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Nakashima H, Ando H, Umegaki H. Comparing prevalence and types of potentially inappropriate medications among patient groups in a post-acute and secondary care hospital. Sci Rep 2023; 13:14543. [PMID: 37714927 PMCID: PMC10504332 DOI: 10.1038/s41598-023-41617-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023] Open
Abstract
Reducing potentially inappropriate medications (PIMs) is a challenge in post-acute care hospitals. Some PIMs may be associated with patient characteristics and it may be useful to focus on frequent PIMs. This study aimed to identify characteristic features of PIMs by grouping patients as in everyday clinical practice. A retrospective review of medical records was conducted for 541 patients aged 75 years or older in a Japanese post-acute and secondary care hospital. PIMs on admission were identified using the Screening Tool for Older Person's Appropriate Prescriptions for Japanese. The patients were divided into four groups based on their primary disease and reason for hospitalization: post-acute orthopedics, post-acute neurological disorders, post-acute others, and subacute. Approximately 60.8% of the patients were taking PIMs, with no significant difference among the four patient groups in terms of prevalence of PIMs (p = 0.08). However, characteristic features of PIM types were observed in each patient group. Hypnotics and nonsteroidal anti-inflammatory drugs were common in the post-acute orthopedics group, multiple antithrombotic agents in the post-acute neurological disorders group, diuretics in the post-acute others group, and hypnotics and diuretics in the subacute group. Grouping patients in clinical practice revealed characteristic features of PIM types in each group.
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Affiliation(s)
- Hirotaka Nakashima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan.
- Wako-Kai Yamada Hospital, Gifu, Gifu, Japan.
| | | | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
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Resnick B, Boltz M, Galik E, Kuzmik A, McPherson R, Drazich B, Kim N, Zhu S, Wells CL. Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01745-9. [PMID: 37580439 PMCID: PMC10864680 DOI: 10.1007/s40615-023-01745-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD, 21218, USA.
| | - Marie Boltz
- Penn State University, University Park, State College, PA, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD, 21218, USA
| | - Ashley Kuzmik
- Penn State University, University Park, State College, PA, USA
| | | | - Brittany Drazich
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD, 21218, USA
| | - Nayeon Kim
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD, 21218, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD, 21218, USA
| | - Chris L Wells
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD, 21218, USA
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Yaghi G, Chahine B. Potentially inappropriate medications use in a psychiatric elderly care hospital: A cross-sectional study using Beers criteria. Health Sci Rep 2023; 6:e1247. [PMID: 37234198 PMCID: PMC10206279 DOI: 10.1002/hsr2.1247] [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: 11/04/2022] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Background and Aims Potentially inappropriate medications (PIMs) carry risks that outweigh any potential benefits when compared to safer or more effective alternative treatments. Adverse drug events are more likely to occur in older adults with psychiatric diseases due to multimorbidity, polypharmacy, and age-related changes in drug pharmacokinetics and pharmacodynamics. The aim of this study was to assess the prevalence and risk factors of PIM use in an aged care hospital's psychogeriatric division, using the American Geriatrics Society Beers criteria 2019. Methods This cross-sectional study was conducted on all current inpatients, having a mental disorder and aged ≥65 years, in one elderly care hospital in Beirut, from March to May 2022. Medications, sociodemographic and clinical characteristics were collected from patients' medical records. PIMs were evaluated based on Beers criteria 2019. Independent variables were described using descriptive statistics. Factors associated with PIM use were identified by bivariate analysis followed by binary logistic regression. A two-sided p value <0.05 was considered statistically significant. Results The study included 147 patients, with a mean age of 76.3 years, 46.9% of them having schizophrenia, 68.7% using 5 or more drugs and 90.5% taking at least 1 PIM. The most prescribed PIMs were antipsychotics (40.2%), anticholinergics (16%), and antidepressants (7.8%). PIM use was significantly associated with polypharmacy (AOR = 20.88, 95% CI: 1.22-357.87, p = 0.04) and anticholinergic cognitive burden (ACB) score (AOR = 7.25, 95% CI: 1.13-46.52, p = 0.04). Conclusion PIMs were highly prevalent among hospitalized Lebanese psychiatric elderly. Polypharmacy and ACB score were the determinants of PIM use. A multidisciplinary medication review led by a clinical pharmacist could reduce PIM use.
