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Stauffer SJ, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Potentially inappropriate medication use among older adults with lower-limb loss. Geriatr Nurs 2024; 56:218-224. [PMID: 38367544 DOI: 10.1016/j.gerinurse.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of, and explore factors related to, prescription of potentially inappropriate medications (PIMs) among older adults with lower-limb loss (LLL). METHODS This was a secondary analysis of a cross-sectional dataset collected through an interdisciplinary limb loss clinic between September 2013 and November 2022. Self-report medication lists were reviewed during in-clinic face-to-face interviews and compared to the American Geriatrics Society Beers Criteria corresponding to the patient's evaluation year. RESULTS Of 82 participants (72.9 ± 6.6 years-old; 78.0 % male), n = 41 (50.0 %) reported using one or more PIM. PIM prescription was significantly associated with presence of phantom limb pain, history of upper gastrointestinal issues, and a greater number of medications. DISCUSSION Polypharmacy and PIM use are common among older adults with LLL. Greater attention should be paid to medications post-amputation, especially pain management medications, to minimize potential adverse side-effects.
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Affiliation(s)
- Samantha Jeanne Stauffer
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA; Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 100 Discovery Blvd, Newark, DE, 19713 USA; University of Delaware, Epidemiology Program, STAR Tower, Suite 614, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA.
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Jang S, Ah YM, Jang S, Kim Y, Lee JY, Kim JH. Potentially inappropriate medication use and associated factors in residents of long-term care facilities: A nationwide cohort study. Front Pharmacol 2023; 13:1092533. [PMID: 36703731 PMCID: PMC9871308 DOI: 10.3389/fphar.2022.1092533] [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: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Residents in long-term care (LTC) facilities (LTCFs) may have multimorbidity and be unable to self-administer medication. Thus, due to the risk of potentially inappropriate medications (PIMs), epidemiological studies on PIM use and its associated factors should be conducted to ensure safe medication use for residents in LTCFs. Objective: We evaluated PIM use among residents of LTCF and the associated factors in residents of LTCFs in Korea using a nationwide database. Methods: This cross-sectional study used the Korea National Health Insurance Service Senior Cohort (KNHIS-SC) database 2.0 of the National Health Insurance Service (NHIS), a single public insurer in Korea. We analyzed older adults aged ≥65 years who were residents of LTCFs in 2018, using the KNHIS-SC database. The 2019 American Geriatrics Society (AGS) Beers criteria was used for PIM identification. The prevalence of PIM use was defined as the proportion of LTCF residents who received PIM prescriptions at least once. We evaluated the frequency of prescriptions, including PIMs, and determined the most frequently used PIMs. We also conducted a multivariable logistic regression analysis to identify the factors associated with PIM use. Results: The prevalence of PIM among the LTCF residents was 81.6%. The prevalence of PIM was 74.9% for LTC grades 1 or 2 (high dependence) and 85.2% for LTC grades 3-5 (low dependence). Quetiapine was the most frequently prescribed PIM, followed by chlorpheniramine. The low dependence level was significantly associated with PIM use (odds ratio of LTC grades 3-5: 1.49, 95% confidence interval 1.32-1.68, reference: LTC grades 1 or 2); moreover, the number of medical institutions visited, and medications emerged as primary influencing factors. Conclusion: Most LTCF residents were vulnerable to PIM exposure. Furthermore, exposure to PIMs is associated with LTC grade. This result highlights the need for comprehensive medication management of LTCF residents.
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Affiliation(s)
- Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Gyeongbuk, South Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, South Korea,*Correspondence: Sunmee Jang,
| | - Yeji Kim
- Department of Statistics, Graduate School, Sungkyunkwan University, Seoul, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Jung-Ha Kim
- Department of Family Medicine, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, South Korea
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Lee Y, Jang S, Kang HJ, Jang S. Comparative analysis of potentially inappropriate medication use in long-term care facility residents and community-dwelling elders: A matched cohort study. Medicine (Baltimore) 2022; 101:e31739. [PMID: 36626501 PMCID: PMC9750672 DOI: 10.1097/md.0000000000031739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.
