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Rodrigues RC, Gomes GKA, Sodré BMC, Lima RF, Barros DSL, Figueiredo ACMG, Stefani CM, Silva DLMD. Lists of potentially inappropriate medications for older people in primary care: a systematic review of health outcomes. CAD SAUDE PUBLICA 2024; 40:e00016423. [PMID: 38775606 PMCID: PMC11111166 DOI: 10.1590/0102-311xen016423] [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: 04/10/2023] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 05/24/2024] Open
Abstract
This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.
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Rodrigues DA, Herdeiro MT, Mateos-Campos R, Figueiras A, Roque F. Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care. Eur J Clin Pharmacol 2024; 80:603-612. [PMID: 38319349 PMCID: PMC10937751 DOI: 10.1007/s00228-024-03633-5] [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: 08/14/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person's Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria. METHODS A retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient. RESULTS The mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0-66.6%), 66.8% (95% CI 64.1-69.5%), and 50.1% (95% CI 47.2-53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6-32.9) and Beers criteria (30.1%, 95% CI 27.6-32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4-11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735). CONCLUSION This study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.
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Affiliation(s)
- Daniela A Rodrigues
- Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), 6300-559, Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506, Covilhã, Portugal
- PhD Student, University of Salamanca, 37007, Salamanca, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37007, Salamanca, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001, Madrid, Spain
| | - Fátima Roque
- Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), 6300-559, Guarda, Portugal.
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506, Covilhã, Portugal.
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Kim WY, Suh Y, Ah YM, Choi JY, Kim KI, Lee JY. Medication-Related Acute Care Admission and Inappropriate Polypharmacy of Nursing Home Residents. J Am Med Dir Assoc 2023; 24:242-249.e7. [PMID: 36529274 DOI: 10.1016/j.jamda.2022.11.011] [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: 07/05/2022] [Revised: 10/15/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the prevalence of medication-related admissions (MRAs) and their association with potentially inappropriate medications (PIMs) used by nursing home residents admitted to the geriatric center of a tertiary hospital. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Older patients admitted from nursing homes to the geriatric center of the Seoul National University Bundang Hospital who had undergone comprehensive geriatric assessment from January 1, 2016, to December 31, 2020. METHODS MRAs were determined and verified using a previously described MRA adjudication guide. The PIMs in the preadmission medication lists were identified according to each of the following criteria (as well as the combined criteria), the Beers, NORGEP-NH, STOPP/START-NH, and STOPPFrail criteria. Medication use factors associated with MRAs were analyzed using multivariate logistic regression. RESULTS Among the 304 acute care admissions, 32.2% were MRAs. The main cause of MRAs was acute kidney injury related with use of renin-angiotensin system inhibitors. Approximately 81% of the patients used at least 1 PIM according to the combined criteria. The use of 1 or more PIMs, renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, and benzodiazepines was significantly associated with MRAs. The combined criteria were able to predict MRAs better than the individual criteria. CONCLUSIONS AND IMPLICATIONS Approximately one-third of acute admissions of nursing home residents may be MRAs. Interventions for the optimal use of medication among nursing home residents are needed.
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Affiliation(s)
- Woo-Youn Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yewon Suh
- Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsangbuk-do, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ju-Yeun Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea; College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
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Albarqouni L, Palagama S, Chai J, Sivananthajothy P, Pathirana T, Bakhit M, Arab-Zozani M, Ranakusuma R, Cardona M, Scott A, Clark J, Smith CF, Effa E, Ochodo E, Moynihan R. Overuse of medications in low- and middle-income countries: a scoping review. Bull World Health Organ 2023; 101:36-61D. [PMID: 36593777 PMCID: PMC9795388 DOI: 10.2471/blt.22.288293] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries - with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Sujeewa Palagama
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Julia Chai
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Respati Ranakusuma
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Anna Scott
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | | | - Emmanuel Effa
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
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Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11133808. [PMID: 35807092 PMCID: PMC9267842 DOI: 10.3390/jcm11133808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/07/2023] Open
Abstract
Inappropriate prescribing in the elderly is a risk factor for higher adverse drugs reactions, hospitalisation, and mortality rates. Therefore, it is necessary to identify irrational prescriptions and implement interventions to improve geriatric clinical practices in nursing homes. This study aimed to examine and compare the prevalence of potentially inappropriate medications in nursing home residents using three different updated criteria: 2019 Beers criteria, PRISCUS list, and v2 STOPP criteria, and to determine the prevalence of potential prescribing omissions according to v2 START criteria. A descriptive, observational, and cross-sectional study design was used. A total of 218 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds. Potentially inappropriate medications were present in 96.3%, 90.8%, and 35.3% of residents, according to the STOPP, Beers, and PRISCUS criteria or list, respectively. Inappropriate medication was found to be significantly associated with polypharmacy and severe or moderate drug–drug interactions with the three tools and with pathologies and unnecessary drugs only for STOPP criteria. The most frequent inappropriate medications were benzodiazepines and proton pump inhibitors. A regular use of software to review medications in nursing home residents would help to reduce the risk of these drug-related problems.
