, Torino, Italy.
| | - L G Armando
- Infologic s.r.l, via Vecchia 43, 35127, Padova, Italy.
| | - A Diarassouba
- Pharmaceutical Centre ASL TO4, via Po 11, 10034, Chivasso, Italy.
| | | | - M Esiliato
- Pharmaceutical Centre ASL TO4, via Po 11, 10034, Chivasso, Italy.
| | - C Rolando
- Pharmaceutical Centre ASL TO4, via Po 11, 10034, Chivasso, Italy.
| | - E Remani
- Pharmaceutical Centre ASL TO4, via Po 11, 10034, Chivasso, Italy.
| | - P de Cosmo
- Infologic s.r.l, via Vecchia 43, 35127, Padova, Italy.
| | - C Cena
- Drug Science and Technology Department, Università degli Studi di Torino, via Pietro Giuria 9, 10125, Torino, Italy.
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12
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San-José A, Pérez-Bocanegra C, Agustí A, Laorden H, Gost J, Vidal X, Oropeza V, Romero R. Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention. Med Clin (Barc) 2020; 156:263-269. [PMID: 32593414 DOI: 10.1016/j.medcli.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity. MATERIAL AND METHODS Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months. RESULTS One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention. CONCLUSIONS An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.
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Affiliation(s)
- Antonio San-José
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Carmen Pérez-Bocanegra
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonia Agustí
- Clinical Pharmacology Service, Vall d'Hebron University Hospital , Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Helena Laorden
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| | - Jordi Gost
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| | - Xavier Vidal
- Clinical Pharmacology Service, Vall d'Hebron University Hospital , Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Vanessa Oropeza
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rosa Romero
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
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13
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Baré M, Herranz S, Jordana R, Gorgas MQ, Ortonobes S, Sevilla D, De Jaime E, Ibarra O, Martín C. Multimorbidity patterns in chronic older patients, potentially inappropriate prescribing and adverse drug reactions: protocol of the multicentre prospective cohort study MoPIM. BMJ Open 2020; 10:e033322. [PMID: 31988230 PMCID: PMC7044922 DOI: 10.1136/bmjopen-2019-033322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Multimorbidity is a major challenge for current healthcare systems and professionals. From the different approaches that have been proposed to analyse this issue, the hypothesis of the existence of association patterns of different chronic conditions is gaining visibility. In addition, multimorbidity can be associated to polypharmacy, which can lead to a higher risk of potentially inappropriate prescribing (PIP) and consequently to adverse drug reactions (ADRs). The general objective of this novel study is to identify the association between PIP, multimorbidity patterns, polypharmacy and the presence of ADRs in older patients admitted for exacerbation of chronic diseases. METHODS AND ANALYSIS The MoPIM (morbidity, potentially inappropriate medication) study is a multicentre prospective cohort study of an estimated sample of 800 older (≥65 years) patients admitted to five general hospitals in Spain due to an exacerbation of a chronic disease. Patients referred to home hospitalisation, admitted due to an acute process or with a fatal outcome expected at the time of admission are excluded. Sociodemographic data, chronic morbidities and geriatric syndromes, number of chronic prescribed medications, PIP at admission to hospital and on discharge, according to the newest screening tool of older screening tool of older person's potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria, and ADRs during hospitalisation are being collected. Multimorbidity patterns will be identified using cluster analyses techniques, and the frequency of polypharmacy, PIP and ADRs will be calculated. Finally, the possible relationship between those indicators will be identified through bivariate and multivariate analyses. ETHICS AND DISSEMINATION The project has been approved by the clinical research ethics committees of each centre: Comité Ético de investigación Clínica del Parc Taulí, Comitè Ètic d'Investigació Clínica Osona per a la Recerca i Educació Sanitàries (FORES), Comité de Ètica de la Investigación con Medicamentos (CEIm)-Parc de Salut MAR, Comité Ético de Investigación Clínica de Euskadi, Comité de Ética de Investigación del Hospital Universitario de Canarias. The results will be actively and mainly disseminated through publication in peer-reviewed journals and communications in scientific conferences. TRIAL REGISTRATION NUMBER NCT02830425.
