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Cave JA. Medicines and global warming: a complex problem. Drug Ther Bull 2024:dtb-2024-000003. [PMID: 38594061 DOI: 10.1136/dtb.2024.000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Wilcock M. Limiting drugs prescribed in primary care. Drug Ther Bull 2024; 62:23-26. [PMID: 38199792 DOI: 10.1136/dtb.2023.000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
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Treadwell J. Continuity of care: good for patients, good for prescribing. Drug Ther Bull 2023; 62:2. [PMID: 38050009 DOI: 10.1136/dtb.2023.000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Julian Treadwell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Prazeres F. [Letter to the Editor on the Identification of Potentially Inappropriate Medications among Elderly Patients in Ambulatory Care in Portugal]. ACTA MEDICA PORT 2023; 36:850-851. [PMID: 37924318 DOI: 10.20344/amp.20389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Filipe Prazeres
- Unidade de Saúde Familiar Beira Ria. Gafanha da Nazaré; Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal
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Khoshbakht R, Semsari Bonab M, Hajizadegan H, Tavakolizadeh Nooghabi E, Ghorbani A, Asgari M, Neshani A, Ghavidel M, Sadeghian H. Comparing self-medication and medical supervised treatment before hospitalization among patients with Covid-19: A retrospective case-control study. J Infect Public Health 2023; 16 Suppl 1:119-124. [PMID: 37925306 DOI: 10.1016/j.jiph.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND During the Covid-19 pandemic, there has been a notable increase in self-medication with antibiotics or other medications due to impaired access to healthcare services. This kind of self-treatment, without comprehending the condition and its related risks, can result in misdiagnosis, overdosing and delaying in acquiring professional medical attention, or may even cause antimicrobial resistance. Additionally, reports have suggested that medical practitioners have prescribed medications inappropriately to patients with Covid-19. To investigate this further, this study compared the medications used by patients with Covid-19 prior to hospitalization with or without a medical recommendation. METHODS Data was extracted a mass survey of patients with of Covid-19 in Mashhad, and the patients were divided into two main groups: those who received medication with guidance from a medical professional (treatment group) and those who self-administered medications without professional oversight (self-treatment group). Statistical analysis was then conducted using SPSS version 26, the Chi-square, and multiple logistic regression test. RESULTS This study examined 3266 patients, with 1466 included in the analysis. Results showed that men (9.5 %), those living in rural areas (21 %), and those with no academic degree (37.5%) had a higher likelihood to self-medicating. Antibiotics were the most frequently used medications prior to hospitalization (9.5%). Comparing the two groups revealed that three drug categories- antibiotics, antivirals and other medications (medicines that are not in the other 4 main categories)- were utilized more often in the treatment group than in the self-treatment group, with a p-value of < 0.05. The only medical condition that had a significant difference between the two groups was diabetes, with 34.1 % in the self-treatment group versus 24.5 % in the treatment group (P < 0.05). CONCLUSIONS The Covid-19 pandemic has caused a surge in the inappropriate use of certain medications through self-medicating. This poses a serious risk to the health of patients, highlighting the need for not only adjusting guidelines but also raising awareness and enforcing compliance to prevent unnecessary use of drugs.
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Affiliation(s)
- Reza Khoshbakht
- Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Homa Hajizadegan
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Atousa Ghorbani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Asgari
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Neshani
- Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdis Ghavidel
- Shahid Hasheminejad Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Sadeghian
- Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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De Las Salas R, Vaca-González C, Eslava-Schmalbach J, Torres-Espinosa C, Figueras A. Tackling potentially inappropriate prescriptions in older adults: development of deprescribing criteria by consensus from experts in Colombia, Argentina, and Spain. BMC Geriatr 2023; 23:682. [PMID: 37864147 PMCID: PMC10588094 DOI: 10.1186/s12877-023-04271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/04/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop and validate a tool for identifying PIMs in older adults within the primary care setting. The tool is composed of a list of criteria and was created based on consensus among experts from three Spanish-speaking countries, including two from Latin America. METHODS A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability. RESULTS Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial). CONCLUSIONS The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.
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Affiliation(s)
- Roxana De Las Salas
- Department of Nursing, Km5 Via Puerto Colombia, Universidad del Norte, Barranquilla, Colombia.