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Ramsdale E, Mohamed M, Yu V, Otto E, Juba K, Awad H, Moorthi K, Plumb S, Patil A, Vogelzang N, Dib E, Mohile S. Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment. Oncologist 2022; 27:e580-e588. [PMID: 35348764 PMCID: PMC9255971 DOI: 10.1093/oncolo/oyac053] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/27/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Polypharmacy is prevalent in older adults starting cancer treatment and associated with potentially inappropriate medications (PIM), potential drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). For a large cohort of vulnerable older adults with advanced cancer starting treatment, we describe patterns of prescription and nonprescription medication usage, the prevalence of PIM, and the prevalence, severity, and type of DDI/DCI. METHODS This secondary analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment (University of Rochester Cancer Center [URCC] 13059; PI: Mohile). PIM were categorized using 2019 Beers criteria and Screening Tool of Older Persons' Prescriptions. Potential DDI/DCI were evaluated using Lexi-Interact Online. Medication classification followed the World Health Organization Anatomical Therapeutic Chemical system. Bivariate associations were evaluated between sociodemographic and geriatric assessment (GA) measures and medication measures. Chord diagrams and network analysis were used to understand and describe DDI/DCI. RESULTS Among 718 patients (mean age 77.6 years), polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and ≥1 PIM were identified in 61.3%,14.5%, and 67.1%, respectively. Cardiovascular medications were the most prevalent (47%), and nonprescription medications accounted for 26% of total medications and 40% of PIM. One-quarter of patients had ≥1 potential major DDI not involving cancer treatment, and 5.4% had ≥1 potential major DCI. Each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively. Polypharmacy and PIM are associated with multiple GA domains. CONCLUSION In a cohort of vulnerable older adults with advanced cancer starting treatment, polypharmacy, PIM, and potential DDI/DCI are very common. Nonprescription medications are frequently PIMs and/or involved in potential DDI/DCI.
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Affiliation(s)
- Erika Ramsdale
- Corresponding Author: Erika Ramsdale, MD, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA. Tel: 585-275-2376;
| | | | - Veronica Yu
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Ethan Otto
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Katherine Juba
- Department of Pharmacy Practice, Wegmans School of Pharmacy, Rochester, NY, USA,Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA
| | - Hala Awad
- Clinical & Translational Science Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Kiran Moorthi
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Sandy Plumb
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Amita Patil
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas Vogelzang
- Nevada Cancer Research Foundation, NCI Community Oncology Research Program, Las Vegas, NV, USA
| | - Elie Dib
- St. Joseph Mercy Cancer Center, Ypsilanti, MI, USA
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
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Zeng Y, Yu Y, Liu Q, Su S, Lin Y, Gu H, Chen S, Li P, Xu T, Sun N, Lin T, Huang Q, Fan Y, Wang F, Yan S. Comparison of the prevalence and nature of potentially inappropriate medication use in geriatric outpatients between tertiary and community healthcare settings: a multicenter cross-sectional study. Int J Clin Pharm 2022; 44:619-629. [PMID: 35212907 DOI: 10.1007/s11096-022-01380-0] [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: 11/30/2021] [Accepted: 01/22/2022] [Indexed: 11/05/2022]
Abstract
Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65 years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.
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Affiliation(s)
- Yan Zeng
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yongpei Yu
- Department of Biostatistics, Peking University Clinical Research Institution, Beijing, China
| | - Qingyang Liu
- Department of Clinical Pharmacy, Capital Medical University, Beijing, China
| | - Su Su
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongyan Gu
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shicai Chen
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Tong Xu
- Department of Pharmacy, Taiyanggong Community Health Center, Beijing, China
| | - Naizhao Sun
- Department of Pharmacy, Datun Community Health Center, Beijing, China
| | - Tao Lin
- Department of Pharmacy, Ganjiakou Community Health Center, Beijing, China
| | - Qian Huang
- Department of Pharmacy, Konggang Community Health Center, Beijing, China
| | - Yujie Fan
- Department of Pharmacy, Guangnei Community Health Center, Beijing, China
| | - Fengzhi Wang
- Department of Data Management, Peking University Clinical Research Institute, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China.