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Affiliation(s)
- Marisa Baré
- Department of Epidemiology and Cancer Screening, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Catalonia, Spain
| | - Susana Herranz
- Internal Medicine Department, Acute Care Geriatric Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Rosa Jordana
- Internal Medicine Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Maria Queralt Gorgas
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Sara Ortonobes
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain
| | - Daniel Sevilla
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Catalonia, Spain
| | - Elisabet De Jaime
- Geriatrics Department, Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalonia, Spain
| | - Olatz Ibarra
- Pharmacy Department, Hospital Galdakao-Usansolo, Galdacano, País Vasco, Spain
| | - Candelaria Martín
- Internal Medicine Department, Hospital Universitario de Canarias, La Laguna, Canarias, Spain
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14
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Manias E, Maier A, Krishnamurthy G. Inappropriate medication use in hospitalised oldest old patients across transitions of care. Aging Clin Exp Res 2019; 31:1661-1673. [PMID: 30632078 DOI: 10.1007/s40520-018-01114-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oldest old patients aged 85 years and over are at risk of experiencing potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) across transitions of care. Geriatricians also face enormous challenges in prescribing medications for these patients. METHODS A mixed-methods, sequential explanatory design was undertaken of electronic medical records and semi-structured interviews with geriatricians at a public teaching hospital. Data were collected at four time points using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START). RESULTS Of 249 patients, the prevalence of at least 1 PIM varied between 36.9 and 51.0%, while the prevalence of at least 1 PPO varied between 36.9 and 44.6%. The most common PIM was use of proton pump inhibitors while the most common PPO was omission of vitamin D supplements in housebound patients or patients experiencing falls. Poisson regression analysis showed that PIMs were significantly associated with use of mobility aids, 1.430 (95% CI 1.109-1.843, p = 0.006), and number of medications prescribed at admission, 1.083 (95% CI 1.058-1.108, p < 0.001). PPOs were significantly associated with comorbidities, 1.172 (95% CI 1.073-1.280, p < 0.001), medications prescribed at admission, 0.989 (95% CI 0.978-0.999, p = 0.035), and length of stay, 1.004 (95% CI 1.002-1.006, p < 0.001). Geriatrician interviews (N = 9) revealed medication-related, health professional-related and patient-related challenges with managing medications. CONCLUSIONS Inappropriate prescribing is common in oldest old patients. Greater attention is needed on actively de-prescribing medications that are not beneficial and commencing medications that would be advantageous. Tailored strategies for improving prescribing practices are needed.
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Affiliation(s)
- Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Royal Parade, Parkville, Victoria, 3052, Australia.
| | - Andrea Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Royal Parade, Parkville, Victoria, 3052, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Gopika Krishnamurthy
- The Royal Melbourne Hospital, Royal Parade, Parkville, Victoria, 3052, Australia
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15
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Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Ena J. Reducción del número de prescripciones inadecuadas: comunicación farmacia-prescriptor. Rev Clin Esp 2019; 219:401-402. [DOI: 10.1016/j.rce.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
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17
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Ena J. Reduction in the number of inadequate prescriptions: Pharmacy-prescriber communication. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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The efficacy of a medication review programme conducted in an emergency department. Int J Clin Pharm 2019; 41:757-766. [DOI: 10.1007/s11096-019-00836-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/30/2018] [Indexed: 10/26/2022]
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19
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Fernández Regueiro R, Estrada Menéndez C, Morís de la Tassa J. Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients. Rev Clin Esp 2019; 219:375-385. [PMID: 31030886 DOI: 10.1016/j.rce.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND OBJECTIVES Potentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. METHOD A quasi-experimental before-after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. RESULTS 174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p=0.005), presented cognitive impairment (p=0.001) and were more institutionalized (p=0.039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p<0.001), odds ratio 242.5 (CI95%: 56.9-1023.6). CONCLUSIONS Review of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders.
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Affiliation(s)
- R Fernández Regueiro
- Servicio de Medicina Interna, Hospital Universtario de Cabueñes, Gijón, Asturias, España.
| | | | - J Morís de la Tassa
- Servicio de Medicina Interna, Hospital Universtario de Cabueñes, Gijón, Asturias, España; Facultad de Medicina y Ciencias de la Salud. Universidad de Oviedo, Oviedo, Asturias, España
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20
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Butool I, Nazir S, Afridi M, Shah SM. Evaluation and assessment of prescribing patterns in elderly patients using two explicit criteria based screening tools: (The PRISCUS list and STOPP/START criteria). Pak J Med Sci 2018; 34:1357-1362. [PMID: 30559785 PMCID: PMC6290224 DOI: 10.12669/pjms.346.14928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 10/15/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND & OBJECTIVES Rational prescribing can prevent medication errors and the associated harm, especially in old age patients, as they are being frequently prescribed with drugs for various ailments. Moreover, polypharmacy is a common practice in them. Therefore, a significant threat of potential drug interactions and adverse effects exist. Current study focuses on assessment of Potentially Inappropriate Medication (PIM) in medication prescribed to old age patients. METHODS It was a forty days, descriptive and observational study conducted from August 15th 2017 to September 25th 2017 in which prescriptions given to elderly patients were reimbursed for collecting various sets of information. In order to assess PIMs (in Pakistani Set-up), STOPP/START addition 2008 (including examples of misprescribing, overprescribing and under prescribing) and the PRISCUS list (misprescribing and overprescribing) was used. Statistical analysis of results was performed using SPSS version 20. RESULTS One hundred forty six cases of PIMs (including incorrect prescribing, overprescribing and under prescribing) were detected. It included incorrect prescriptions 104, under prescription 28 and over prescriptions 14. NSAIDS accounted for most incorrect prescriptions followed by benzodiazepines. Mostly NSAIDS were used for myalgia, backache and rheumatoid disorders. CONCLUSION Current findings highlighted Potentially Inappropriate Prescribing (PIP), particularly of NSAIDs and under prescribing of statins in cardiovascular diseases. Study findings suggest introducing pertinent interventions at the stages involved in prescribing, prescription review and its follow up to reduce the PIP and PIMs.