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Affiliation(s)
- Yumin Lee
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Hee-Jin Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * Correspondence: Sunmee Jang, College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea (e-mail: )
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Patient- and Prescriber-Related Factors Associated with Potentially Inappropriate Medications and Drug-Drug Interactions in Older Adults. J Clin Med 2021; 10:jcm10112305. [PMID: 34070618 PMCID: PMC8198936 DOI: 10.3390/jcm10112305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 01/25/2023] Open
Abstract
We aimed to evaluate the prevalence of potentially inappropriate medication (PIM) use and drug–drug interactions (DDIs) in older adults and their associated factors. This cross-sectional study used National Health Insurance data of older adults in South Korea. The 2015 AGS Beers Criteria were used to classify PIM use and DDIs. The associations of PIM use and DDIs with patient- and prescriber-related factors were evaluated using multiple logistic regression. Of the older adults who received at least one outpatient prescription (N = 1,277,289), 73.0% and 13.3% received one or more prescriptions associated with PIM use or DDIs, respectively. Chlorphenamine was most commonly associated with PIM, followed by diazepam. Co-prescriptions of corticosteroids and NSAIDs accounted for 82.8% of DDIs. Polypharmacy and mainly visiting surgeons or neurologists/psychiatrists were associated with a higher likelihood of prescriptions associated with PIM use or DDIs. Older age, high continuity of care (COC), and mainly visiting a hospital were associated with a lower likelihood of PIM use or DDIs. Prescriptions associated with PIM use and DDIS were more frequent for low COC patients or those who mainly visited clinics; therefore, patients with these characteristics are preferred intervention targets for reducing prescriptions associated with PIM use and DDIs.
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Kim K, Jung J, Kim H, Kim JT, Oh JM, Kim H. Potentially Inappropriate Prescriptions to Older Patients in Emergency Departments in South Korea: A Retrospective Study. Ther Clin Risk Manag 2021; 17:173-181. [PMID: 33642859 PMCID: PMC7903959 DOI: 10.2147/tcrm.s291458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the incidence of the administration of potentially inappropriate medications (PIMs) and the potential drug–drug interactions (pDDIs) in older patients in emergency departments (EDs) over a 12-month period and to identify the factors associated with the administration of PIMs. Patients and Methods This retrospective study was conducted using the electronic medical records from two university-affiliated teaching hospitals in South Korea. ED visit cases of patients aged 65 and older from January 1, 2013, to December 31, 2013, were included in the analysis. Among the medications administered in ED, PIMs or pDDIs were identified using a drug utilization review program available in Korea. Results During the study period, a total of 13,002 ED visit cases were reported from 10,686 patients. The proportion of ED visit cases with any PIM was 79.2% and the average number of PIMs was 2.7 (range, 1–17). The most commonly administered PIMs that were contraindicated or should have been used with caution were ketorolac (41.3%) and metoclopramide (10.3%), respectively. Multivariate regression analysis indicated that female patients (p = 0.012), patients with more than six drugs in the ED (p < 0.001), and visits longer than 300 minutes (p = 0.026) were significantly associated with PIM administration in the ED. Potential DDIs between the medications administered in EDs were observed in 20.5% of total visit cases, with ketorolac being the most frequently reported drug in contraindicated drug combinations. Conclusion This study demonstrated a high incidence of the administration of PIMs and medications with pDDIs in older patients in EDs and revealed the characteristics that are significantly associated with an increased risk of PIM administration. Healthcare providers in EDs should consider the risk of administering PIMs or medications with pDDIs, especially when treating older patients.