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Varavithya V, Tirapat C, Rojpibulstit P, Poovichayasumlit P, Prasert V, Vatcharavongvan P. Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study. Eur J Clin Pharmacol 2022; 78:847-855. [DOI: 10.1007/s00228-021-03269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
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Vatcharavongvan P, Prasert V, Ploylearmsang C, Puttawanchai V. Prevalence and Factors that Influence Potentially Inappropriate Medication Use among Thai Elderly in Primary Care Settings. Can Geriatr J 2021; 24:332-340. [PMID: 34912488 PMCID: PMC8629499 DOI: 10.5770/cgj.24.516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Older age increases the likelihood of chronic diseases and polypharmacy with the likelihood of potentially inappropriate medications (PIMs) in secondary and tertiary care levels, but in the primary care settings of Thailand there still is a need for more evidence. This study aimed to examine the prevalence of PIM in primary care settings, and to identify factors that influence the use of PIM. Methods A cross-sectional retrospective study was conducted in 2017. Eight primary care units from four regions of Thailand were randomly selected. People aged ≥ 60 years in the eight units were studied as participants. The List of Risk Drugs for Thai Elderly (LRDTE) was used as the reference. Multivariate logistic regression was carried out to identify factors that influence. Results A total of 4,848 patients aged ≥60 years with 20,671 prescriptions were studied. The mean age was 70.7±8.3 years for males, and 61.2% for females. A little more than 5% (5.1%) had ≥ 3 chronic diseases and 15.0% received polypharmacy (≥5 medications). The prevalence of prescriptions with PIMs was 65.9%. The most frequent PIMs were antidepressants: amitriptyline (28.1%), antihistamines: dimenhydrinate (22.4%) and chlorpheniramine maleate (CPM) (11.2%); and Benzodiazepines: lorazepam (6.5%). Three factors that significantly influenced prescribing of PIMs were polypharmacy (adjusted OR 3.51; 95% CI 2.81-4.32), having ≥3 chronic diseases (adjusted OR 1.44; 95% CI 1.04-2.01), and age ≥75 years (adjusted OR 1.18; 95% CI 1.01-1.38). Conclusion More than two-thirds of elderly Thai patients in the primary care settings were prescribed PIMs. Multidisciplinary prescription review and PIM screening in patients aged ≥75 years who have ≥3 chronic diseases or polypharmacy should be implemented in primary care and supportive computerized PIMs alert system is needed.
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Affiliation(s)
- Pasitpon Vatcharavongvan
- Thammasat University Research Unit in Physical Anthropology and Health Science, Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, Thailand
| | - Vanida Prasert
- Faculty of Public Health and Allied Health Sciences, Royal Institute Office of the Permanent Secretary, Ministry of Public Health, Thailand
| | - Chanuttha Ploylearmsang
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kamriang Kantarawichai, Thailand
| | - Viwat Puttawanchai
- Thammasat University Research Unit in Physical Anthropology and Health Science, Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, Thailand
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Xu Z, Liang X, Zhu Y, Lu Y, Ye Y, Fang L, Qian Y. Factors associated with potentially inappropriate prescriptions and barriers to medicines optimisation among older adults in primary care settings: a systematic review. Fam Med Community Health 2021; 9:fmch-2021-001325. [PMID: 34794961 PMCID: PMC8603289 DOI: 10.1136/fmch-2021-001325] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To identify factors that likely contribute to potentially inappropriate prescriptions (PIPs) among older adults in primary care settings, as well as barriers to medicines optimisation and recommended potential solutions. Design Systematic review. Eligibility criteria Quantitative studies that analysed the factors associated with PIPs among older adults (≥65 years) in primary care settings, and qualitative studies that explored perceived barriers and potential solutions to medicines optimisation for this population. Information sources PubMed, EMBASE, Scopus, CINAHL, PsycINFO, Web of Science, CNKI and Wanfang. Results Of the 13 167 studies identified, 50 were included (14 qualitative, 34 cross-sectional and 2 cohort). Nearly all quantitative studies examined patient-related non-clinical factors (eg, age) and clinical factors (eg, number of medications) and nine studies examined prescriber-related factors (eg, physician age). A greater number of medications were identified as positively associated with PIPs in 25 quantitative studies, and a higher number of comorbidities, physical comorbidities and psychiatric comorbidities were identified as patient-related clinical risk factors for PIPs. However, other factors showed inconsistent associations with the PIPs. Barriers to medicines optimisation emerged within four analytical themes: prescriber related (eg, inadequate knowledge, concerns of adverse consequences, clinical inertia, lack of communication), patient related (eg, limited understanding, patient non-adherence, drug dependency), environment related (eg, lack of integrated care, insufficient investment, time constraints) and technology related (eg, complexity of implementation and inapplicable guidance). Recommended potential solutions were based on each theme of the barriers identified accordingly (eg, prescriber-related factors: incorporating training courses into continuing medical education). Conclusions Older adults with more drugs prescribed and comorbidities may have a greater risk of receiving PIPs in the primary care setting, but it remains unclear whether other factors are related. Barriers to medicines optimisation among primary care older adults comprise multiple factors, and evidence-based and targeted interventions are needed to address these difficulties. PROSPERO registration number CRD42020216258.