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Affiliation(s)
- Irum Butool
- Irum Butool, Department of Pharmacy, Kohat University of science and Technology, Kohat, Pakistan
| | - Shabnam Nazir
- Shabnam Nazir, Assistant Professor, Department of Pharmacy, Kohat University of science and Technology, Kohat, Pakistan
| | - Maryam Afridi
- Maryam Afridi, Department of Pharmacy, Kohat University of science and Technology, Kohat, Pakistan
| | - Syed Majid Shah
- Syed Majid Shah, Department of Pharmacy, Kohat University of science and Technology, Kohat, Pakistan
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Bo M, Gibello M, Brunetti E, Boietti E, Sappa M, Falcone Y, Aurucci ML, Iacovino M, Fonte G, Cappa G. Prevalence and predictors of inappropriate prescribing according to the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria in older patients discharged from geriatric and internal medicine ward. Geriatr Gerontol Int 2018; 19:5-11. [DOI: 10.1111/ggi.13542] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/09/2018] [Accepted: 09/04/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Mario Bo
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Maddalena Gibello
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Enrico Brunetti
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Edoardo Boietti
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Matteo Sappa
- Unit of Geriatrics and Intermediate Care; Santa Croce and Carle Hospital; Cuneo Italy
| | - Yolanda Falcone
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Maria Luigia Aurucci
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Marina Iacovino
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Gianfranco Fonte
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Giorgetta Cappa
- Unit of Geriatrics and Intermediate Care; Santa Croce and Carle Hospital; Cuneo Italy
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22
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Riera-Mestre A, Formiga F. Medication regimen complexity: A new challenge. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Riera-Mestre A, Formiga F. Complejidad terapéutica: un nuevo reto. Rev Clin Esp 2018; 218:356-357. [DOI: 10.1016/j.rce.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
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24
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Inappropriate Prescribing in Elderly Inpatients at a University Hospital in Saudi Arabia. Drugs Real World Outcomes 2018; 5:211-216. [PMID: 30194620 PMCID: PMC6265234 DOI: 10.1007/s40801-018-0142-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Elderly populations usually use more medications than any other age group and are therefore more susceptible to potentially inappropriate prescribing (PIP), drug-drug interactions, and the related health consequences. In this study, we aimed to determine PIP prevalence and explore the most common potentially inappropriate medications (PIMs) prescribed. METHODS This was a retrospective study involving elderly patients admitted at King Abdulaziz Medical City-Jeddah (KAMC-JD), between November 2014 and January 2015. We included all elderly patients aged 60 years and above admitted to KAMC-JD through the emergency department (ED), clinic, and direct admissions during the study period. Patients admitted to the intensive care unit, oncology department, and/or those who passed way in the ED before admission were excluded from the study. Prescriptions were assessed for PIP using the 2012 Beers Criteria, which categorizes PIMs to three classes: first class are medications to avoid in older adults regardless of their conditions; second class are medications to avoid with certain diseases or syndromes; and third class are medications that should be used with caution. RESULTS Our study included 135 patients, of which 49.6% were males. The mean age was 71.26 ± 8.1 years. According to the 2012 Beers Criteria, 80% of patients were using at least one listed PIM. For the Criteria's first, second, and third classes, PIM prescription rates were 72.6%, 59.2%, and 37.7%, respectively. Regarding the most prescribed PIM in each class, insulin (sliding scale) was the most reported PIM in the first class, NSAIDs in the second class, and, lastly, vasodilators in the third class. CONCLUSION PIP is a serious health issue threatening elderly patients. There is a need to develop evidence-based, context-sensitive, and user-friendly tools to assess PIP, as well as supportive training programs.
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25
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Petersen AW, Shah AS, Simmons SF, Shotwell MS, Jacobsen JML, Myers AP, Mixon AS, Bell SP, Kripalani S, Schnelle JF, Vasilevskis EE. Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care. Ther Adv Drug Saf 2018; 9:523-533. [PMID: 30181860 PMCID: PMC6116773 DOI: 10.1177/2042098618781524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. METHODS This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively. RESULTS There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 versus 9.1 (p = 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5-6.7, p < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI -0.01 to 1.1) in the drug burden index. CONCLUSIONS A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.