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Affiliation(s)
- Gracia Yaghi
- School of PharmacyLebanese International UniversityBeirutLebanon
| | - Bahia Chahine
- School of PharmacyLebanese International UniversityBeirutLebanon
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Nalls V, Galik E, Klinedinst NJ, Barr E, Brandt N, Lerner N, Resnick B. Racial Differences in Antidepressant Use in Nursing Facility Residents With Moderate to Severe Cognitive Impairment. Sr Care Pharm 2022; 37:448-457. [PMID: 36039002 DOI: 10.4140/tcp.n.2022.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To describe and compare the use of antidepressants between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment. Design This was a secondary data analysis using baseline data from the Function and Behavior Focused Care for Nursing Facility Residents with Dementia randomized control trial. Setting Participants were recruited from 10 urban and two rural nursing facilities from Maryland. Methods Participants had to be 55 years of age or older, English-speaking, reside in long-term care at time of recruitment, and score a 15 or less on the Mini Mental-State Examination. A total of 336 residents participated at baseline. Data were collected by a research evaluator through observation, proxy report from staff caring for the resident the day of testing, and patient charts. Main Outcomes A significant difference of antidepressant use between Black or African descent and White nursing facility residents with moderate to severe cognitive impairment would be noted when controlling for depression, age, gender, functional status, agitation, and number of co-morbidities. Results In adjusted models, Black or African descent residents were less likely to be prescribed antidepressants compared with White residents. Conclusion Racial differences were noted regarding antidepressant use among nursing facility residents with moderate to severe cognitive impairment, but it is unknown if race could impact prescribing practices when indications for use are known. Further research is needed to ascertain if knowing the specific indications for use might contribute to racial disparities with antidepressant prescribing in nursing facility residents with moderate to severe cognitive impairment.
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Affiliation(s)
- Victoria Nalls
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Elizabeth Galik
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | | | - Erik Barr
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Nicole Brandt
- 2 School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Nancy Lerner
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
| | - Barbara Resnick
- 1 School of Nursing, University of Maryland, Baltimore, Maryland
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Pohontsch NJ, Zimmermann T, Lehmann M, Rustige L, Kurz K, Löwe B, Scherer M. ICD-10-Coding of Medically Unexplained Physical Symptoms and Somatoform Disorders-A Survey With German GPs. Front Med (Lausanne) 2021; 8:598810. [PMID: 33859988 PMCID: PMC8042316 DOI: 10.3389/fmed.2021.598810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background: General practitioners (GPs) are reluctant to use codes that correspond to somatization syndromes. Aim: To quantify GPs' views on coding of medically unexplained physical symptoms (MUPS), somatoform disorders, and associated factors. Design and Setting: Survey with German GPs. Methods: We developed six survey items [response options “does not apply at all (1)”—“does fully apply (6)”], invited a random sample of 12.004 GPs to participate in the self-administered cross-sectional survey and analysed data using descriptive statistics and logistic regression analyses. Results: Response rate was 15.2% with N = 1,731 valid responses (54.3% female). Participants considered themselves familiar with ICD-10 criteria for somatoform disorders (M = 4.52; SD =.036) and considered adequate coding as essential prerequisite for treatment (M = 5.02; SD = 1.21). All other item means were close to the scale mean: preference for symptom or functional codes (M = 3.40; SD = 1.21), consideration of the possibility of stigmatisation (M = 3.30; SD = 1.35) and other disadvantages (M = 3.28; SD = 1.30) and coding only if psychotherapy is intended (M = 3.39; SD = 1.46). Exposure, guideline knowledge, and experience were most strongly associated with GPs' self-reported coding behaviour. Conclusions: Subjective exposure, guideline knowledge, and experience as a GP, but no sociodemographic variable being associated with GPs' subjective coding behaviour could indicate that GPs offer a relatively homogeneous approach to coding and handling of MUPS and somatoform disorders. Strengthening guideline knowledge and implementation, and practise with simulated patients could increase the subjective competence to cope with the challenge that patients with MUPS and somatoform disorders present.