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Affiliation(s)
- Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xujian Liang
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yue Zhu
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yiting Lu
- Zhongdai Community Healthcare Center, Huzhou, China
| | - Yuanqu Ye
- Baili Community Healthcare Center, The People's Hospital of Longhua, Shenzhen, China
| | - Lizheng Fang
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yi Qian
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Tao L, Qu X, Gao H, Zhai J, Zhang Y, Song Y. Polypharmacy and potentially inappropriate medications among elderly patients in the geriatric department at a single-center in China: A retrospective cross-sectional study. Medicine (Baltimore) 2021; 100:e27494. [PMID: 34678882 PMCID: PMC8542109 DOI: 10.1097/md.0000000000027494] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/22/2021] [Indexed: 01/05/2023] Open
Abstract
The aging of the population has become a worldwide concern, especially in China. Polypharmacy and potentially inappropriate medications (PIMs) are prominent issues in elderly patients. Therefore, the aim of this study was to investigate the prevalence of polypharmacy and PIMs in older inpatients and further to explore the factors associated with PIM use.A retrospective, single-center, cross-sectional study was conducted. A total of 1200 inpatients aged 65 years or older admitted from January 2015 to December 2015 were included. The prevalence of polypharmacy (5-9 medications) and hyperpolypharmacy (10 or more medications) was calculated. The 2019 American Geriatric Society Beers criteria were applied to assess PIMs use. Multivariate logistic regression was used to determine the independent factors of PIM use, while zero-inflated negative binomial regression was performed to evaluate the relationship between polypharmacy and PIM use.The median age of the study population was 76 years (interquartile range = 71-81). The median number of medications was 9 (interquartile range = 7-12). 91.58% of the patients took 5 or more medications simultaneously, and 30.08% of the patients were subjected to one or more PIMs. Spironolactone, furosemide, and zopiclone were the top 3 most frequently encountered PIMs. Hyperpolypharmacy and older age were identified as independent factors associated with PIM use. The risk of PIMs rises with the number of medications prescribed.Polypharmacy and PIM use were common in our study, and the risk of PIM use correlated with an increase in the number of medications already prescribed.
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Vatcharavongvan P, Puttawanchai V. Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications. J Prim Care Community Health 2021; 12:21501327211035088. [PMID: 34315288 PMCID: PMC8323440 DOI: 10.1177/21501327211035088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Most older adults with comorbidities in primary care clinics use multiple
medications and are at risk of potentially inappropriate medications (PIMs)
prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai
criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected
from electronic medical records in a primary care clinic in 2018. Samples
were patients aged ≥65 years old with at least 1 prescription. Variables
included age, gender, comorbidities, and medications. The list of risk drugs
for Thai elderly version 2 was the criteria for PIMs. The prevalence of
polypharmacy and PIMs were calculated, and multiple logistic regression was
conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively.
Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were
anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory
drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM
prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI
2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing
unnecessary medications is crucial to prevent negative health outcomes from
PIMs. Computer-based clinical decision support, pharmacy-led interventions,
and patient-specific drug recommendations are promising interventions to
reduce PIMs in a primary care setting.