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Affiliation(s)
- Alec W. Petersen
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Avantika S. Shah
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Sandra F. Simmons
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | | | | | - Amy P. Myers
- Pharmaceutical Services, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Amanda S. Mixon
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Section of Hospital Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation
Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan P. Bell
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Cardiovascular Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation
Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John F. Schnelle
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eduard E. Vasilevskis
- Vanderbilt Center for Health Services Research,
Center for Quality Aging, Division of General Internal Medicine and Public
Health, Geriatric Research Education and Clinical Center, VA Tennessee
Valley, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
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26
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Salgueiro E, Elizarde BC, Elola AI, García-Pulido B, Nicieza-García ML, Manso G. [The most common STOPP/START criteria in Spain. A review of the literature]. Rev Esp Geriatr Gerontol 2018; 53:274-278. [PMID: 29903667 DOI: 10.1016/j.regg.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/01/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To analyse STOPP/START criteria found most frequently in the studies carried out in Spain, in order to identify the main areas of potentially inappropriate prescribing. METHODS A literature review was carried out on the original studies performed in Spain that applied the original version of the STOPP/START criteria and that described the most common STOPP and/or START criteria found. In each study, a weighted analysis was performed on the criteria found, by assigning 5 points to the criterion in first position, 4 points to the criterion in second position, and so on to fifth criterion. The total points of each analysed criterion were then obtained. RESULTS A total of 19 original studies analysing STOPP criteria were selected, 14 of them also studying all START criteria. From the total of studies, 11 were developed in out-of-hospital care, and 8 in hospital care. The STOPP criterion with the highest weighted assessment was B7 (long-term, long-acting benzodiazepines), followed by J (any duplicate drug class prescription). The START criterion with the highest weighted assessment was F4 (statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present), followed by E3 (calcium and vitamin D supplement in patients with known osteoporosis: previous fragility fracture, acquired dorsal kyphosis). CONCLUSIONS The most common areas of potentially inappropriate prescribing are well defined, and suggest a particular intervention in some specific therapeutic points.
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Affiliation(s)
- Esther Salgueiro
- Departamento de Medicina, Área de Farmacología, Universidad de Oviedo, Oviedo (Asturias), España
| | | | - Ana Isabel Elola
- Departamento de Medicina, Área de Farmacología, Universidad de Oviedo, Oviedo (Asturias), España
| | - Beatriz García-Pulido
- Departamento de Medicina, Área de Farmacología, Universidad de Oviedo, Oviedo (Asturias), España
| | - María Luisa Nicieza-García
- Departamento de Medicina, Área de Farmacología, Universidad de Oviedo, Oviedo (Asturias), España; Servicio de Farmacia de Atención Primaria, Hospital Carmen y Severo Ochoa, Oviedo (Asturias), España
| | - Gloria Manso
- Departamento de Medicina, Área de Farmacología, Universidad de Oviedo, Oviedo (Asturias), España.
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27
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Delgado-Silveira E, Albiñana-Pérez MS, Muñoz-García M, García-Mina Freire M, Fernandez-Villalba EM. Pharmacist comprehensive review of treatment compared with STOPP-START criteria to detect potentially inappropriate prescription in older complex patients. Eur J Hosp Pharm 2018; 25:16-20. [PMID: 31156979 DOI: 10.1136/ejhpharm-2016-001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/24/2016] [Accepted: 11/02/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives To compare potentially inappropriate prescribing (PIP) according to the clinical judgement of the pharmacist with PIP according to explicit STOPP-START criteria in institutionalised and hospitalised patients with multiple pathologies. To describe and compare the main pharmacological groups involved and determine the factors associated with the detection of PIP in these patients. Method A prospective multicentre observational study of institutionalised and hospitalised multipathology patients aged >65 years. A specialised pharmacist used his best clinical judgement to detect PIP based on a comprehensive review of the complete chronic treatment of patients, which is an essential activity in interdisciplinary care. STOPP-START criteria were used as an aid tool to detect PIP. The main variable was the number of PIP incidents detected. Results Detected PIP incidents were analysed in 338 patients. Clinical judgement detected more PIP incidents (35%) than did STOPP-START criteria. More PIP incidents unrelated to these criteria were detected in institutionalised patients than in hospitalised patients. Clinical judgement mainly detected PIP incidents related to incorrect doses and drug interactions (p<0.001); however, STOPP-START criteria mainly detected PIP incidents related to drug duplication and insufficiently treated diagnosis or symptoms (p=0.001 and p<0.001). In total, 93.8% of the PIP incidents were detected in polypharmacy patients (≥5 drugs). Institutionalised and high-level polypharmacy (≥10 drugs) patients were at the highest risk of PIP. Conclusions A large number of PIP incidents were detected in institutionalised and hospitalised patients with multiple pathologies. The inclusion of a pharmacist in the multidisciplinary team facilitated the detection of PIP incidents, particularly in the institutionalised population and patients treated with high-level polypharmacy which were not detected by explicit STOPP-START criteria.