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Affiliation(s)
- Nadine J Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Rustige
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katinka Kurz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chou LN, Kuo YF, Raji MA, Goodwin JS. Potentially inappropriate medication prescribing by nurse practitioners and physicians. J Am Geriatr Soc 2021; 69:1916-1924. [PMID: 33749843 DOI: 10.1111/jgs.17120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/06/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. However, there were few studies focusing on the impact of provider type on PIM use. OBJECTIVE We aimed to estimate the initial and refill PIM prescribing rate for physician visits and nurse practitioner (NP) visits and the impact of provider type on PIM prescribing. RESEARCH DESIGN We used 100% Texas Medicare data to define physician visits and NP visits in 2016. The rate of visits with a PIM prescription from the same provider was measured, distinguishing between initial and refill prescription to estimate the PIM rate and adjusted odds ratio (OR) by provider type. RESULTS There were 24.1 per 1000 visits with a prescription for a PIM: 9.0 per 1000 visits for an initial PIM and 15.1 per 1000 visits for a refill PIM. A visit to an NP was less likely to result in an initial (OR = 0.74, 95% confidence interval [CI] = 0.70-0.79) or refill (OR = 0.54, 95% CI = 0.51-0.57) PIM. The association of lower odds of receiving a prescription for an initial PIM from an NP was substantially stronger among black enrollees than white enrollees (OR = 0.44, 95%CI = 0.30-0.65 for blacks and OR = 0.73, 95%CI = 0.68-0.78 for white enrollees). The association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities. CONCLUSIONS NPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. The lower odds of receiving PIMs during an NP visit varied by age, race/ethnicity, rurality, and number of comorbidities.
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Affiliation(s)
- Lin-Na Chou
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA.,Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA.,Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA.,Department in Internal Medicine, Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila A Raji
- Department in Internal Medicine, Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - James S Goodwin
- Department in Internal Medicine, Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
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Jungo KT, Streit S, Lauffenburger JC. Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications. BMC Geriatr 2021; 21:163. [PMID: 33676398 PMCID: PMC7937195 DOI: 10.1186/s12877-021-02089-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is common in older adults and is associated with potential negative consequences, such as falls and cognitive decline. Our objective was to investigate measurable patient factors associated with new outpatient prescribing of potentially inappropriate medications in older multimorbid adults already using multiple medications. METHODS In this retrospective US cohort study, we used linked Medicare pharmacy and medical claims and electronic health record data from a large healthcare system in Massachusetts between 2007 and 2014. We identified patients aged ≥65 years with an office visit who had not been prescribed or used a PIM in the prior 180 days. PIMs were defined using 2019 Beers criteria of the American Geriatrics Society. To specifically evaluate factors in patients with polypharmacy and multimorbidity, we selected those who filled medications for ≥90 days (i.e., chronic use) from ≥5 pharmaceutical classes in the prior 180 days and had ≥2 chronic conditions. Multivariable Cox regression analysis was used to estimate the association between baseline demographic and clinical characteristics on the probability of being prescribed a PIM in the 90-day follow-up period. RESULTS In total, we identified 17,912 patients aged ≥65 years with multimorbidity and polypharmacy who were naïve to a PIM in the prior 180 days. Of those, 10,497 (58.6%) were female, and mean age was 78 (SD = 7.5). On average, patients had 5.1 (SD = 2.3) chronic conditions and previously filled 6.1 (SD = 1.4) chronic medications. In total, 447 patients (2.5%) were prescribed a PIM during the 90-day follow-up. Male sex (adjusted hazard ratio (HR) = 1.29; 95%CI: 1.06-1.57), age (≥85 years: HR = 0.75, 95%CI: 0.56-0.99, 75-84 years: HR = 0.87, 95%CI: 0.71-1.07; reference: 65-74 years), ambulatory visits (18-29 visits: HR = 1.42, 95%CI: 1.06-1.92; ≥30 visits: HR = 2.12, 95%CI: 1.53-2.95; reference: ≤9 visits), number of prescribing orders (HR = 1.02, 95%CI: 1.01-1.02 per 1-unit increase), and heart failure (HR = 1.38, 95%CI: 1.07-1.78) were independently associated with being newly prescribed a PIM. CONCLUSION Several demographic and clinical characteristics, including factors suggesting lack of care coordination and increased clinical complexity, were found to be associated with the new prescribing of potentially inappropriate medications. This knowledge could inform the design of interventions and policies to optimize pharmacotherapy for these patients.
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Affiliation(s)
- Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Amorim WW, Passos LC, Gama RS, Souza RM, Graia LT, Macedo JC, Santos DB, Oliveira MG. Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil. SAO PAULO MED J 2021; 139:107-116. [PMID: 33825769 PMCID: PMC9632519 DOI: 10.1590/1516-3180.2020.0411.r1.18112020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.