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Pala E, Ersoy S, Engin VS, Benli AR. Effectiveness of STOPP/START criteria in primary prevention of polypharmacy and under-treatment in older patients. Therapie 2021; 77:361-369. [PMID: 34454744 DOI: 10.1016/j.therap.2021.07.003] [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: 04/03/2021] [Revised: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY STOPP/START criteria appear to be a useful tool to curb inappropriate prescribing (IP), which encompasses errors of both, over and under-treatment. This study aimed to find out whether application of STOPP/START reduces the IP effectively in primary care. METHODS This prospective cross-sectional study was conducted in two family health centers (FHCs) in Istanbul. All older adults who applied to FHCs between 01-07-2018 and 01-07-2020 were enrolled. The potential inappropriate medications (PIMs) and potential prescription omissions (PPOs) were identified according to STOPP/START version 2 criteria. Mean drug consumptions before and after STOPP/START were compared using Student's t-test. RESULTS Among 1023 participants there were 626 females and 397 males. The mean age was 73.33±7.30 years. The number of the patients seen at FHCs was 657 (64.2%) while 366 (35.8%) of them were visited at home. Of the patients, 383 (37.8) were 75 years old or older and 631 (62.2%) of them were under 75. Overall number of drugs consumed per patient was 5.49±3.93 while it was 6.01±3.71 and 4.55±4.138 for outpatients and home patients respectively (p<0.001). By application of STOPP criteria, among the 5616 medications consumed by the overall patients, 881(%15.6) of them were found to be potentially inappropriate. 424 (41.4%) patients were using at least one PIM. This ratio was 354 (53.8%) in outpatients and 70 (19%) in home patients. START criteria identified 380 (%7.4) PPOs. There were 246 (24.0%) patients with at least with one PPO; 155 (42.3%) of whom were home patients and 91 (13.8%) were outpatients. Regarding the age groups; PIM ratio was 35.5% in patients under 75 and 52.1% over 75 whereas PPO ratio was 22.5% under 75 and 26.8% over 75. CONCLUSION This study supports the data reporting the effectiveness of STOPP/START criteria in primary care units in implementing appropriate prescription criteria.
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Affiliation(s)
- Emin Pala
- University of Health Sciences, Hamidiye Medical Faculty, Department of Family Medicine, 34668 Istanbul, Turkey
| | - Suleyman Ersoy
- University of Health Sciences, Hamidiye Medical Faculty, Department of Family Medicine, 34668 Istanbul, Turkey.
| | | | - Ali Ramazan Benli
- Karabuk University, Medical Faculty, Department of Family Medicine, 55900 Karabuk, Turkey
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Abukhalil AD, Shaloudi AY, Shamasneh NM, Aljamal AM. Awareness of Beers criteria and potentially inappropriate medications among physicians and pharmacists in Palestine. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Asil Maher Aljamal
- Department of Pharmacy, Nursing and Health Professions Birzeit University Birzeit Palestine
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15
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Bories M, Bouzillé G, Cuggia M, Le Corre P. Drug-Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study. Pharmaceutics 2021; 13:pharmaceutics13020266. [PMID: 33669162 PMCID: PMC7919637 DOI: 10.3390/pharmaceutics13020266] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/18/2023] Open
Abstract
Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the inappropriate character of PIM. The aim of this study was (1) to describe the prevalence and severity of DDI in patients with PIM and (2) to evaluate the DDI specifically regarding PIM. This systematic review is based on a search carried out on PubMed and Web-of-Science from inception to June 30, 2020. We extracted data of original studies that assessed the prevalence of both DDI and PIM in elderly patients in primary care, nursing home and hospital settings. Four hundred and forty unique studies were identified: 91 were included in the qualitative analysis and 66 were included in the quantitative analysis. The prevalence of PIM in primary care, nursing home and hospital were 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% (95% CI: 27.8–31.6%) and 44.6% (95% CI: 28.3–60.9%), respectively. Clinically significant severe risk-rated DDI averaged 28.9% (95% CI: 17.2–40.6), in a hospital setting; and were approximately 7-to-9 lower in primary care and nursing home, respectively. Surprisingly, only four of these studies investigated DDI involving specifically PIM. Hence, given the high prevalence of severe DDI in patients with PIM, further investigations should be carried out on DDI involving specifically PIM which may increase their inappropriate character, and the risk of adverse drug reactions.