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Affiliation(s)
- Kyungim Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea.,Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Jinyoung Jung
- Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Haesook Kim
- Department of Pharmacy, Gang Neung Asan Hospital, Gangneung, Republic of Korea
| | - Jung Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea.,Drug Information Research Institute, College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
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Jang S, Jeong S, Kang E, Jang S. Impact of a nationwide prospective drug utilization review program to improve prescribing safety of potentially inappropriate medications in older adults: An interrupted time series with segmented regression analysis. Pharmacoepidemiol Drug Saf 2020; 30:17-27. [PMID: 32964569 DOI: 10.1002/pds.5140] [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: 05/20/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE A nationwide prospective drug utilization review (DUR) for potentially inappropriate medications (PIMs) in older adults was implemented in October 2015 in South Korea. We aimed to evaluate the effects of the DUR on reducing PIMs, in comparison with the PIMs defined using the Beers criteria that were not included in the DUR. METHODS We divided the study period into a pre- and post-DUR period. The monthly percentage of patients or prescriptions with at least one PIM in the DUR or defined by the Beers criteria was calculated using national health insurance data. We evaluated the effect of the DUR on the prevalence of PIM use in older adults using an interrupted time series with segmented regression analysis. RESULTS The prevalence of older adults prescribed PIMs in the DUR decreased by 0.49% (95% confidence interval (CI) [-0.60, -0.37]) based on patient-based measures and, by 0.41% (95% CI [-0.58, -0.23]) based on prescription-based measure, immediately after DUR implementation. However, there were no statistically significant changes in trend. Further, the prevalence of PIMs based on the Beers criteria had no statistically significant changes in terms of either level or trend. After 12 months of DUR, there was a reduction of 11.5% (95% CI [2.6 20.4]) relative to the PIMs in Beers. CONCLUSIONS The implementation of a nationwide prospective DUR lowered the prescription of PIMs for older adults. On the other hand, PIMs that were not included were unchanged. Thus, it is worth considering expanding the DUR list to improve prescribing safety.
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Affiliation(s)
- Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, South Korea
| | - Sohyun Jeong
- Marcus Institute for Aging Research, Hebrew Senior Life and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Eunjeong Kang
- Department of Health Administration and Management, Soonchunhyang University, Asan, Choongnam, South Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, South Korea
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Yoon SJ, Kim JS, Jung JG, Ahn SK, Song YS, Bae NK, Seon JY, Kim JH. Factors associated with potentially harmful drug-drug interactions in older Korean people: A population-based study. Geriatr Gerontol Int 2018; 18:1378-1382. [PMID: 30094910 DOI: 10.1111/ggi.13495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 12/11/2022]
Abstract
AIM The present study investigated the status of potentially harmful drug-drug interactions (PHDI) in older adults, to obtain insight into factors that influence the risk of PHDI. METHODS The present study included Korean people aged ≥65 years who were prescribed one or more drugs included in the list of PHDI under the Beers Criteria 2015 from January to December, 2016 (n = 1 257 317). PHDI were defined based on the Beers Criteria 2015. Among 10 PHDI, a prevalence of >5% was taken to be clinically significant, and the relationships between multiple variables and PHDI were examined. RESULTS The most frequent PHDI was corticosteroids and non-steroidal anti-inflammatory drugs (n = 259 499, 20.64%), followed by a combination of two or more anticholinergic drugs (n = 139 622, 11.1%), and three or more drugs acting on the central nervous system (n = 86 023, 6.84%). These three types of PHDI were more frequent in women (OR 1.066-1.141) and medical aid beneficiaries (OR 1.095-1.510). The risk of PHDI increased in proportion to the number of healthcare institutions used by the participants and their outpatient visits during the year (OR 1.043-1.079, 1.008-1.010, respectively). The risk of PHDI was low when patients took no more than five medications in a single prescription (OR 0.017-0.791). CONCLUSIONS The findings of the present study highlight the three most frequent PHDI in Korea according to the Beers Criteria 2015. Healthcare providers should take PHDI into account when treating female patients, medical aid beneficiaries, patients using multiple healthcare institutions, frequent outpatient visitors and patients prescribed more than six medications in a single prescription. Geriatr Gerontol Int 2018; 18: 1378-1382.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Sung Kim
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Gyu Jung
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soon-Ki Ahn
- Public Health and Medical Service Office, Chungnam National University Hospital, Daejeon, Korea
| | - Young-Su Song
- Department of Long-term Care Service for Elderly, Korean National Health Insurance Review & Assessment Service, Daejeon, Korea
| | - Nam-Kyou Bae
- Department of Long-term Care Service for Elderly, Korean National Health Insurance Review & Assessment Service, Daejeon, Korea
| | - Jeong-Yeon Seon
- Department of Long-term Care Service for Elderly, Korean National Health Insurance Review & Assessment Service, Daejeon, Korea
| | - Jeong-Hyun Kim
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
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