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Affiliation(s)
- E Delgado-Silveira
- Department of Pharmacy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M S Albiñana-Pérez
- Department of Pharmacy, Complejo hospitalario Arquitecto Marcide, Ferrol, Spain
| | - M Muñoz-García
- Department of Pharmacy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - E M Fernandez-Villalba
- Department of Pharmacy, Residencia para mayores dependientes La Cañada, Paterna, Valencia, Spain
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28
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Bo M, Quaranta V, Fonte G, Falcone Y, Carignano G, Cappa G. Prevalence, predictors and clinical impact of potentially inappropriate prescriptions in hospital-discharged older patients: A prospective study. Geriatr Gerontol Int 2017; 18:561-568. [DOI: 10.1111/ggi.13216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mario Bo
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Valeria Quaranta
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Gianfranco Fonte
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Yolanda Falcone
- Unit of Geriatrics and Metabolic Bone Diseases; City of Health and Science- Molinette Hospital; Turin Italy
| | - Giulia Carignano
- Unit of Geriatrics and Intermediate Care; Santa Croce and Carle Hospital; Cuneo Italy
| | - Giorgetta Cappa
- Unit of Geriatrics and Intermediate Care; Santa Croce and Carle Hospital; Cuneo Italy
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29
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Blanc AL, Spasojevic S, Leszek A, Théodoloz M, Bonnabry P, Fumeaux T, Schaad N. A comparison of two tools to screen potentially inappropriate medication in internal medicine patients. J Clin Pharm Ther 2017; 43:232-239. [PMID: 28990244 DOI: 10.1111/jcpt.12638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN Potentially inappropriate medication (PIM) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. OBJECTIVE To compare two PIM-screening tools-STOPP/START and PIM-Check-applied to internal medicine patients. A second objective was to compare the use of PIMs in readmitted and non-readmitted patients. METHOD A retrospective observational study, in the general internal medicine ward of a Swiss non-university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex- and age-matched patients who were not readmitted. PIMs were screened using the STOPP/START tool, developed for geriatric patients, and the PIM-Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIMs involving readmitted and non-readmitted patients were compared. RESULTS Across the whole population, PIM-Check and STOPP/START detected 1348 and 537 PIMs, respectively, representing 13.5 and 5.4 PIMs/patient. Screening time was substantially shorter with PIM-Check than with STOPP/START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIMs detected using PIM-Check and STOPP/START, respectively, were clinically relevant to individual patients' cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non-readmitted patients. WHAT IS NEW AND CONCLUSION Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly half of the PIMs detected were judged to be non-clinically relevant, however, potentially overalerting the prescriber. These tools can, nevertheless, be considered useful in daily practice. Furthermore, the relevance of any PIM detected by these tools should always be carefully evaluated within the clinical context surrounding the individual patient.
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Affiliation(s)
- A-L Blanc
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,Pharmacie Interhospitalière de la Côte, Morges, Switzerland.,School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - S Spasojevic
- School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - A Leszek
- Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland
| | - M Théodoloz
- Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - P Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva-University of Lausanne, Geneva, Switzerland
| | - T Fumeaux
- Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - N Schaad
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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30
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Sousa SRAE, Shoemaker SJ, do Nascimento MMG, Costa MS, Ramalho de Oliveira D. Development and validation of a logic model for comprehensive medication management services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:250-257. [DOI: 10.1111/ijpp.12392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/04/2017] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
To develop and validate a theoretical logic model for comprehensive medication management (CMM) services.
Methods
The components of a logic model were constructed after a literature review and interviews with 4 CMM professionals. To validate the logic model, a panel of 17 CMM experts participated in three online Delphi method rounds to achieve consensus on the model. The consensus between the experts on each component of the logic model was evaluated using the Content Validity Index and Inter-rater Agreement in each of the rounds.
Key findings
A logic model for CMM services containing 51 items was constructed and validated. Both the items of each component of the model and the linkage between the main components were agreed upon among the experts.
Conclusions
A logic model for CMM services was developed and validated. It is an innovative tool that, if used as a theoretical framework for the implementation of CMM, can ensure greater reproducibility of CMM services in different scenarios of practice and levels of care.