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Affiliation(s)
- Mathilde Bories
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
| | - Guillaume Bouzillé
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Marc Cuggia
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, F-35000 Rennes, France; (G.B.); (M.C.)
| | - Pascal Le Corre
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France
- Correspondence:
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16
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de Araújo NC, Silveira EA, Mota BG, Neves Mota JP, de Camargo Silva AEB, Alves Guimarães R, Pagotto V. Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up. PLoS One 2020; 15:e0240104. [PMID: 33112864 PMCID: PMC7592782 DOI: 10.1371/journal.pone.0240104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/19/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Pharmacological therapy plays an important role in disease control in the elderly; unfortunately, this comes with a high prevalence in the use of medications classified as potentially inappropriate. OBJECTIVE To analyze the incidence, risk factors, and survival of elderly people using potentially inappropriate medications (PIM). METHOD A ten-year follow-up assessment of elderly participants residing in a capital of Central Brazil was conducted. The initial assessment (baseline) included 418 elderly people. Data were collected through home interviews guided by a questionnaire covering socioeconomic, demographic, living conditions, and health variables. The medication information obtained comprised active ingredient, dosage, route, and regimen for the medications. The PIMs were classified according to 2019 Beers Criteria. The analyses were performed using STATA 15.0. For survival analysis, a Cox Regression was performed with the respective Kaplan Meier curve. RESULTS The incidence of PIM was 44.1 cases (95% CI: 35.2-54.7) per 1,000 people a year. The most used PIMs were nifedipine, glibenclamide, and sodium diclofenac. The risk factors were polypharmacy (aRR: 3.00; 95% CI: 1.31-6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03-2.39). We identified no statistically significant association between survival and the use of PIM. CONCLUSION The study highlights the high consumption of PIM among the elderly causing polypharmacy risks. Health professionals working in drug treatment need to be alert to polypharmacy risks to ensure the rational use of medications to prevent adverse reactions and other health problems.
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Affiliation(s)
| | - Erika Aparecida Silveira
- Faculty of Medicine, Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Brenda Godoi Mota
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Rafael Alves Guimarães
- Faculty of Nursing, Postgraduate Program in Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Valéria Pagotto
- Faculty of Nursing, Postgraduate Program in Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail:
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Harasani K, Xhafaj D, Begolli A, Olvera-Porcel MC. Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment. Pharm Pract (Granada) 2020; 18:2017. [PMID: 32922574 PMCID: PMC7470240 DOI: 10.18549/pharmpract.2020.3.2017] [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: 06/08/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Potentially inappropriate prescribing is clearly associated with adverse
health consequences among older people. Nevertheless, scarce evidence exists
regarding the prevalence of potentially inappropriate prescriptions (PIP) in
Albania, a Western Balkans country. Objective: The aim of this study was to assess the prevalence of PIP among older
Albanian patients in primary care and to determine the associated
sociodemographic and medical factors, including the presence of mild
cognitive impairment (MCI). Methods: Cross-sectional study in two primary healthcare centers located in two
different cities of Albania, a middle-income country in the Western Balkans.
The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI.
PIPs were assessed by two trained pharmacists using the Beers criteria 2019
update. Multivariate logistic regression analysis was conducted for possible
risk factors predicting PIP in the study population. Results: At least one PIP was identified among 40.23 % of the participants (174
older patients) and 10.35 % had more than one PIP. MCI was detected
among 79.31 % of the patients. The most commonly represented drug
groups in PIP were diuretics (24.71 %), benzodiazepines in the
presence of MCI and antidepressants (both 8.62 %). The lack of
electrolytes monitoring was the most common reason for PIP. According to the
multivariate analysis, the only statistically significant association
observed was between PIP and number of drugs prescribed [three to four drugs
(OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08;
95% CI 1.42:11.69)]. Conclusions: About four out of 10 older Albanian patients experience PIP in primary care.
Further studies are needed for a comprehensive estimation of the prevalence
and factors associated with PIP, particularly among elderly with mild
cognitive impairment.
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Affiliation(s)
- Klejda Harasani
- PhD. Department of Pharmacy, Faculty of Medicine, University of Medicine of Tirana. Tirana (Albania).
| | - Delina Xhafaj
- PhD. Department of Pharmacy, Faculty of Medicine, University of Medicine of Tirana. Tirana (Albania).
| | - Anxhela Begolli
- MSc. Department of Pharmacy, Faculty of Medicine, University of Medicine of Tirana. Tirana (Albania).
| | - Maria C Olvera-Porcel
- PhD. Public Foundation for Biomedical Research of Oriental Andalusia. Granada (Spain).