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Affiliation(s)
- Welma Wildes Amorim
- MD, PhD. Internal Medicine Professor, Medicine Course, Department of Natural Sciences, Vitória da Conquista Campus, Universidade Estadual do Sudoeste da Bahia (UESB), Vitória da Conquista (BA), Brazil.
| | - Luiz Carlos Passos
- MD, PhD. Internal Medicine Professor, Postgraduate Program on Medicine and Health, Department of Internal Medicine, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | - Romana Santos Gama
- BPharm. Master's Student, Postgraduate Program on Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | - Renato Morais Souza
- BPharm. Research Assistant, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia (UFBA), Vitória da Conquista (BA), Brazil.
| | - Lucas Teixeira Graia
- BPharm. Research Assistant, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia (UFBA), Vitória da Conquista (BA), Brazil.
| | - Jéssica Caline Macedo
- BPharm. Master's Student, Master's Program on Collective Health, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia (UFBA), Vitória da Conquista (BA), Brazil.
| | - Djanilson Barbosa Santos
- PhD. Epidemiology Professor, Department of Collective Health, Universidade Federal do Recôncavo da Bahia (UFRB), Santo Antônio de Jesus (BA), Brazil.
| | - Marcio Galvão Oliveira
- BPharm, PhD. Evidence-Based Healthcare Professor, Master's Program on Collective Health, Multidisciplinary Health Institute, Anísio Teixeira Campus, Universidade Federal da Bahia, Vitória da Conquista (BA), Brazil.
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Bazargan M, Cobb S, Wisseh C, Assari S. Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults. PHARMACY 2020; 8:E74. [PMID: 32349239 PMCID: PMC7355863 DOI: 10.3390/pharmacy8020074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 01/09/2023] Open
Abstract
African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cheryl Wisseh
- Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 90004, USA
| | - Shervin Assari
- Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
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10
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Nothelle SK, Sharma R, Oakes A, Jackson M, Segal JB. Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:408-423. [PMID: 30964225 PMCID: PMC7938818 DOI: 10.1111/ijpp.12541] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 03/12/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Potentially inappropriate medication (PIM) use in older adults is a prevalent problem associated with poor health outcomes. Understanding drivers of PIM use is essential for targeting interventions. This study systematically reviews the literature about the patient, clinician and environmental/system factors associated with PIM use in community-dwelling older adults in the United States. METHODS PRISMA guidelines were followed when completing this review. PubMed and EMBASE were queried from January 2006 to September 2017. Our search was limited to English-language studies conducted in the United States that assessed factors associated with PIM use in adults ≥65 years who were community-dwelling. Two independent reviewers screened titles and abstracts. Reviewers abstracted data sequentially and assessed risk of bias independently. KEY FINDINGS Twenty-two studies were included. Nineteen examined patient factors associated with PIM use. The most common statistically significant factors associated with PIM use were taking more medications, female sex, and higher outpatient and emergency department utilization. Only three studies examined clinician factors, and few were statistically significant. Fifteen studies examined system-level factors such as geographic region and health insurance. The most common statistically significant association was the south and west geographic region relative to the northeast United States. CONCLUSIONS Amongst older adults, women and persons on more medications are at higher risk of PIM use. There is evidence that increased healthcare use is also associated with PIM use. Future studies are needed exploring clinician factors, such as specialty, and their association with PIM prescribing.
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Affiliation(s)
- Stephanie K Nothelle
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison Oakes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Madeline Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jodi B Segal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, MD, USA
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11
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Blanco-Reina E, Valdellós J, Aguilar-Cano L, García-Merino MR, Ocaña-Riola R, Ariza-Zafra G, Bellido-Estévez I. 2015 Beers Criteria and STOPP v2 for detecting potentially inappropriate medication in community-dwelling older people: prevalence, profile, and risk factors. Eur J Clin Pharmacol 2019; 75:1459-1466. [PMID: 31338540 DOI: 10.1007/s00228-019-02722-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person's potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM. METHODS Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. RESULTS A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%. CONCLUSIONS The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.
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Affiliation(s)
- Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, School of Medicine, Instituto de Investigación Biomédica de Málaga-IBIMA, University of Málaga, Campus de Teatinos, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain.
| | | | | | | | | | - Gabriel Ariza-Zafra
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Inmaculada Bellido-Estévez
- Pharmacology and Therapeutics Department, School of Medicine, Instituto de Investigación Biomédica de Málaga-IBIMA, University of Málaga, Campus de Teatinos, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain
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