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Affiliation(s)
- Samuel R A e Sousa
- School of Pharmacy, Federal University of Minas Gerais (FAFAR/UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariana M G do Nascimento
- School of Pharmacy, Federal University of Minas Gerais (FAFAR/UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Marianne S Costa
- School of Pharmacy, Federal University of Minas Gerais (FAFAR/UFMG), Belo Horizonte, Minas Gerais, Brazil
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31
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Agustí A, Formiga F, San-José A. [Polypharmacy and inappropriate prescription of medicines in the elderly]. Rev Esp Geriatr Gerontol 2017; 52:233-234. [PMID: 28131400 DOI: 10.1016/j.regg.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Antònia Agustí
- Servicio de Farmacología Clínica, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Farmacología, Terapéutica y Toxicología, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España.
| | - Francesc Formiga
- Servicio de Medicina Interna, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Antonio San-José
- Servicio de Medicina Interna, Hospital Universitari Vall d'Hebron, Barcelona, España
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32
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Rivas-Cobas PC, Ramírez-Duque N, Gómez Hernández M, García J, Agustí A, Vidal X, Formiga F, López-Soto A, Torres OH, San-José A. Características del uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. GACETA SANITARIA 2017; 31:327-331. [DOI: 10.1016/j.gaceta.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 11/27/2022]
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33
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Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study. Drugs Aging 2017; 34:453-466. [DOI: 10.1007/s40266-017-0452-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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34
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Mucalo I, Hadžiabdić MO, Brajković A, Lukić S, Marić P, Marinović I, Bačić-Vrca V. Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Eur J Clin Pharmacol 2017; 73:991-999. [PMID: 28405697 DOI: 10.1007/s00228-017-2246-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to measure the prevalence of potentially inappropriate medications (PIMs) by using the EU(7)-PIM list, STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) version 2 criteria and the new comprehensive protocol. METHODS This prospective study involved a sample of 276 consecutive elderly patients discharged from the university teaching hospital. Age, gender, diagnoses, medication history and medicines at discharge were recorded. The main outcome measure was the prevalence of PIMs according to each set of criteria: EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. RESULTS The median patient age (range) was 74 (65-92) years. The median number of prescribed medications was 7 (1-17). STOPP identified 393 PIMs affecting 190 patients (69%), EU(7)-PIM list identified 330 PIMs in 184 patients (66.7%) whilst the comprehensive protocol identified 134 PIMs in 102 patients (37%). STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (p < 0.001). Gender (p = 0.002), glomerular filtration rate (p = 0.039) and number of comorbidities (p = 0.001) were associated with the proportion of PIMs for the STOPP version 2 criteria only. CONCLUSION A very high PIM prevalence at discharge was reported suggesting the urgent need for actions to reduce them. STOPP version 2 criteria identified significantly more PIMs than the EU(7)-PIM list and the comprehensive protocol and was found as a more sensitive tool for PIM detection.
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Affiliation(s)
- Iva Mucalo
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia.
| | - Maja Ortner Hadžiabdić
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Andrea Brajković
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Sonja Lukić
- University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Patricia Marić
- University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia
| | - Ivana Marinović
- Department of Clinical Pharmacy, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Vesna Bačić-Vrca
- Centre for Applied Pharmacy, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000, Zagreb, Croatia.,Department of Clinical Pharmacy, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
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35
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Li H, Pu S, Liu Q, Huang X, Kuang J, Chen L, Shen J, Cheng S, Wu T, Li R, Li Y, Mo L, Jiang W, Song Y, He J. Potentially inappropriate medications in Chinese older adults: The beers criteria compared with the screening tool of older persons' prescriptions criteria. Geriatr Gerontol Int 2017; 17:1951-1958. [PMID: 28224703 DOI: 10.1111/ggi.12999] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 02/05/2023]
Abstract
AIM The present study aimed to assess the prevalence of potentially inappropriate medications (PIM) use in West China Hospital residents aged ≥65 years, using two sets of criteria - the Beers and Screening Tool of Older Persons' Prescriptions (STOPP) criteria - and to compare the Beers and STOPP criteria, and to determine the better criteria for assessing PIM of older adults in China. METHODS This was a retrospective cross-sectional study, and all patients were aged ≥65 years and admitted through the Information Center of West China Hospital from October 2010 to April 2013. The Beers and STOPP criteria were used to identify PIM. A multivariate logistic regression study was used to identify the predictors of PIM use. RESULTS In the 6337 patients included, the mean age was 81.30 years (SD 6.75), 4795 (75.70%) were male and 5033 (79.42%) were prescribed at least one PIM by either criterion. The Beers criteria identified PIM use in 4593 (72.48%) of patients, and 3278 (51.73%) of patients used at least one PIM according to the STOPP criteria. The most prevalent PIM according to the Beers criteria were benzodiazepines (34.40%); according to the STOPP criteria, it was calcium channel blockers with chronic constipation (18.52%). Increasing age, sex (female), the number of diagnostic diseases and the number of prescribed medications predicted PIM use by both criteria. CONCLUSION The present study showed a high frequency of PIM in China. The Beers criteria had a higher detection rate and were more sensitive for assessing PIM of older adults in China. Geriatr Gerontol Int 2017; 17: 1951-1958.