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Rattanachotphanit T, Waleekhachonloet O. Effect of a Rational Drug Use Policy on the prescribing safety in outpatient settings in Thailand. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:608-616. [PMID: 32813302 DOI: 10.1111/ijpp.12665] [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: 12/23/2019] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In Thailand, the 'Rational Drug Use (RDU) policy' has been implemented in the Ministry of Public Health (MOPH) hospitals since October 2016. This study aimed to explore the effects of the RDU policy on prescribing safety indicators for elderly patients and those with common chronic diseases. METHOD Electronic outpatient databases were obtained from 15 MOPH hospitals. The selected indicators were the (1) glibenclamide prescribing in patients with diabetes mellitus who were elderly or had renal impairment; (2) duplicate prescribing of renin angiotensin system (RAS) blockers in patients with hypertension; (3) non-steroidal anti-inflammatory drugs (NSAIDs) prescribing in patients with chronic kidney disease stages 3-5; and (4) long-acting benzodiazepines prescribing in patients ≥65 years. The policy effects in terms of changes in prescribing trends were estimated using interrupted time-series analysis based on quarterly (Q) data. The postpolicy trends (2016, Q4-2017, Q4) were compared with the prepolicy trend (2014, Q1-2016, Q3). KEY FINDINGS The unsafe prescribing of glibenclamide in patients with diabetes mellitus was 19.2% in Q1, 2014 and decreased significantly due to the RDU policy to 11.0% in Q4, 2017 (-4.23 percentage points quarterly, P < 0.001). The unsafe prescribing of RAS blockers and long-acting benzodiazepines was relatively low in Q1, 2014 (1.0% and 1.1%, respectively) and did not decrease further after the RDU policy. The unsafe prescribing of NSAIDs was 4.2% in Q1, 2014, increased abruptly one quarter after the policy and decreased afterwards. CONCLUSION The RDU policy seemed to be a contributing factor that decreased the unsafe prescribing of glibenclamide, while the policy effect was minimal for the other indicators.
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Huang Y, Zhang L, Huang X, Liu K, Yu Y, Xiao J. Potentially inappropriate medications in Chinese community-dwelling older adults. Int J Clin Pharm 2020; 42:598-603. [PMID: 32026350 DOI: 10.1007/s11096-020-00980-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Abstract
Background There is a lack of data on the prevalence of potentially inappropriate medications (PIMs) in community-dwelling older adults in China. Objective To assess the prevalence of potentially inappropriate medication in community dwelling older adults in China and to investigate risk factors associated with the use of such medication. Setting Ambulatory Care Clinic of Xiangya Hospital, Central South University. Method A cross-sectional retrospective review of prescriptions for older patients (aged ≥ 65 years) was performed using the 2019 American Geriatrics Society (AGS) Beers Criteria and the 2017 Chinese Criteria. We only assessed potentialli inappropriate medications independently from diagnosis and drug-drug interactions. Each patient was classified as PIM-user or non-PIM-user, according to whether a patient took at least one potentially inappropriate medication. Main outcome measure Prevalence of potentially inappropriate medication based on the two criteria. Results A total of 8477 medications among 1874 elderly patients were examined over the study period from January 1 to December 31, 2018. The Chinese Criteria detected significantly more PIM-users than the AGS Beers Criteria (50.6% vs 35.0%, P < 0.001), and also a higher percentage of inappropriate medication in prescribed medications (14.7% vs 8.5%, P < 0.001). Benzodiazepines, anticholinergics, antipsychotics, and insulin were the most frequently prescribed classes by both criteria. Alprazolam (47.7%) was the most frequently found inappropriate medicine based on the 2019 AGS Beers Criteria compared to clopidogrel (42.2%) based on the Chinese Criteria. The number of medications was a significant risk factor to the use of potentially inappropriate medication in both criteria. Conclusion The prevalence of the use of potentially inappropriate medication in Chinese community-dwelling older adults is high, and explicit criteria are a useful tool to evaluate the prescription of such medication in the elderly.
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Affiliation(s)
- Yamin Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xingxing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Keke Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yangyong Yu
- Department of Pharmacy, The Second People's Hospital of Beihai, Beihai, 536000, Guangxi, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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