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Affiliation(s)
- Hong Li
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Shiyun Pu
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Qinhui Liu
- Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Xin Huang
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Jiangying Kuang
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Lei Chen
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Jing Shen
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Shihai Cheng
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Tong Wu
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Rui Li
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Yanping Li
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Li Mo
- The Center of Gerontology and Geriatrics, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Wei Jiang
- Molecular Medicine Research Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Yi Song
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
| | - Jinhan He
- Department of Pharmacy, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China.,Laboratory of Clinical Pharmacy and Adverse Drug Reaction, West China Hospital of Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
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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] [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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Formiga F, Agustí A, José AS. Polypharmacy in elderly people with diabetes admitted to hospital. Acta Diabetol 2016; 53:857-8. [PMID: 26607825 DOI: 10.1007/s00592-015-0818-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Antonia Agustí
- Clinical Pharmacology Service, Department of Pharmacology, Therapeutics and Toxicology, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio San José
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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38
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Primejdie DP, Bojita MT, Popa A. Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study. BMC Pharmacol Toxicol 2016; 17:38. [PMID: 27544266 PMCID: PMC4992561 DOI: 10.1186/s40360-016-0081-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 07/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background The elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design. Methods All reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes. Results The analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients’ medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients’ medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients’ medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients’ data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient’s data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients’ data). Conclusions The PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.
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Affiliation(s)
- Daniela Petruta Primejdie
- Department of Clinical Pharmacy, "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, 12 Ion Creanga St, 400010, Cluj-Napoca, Romania.
| | - Marius Traian Bojita
- Department of Pharmaceutical Analysis, "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, 6 Louis Pasteur St, 400349, Cluj-Napoca, Romania
| | - Adina Popa
- Department of Clinical Pharmacy, "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Pharmacy, 12 Ion Creanga St, 400010, Cluj-Napoca, Romania
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Bahat G, Bay I, Tufan A, Tufan F, Kilic C, Karan MA. Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version 2. Geriatr Gerontol Int 2016; 17:1245-1251. [DOI: 10.1111/ggi.12850] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/07/2016] [Accepted: 05/22/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics; Istanbul University; Istanbul Turkey
| | - Ilker Bay
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics; Istanbul University; Istanbul Turkey
| | - Asli Tufan
- Department of Internal Medicine, Division of Geriatrics; Marmara University Hospital; Istanbul Turkey
| | - Fatih Tufan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics; Istanbul University; Istanbul Turkey
| | - Cihan Kilic
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics; Istanbul University; Istanbul Turkey
| | - Mehmet Akif Karan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics; Istanbul University; Istanbul Turkey
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da Costa FA, Periquito C, Carneiro MC, Oliveira P, Fernandes AI, Cavaco-Silva P. Potentially inappropriate medications in a sample of Portuguese nursing home residents: Does the choice of screening tools matter? Int J Clin Pharm 2016; 38:1103-11. [PMID: 27343120 DOI: 10.1007/s11096-016-0337-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Background Potentially inappropriate medications (PIMs) are often found in high proportion among the elderly population. The STOPP criteria have been suggested to detect more PIMs in European elderly than the Beers criteria. Objective This study aimed to determine the prevalence of PIMs and potential prescribing omissions (PPOs) in a sample of Portuguese nursing homes residents. Setting Four elderly facilities in mainland Portugal Method A descriptive cross-sectional study was used. Elderly polypharmacy patients were included in the study and their medication (registered in patient clinical records) analysed using the Beers (2012 original version and 2008 version adapted to Portugal), STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria. Data were analysed using univariate and bivariate descriptive statistics, considering a confidence interval of 95 %. MAIN OUTCOME MEASURES Prevalence of PIMs and PPOs. Results The sample included 161 individuals, with a mean age of 84.7 years (SD = 6.35), 68.9 % being female. A total of 807 PIMs and 90 PPOs were identified through the application of the three set of criteria. The prevalence of PIMs using the most recent version of the Beers criteria was 85.1 and 42.1 % for independent and dependent of diagnosis, respectively. The Portuguese adaptation of this same tool indicated a lower prevalence of PIMs, 60.3 and 16.7 %, respectively. The prevalence of PIMs using the STOPP criteria was 75.4 %, whilst the prevalence of PPOs, using START, was 42.9 %. There were significant differences in the mean number of PIMs detected depending on the tool used. (p < 0.001). Conclusions The application of the studied criteria in an elderly sample enabled the identification of a notable amount of PIMs and PPOs, indicating there is room for improving the quality of care. The variation in prevalence indicates careful choice of the tool is a prerequisite for engaging in medication review. Using START/STOPP criteria enabled a more holistic approach to the quality of prescribing in the elderly, highlighting low levels of cardiovascular risk prevention and abuse of psychotropic drugs, aside with system failures largely preventable by electronic prescribing and alert generation.
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Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal. .,Epidemiology Department (ROR-Sul), Portuguese Institute of Oncology Lisbon Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal. .,Pharmaceutical Society (OF), Rua da Sociedade Farmacêutica 18, 1169-075, Lisboa, Portugal.
| | - Catarina Periquito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Maria Clara Carneiro
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Pedro Oliveira
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Ana Isabel Fernandes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Patrícia Cavaco-Silva
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
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Formiga F, Vidal X, Agustí A, Chivite D, Rosón B, Barbé J, López-Soto A, Torres OH, Fernández-Moyano A, García J, Ramírez-Duque N, San José A. Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabet Med 2016; 33:655-62. [PMID: 26333026 DOI: 10.1111/dme.12894] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
AIMS To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.
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Affiliation(s)
- F Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - X Vidal
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Agustí
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Chivite
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - B Rosón
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J Barbé
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
| | - A López-Soto
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain
| | - O H Torres
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Fernández-Moyano
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Seville, Spain
| | - J García
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicina Service, Hospital General Juan Ramón Jiménez, Huelva, Spain
| | - N Ramírez-Duque
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A San José
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
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Elderly patients treated with psychotropic medicines admitted to hospital: associated characteristics and inappropriate use. Eur J Clin Pharmacol 2016; 72:755-64. [DOI: 10.1007/s00228-016-2032-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/24/2016] [Indexed: 12/22/2022]
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Morin L, Fastbom J, Laroche ML, Johnell K. Potentially inappropriate drug use in older people: a nationwide comparison of different explicit criteria for population-based estimates. Br J Clin Pharmacol 2015; 80:315-24. [PMID: 25702921 DOI: 10.1111/bcp.12615] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/31/2015] [Accepted: 02/17/2015] [Indexed: 01/18/2023] Open
Abstract
AIMS The aim was to investigate the prevalence of potentially inappropriate medication use among older people in Sweden according to five different published sets of explicit criteria from Europe and the US. METHODS This was a nationwide cross-sectional, register-based study across the whole of Sweden in 2008. All individuals aged 65 years and older were included (n = 1 346 709, both community-dwelling and institutionalized persons). We applied all drug-specific criteria included in the 2012 Beers Criteria, the Laroche's list, the PRISCUS list, the NORGEP criteria and the Swedish National Board of Health and Welfare criteria. The main outcome was the potentially inappropriate drug use according to each set of criteria, separately and combined. Multivariate logistic regression models were used to identify individual factors associated with the use of potentially inappropriate drugs. RESULTS The prevalence of potentially inappropriate medication use varied between the explicit criteria from 16% (NORGEP criteria) to 24% (2012 Beers criteria). Overall, 38% of the older people were exposed to potentially inappropriate drug use by at least one of the five sets of criteria. While controlling for other possible covariates, female gender, institutionalization and polypharmacy were systematically associated with inappropriate drug use, regardless of the set of explicit criteria we considered. CONCLUSION Although explicit criteria for inappropriate drug use among older people have been reported to be quite different in their content, they provide similar measures of the prevalence of potentially inappropriate drug use at the population level.
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Affiliation(s)
- Lucas Morin
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Marie-Laure Laroche
- Centre Hospitalier Universitaire de Limoges, Service de Pharmacologie, Toxicologie et Pharmacovigilance, Limoges, France.,Université de Limoges, Faculté de Médecine, Limoges, France
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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San-José A, Agustí A, Vidal X, Formiga F, Gómez-Hernández M, García J, López-Soto A, Ramírez-Duque N, Torres OH, Barbé J. Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors. BMC Geriatr 2015; 15:42. [PMID: 25887546 PMCID: PMC4403827 DOI: 10.1186/s12877-015-0038-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/24/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population. METHODS In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists. RESULTS A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86-90) years. The median medicines taken during the month prior to admission was 10 (7-13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1). CONCLUSIONS Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.
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Affiliation(s)
- Antonio San-José
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Àrea General 3ª planta, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Antonia Agustí
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Xavier Vidal
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Francesc Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Mercedes Gómez-Hernández
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Sevilla, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Juana García
- Internal Medicine Service, Hospital General Juan Ramón Jiménez, Huelva, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Alfonso López-Soto
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Nieves Ramírez-Duque
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Olga H Torres
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - José Barbé
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Àrea General 3ª planta, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
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