| | - Claudia Vaca-González
- Faculty of Science, Department of Pharmacy, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Bogota, Colombia
| | - Javier Eslava-Schmalbach
- Faculty of Medicine, Department of Surgery, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Bogota, Colombia
| | - Catalina Torres-Espinosa
- Faculty of Medicine, Department of Internal Medicine, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Bogota, Colombia
| | - Albert Figueras
- Faculty of Medicine, Autonomus University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain
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Intravenous vitamin injections: where is the evidence? Drug Ther Bull 2023; 61:151-5. [PMID: 37640530 DOI: 10.1136/dtb.2023.000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The body needs small daily quantities of vitamins and minerals, which are usually obtained from the diet. Intravenous vitamins are used for a few serious medical conditions (eg, malabsorption syndromes with severe vitamin depletion, Wernicke's encephalopathy or critical illness). Intravenous drips containing high doses of various vitamins and minerals (eg, the so-called 'Myers' cocktail') have been promoted in popular culture to 'reduce stress', 'increase energy' or 'boost immunity', with claims that the intravenous route allows faster absorption of vitamins into the bloodstream than if they are taken orally. There is a lack of high-quality evidence to suggest that high-dose vitamin infusions are necessary or offer any health benefit in the absence of a specific vitamin deficiency or medical condition. There may be harms from taking high (non-physiological) quantities of some vitamins and minerals. Licensed forms of injectable vitamins that are prescription-only medicines should not be advertised to the public and should only be supplied and administered by appropriately qualified healthcare professionals.
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Congleton J. Improving asthma prescribing: is FeNO the answer? Drug Ther Bull 2023; 61:114. [PMID: 37402644 DOI: 10.1136/dtb.2023.000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Jo Congleton
- Respiratory Department, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Abstract
Toxocara canis (from dogs) is recognised as a potential cause of human toxocarosis, but Toxocara cati (from cats) and other species (eg, Toxascaris leonina found in foxes) are also possible causes. Most colonisation with Toxocara species does not lead to symptomatic infection in well-cared for adult animals; young and debilitated animals are at greater risk. Humans can acquire infection from infected animals, for example, via soil contaminated with faeces; however, most human infections are asymptomatic, with symptomatic infection being very rare in the UK. The risk of human infection is reduced by measures such as hand washing and responsible disposal of dog faeces. Some organisations recommend regular prophylactic treatment of pet dogs and cats. However, there are concerns that some parasiticides are contaminating the environment. As an example of a One-Health problem there is a potential conflict between the needs of animal health, human health and the health of the wider ecosystem. Also, considering that only about 5% of non-juvenile household dogs shed Toxocara eggs at a given time, it has been questioned whether it is worthwhile to invest in frequent blind treatments. British veterinary organisations have suggested less frequent treatment may be more appropriate and should be based on individual risk assessment and faecal examinations for worms rather than blanket regular prophylactic treatment, which could reduce the impact of parasiticides on the environment without greatly increasing the risks to animal or human health.
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Mintzes B, Vitry A. Australia to lose agency dedicated to better quality medicine use. Drug Ther Bull 2023; 61:2. [PMID: 36456031 DOI: 10.1136/dtb.2022.000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Vitry
- Clinical and Health Sciences, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
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González-Morcillo G, Calderón-Hernanz B, Martín-Fajardo ML, Calderón-Torres MD, Raya-Cruz M, Sarubbo F. Evaluation of the antibiotic prescription in a hospital emergency department: Pilot study. Farm Hosp 2023; 47:3-9. [PMID: 36697339 DOI: 10.1016/j.farma.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription. METHOD Observational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to 7 different days of the week, in 7 consecutive weeks. INCLUSION CRITERIA patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by 2 specialists in emergencies, 2 pharmacists and one specialist in infectious diseases, all unrelated to prescriptions. RESULTS One hundred sixty eight patients with 192 prescriptions were evaluated. 76 (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa=0.71). CONCLUSIONS A high rate of inappropriate antimicrobial prescriptions was obtained in a hospital emergency department according to local guidelines. The hospital pharmacist has an opportunity to improve the use of antimicrobials in this area.
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González-Morcillo G, Calderón-Hernanz B, Martín-Fajardo ML, Calderón-Torres MD, Raya-Cruz M, Sarubbo F. [Translated article] Evaluation of the antibiotic prescription in a hospital emergency department: Pilot study. Farm Hosp 2023; 47:T3-T9. [PMID: 36725390 DOI: 10.1016/j.farma.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription. METHOD Observational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to seven different days of the week, in seven consecutive weeks. INCLUSION CRITERIA patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by two specialists in emergencies, two pharmacists and one specialist in infectious diseases, all unrelated to prescriptions. RESULTS 168 patients with 192 prescriptions were evaluated. Seventy-six (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa = 0.71). CONCLUSIONS A high rate of inappropriate antimicrobial prescriptions was obtained in a hospital emergency department according to local guidelines. The hospital pharmacist has an opportunity to improve the use of antimicrobials in this area.
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Affiliation(s)
- Gonzalo González-Morcillo
- Hospital Pharmacy Service, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISba), Palma de Mallorca, Spain.
| | - Beatriz Calderón-Hernanz
- Hospital Pharmacy Service, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISba), Palma de Mallorca, Spain
| | - María Luisa Martín-Fajardo
- Emergency Service, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISba), Palma de Mallorca, Spain
| | - María Dolores Calderón-Torres
- Emergency Service, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISba), Palma de Mallorca, Spain
| | - Manuel Raya-Cruz
- Infectious Services, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISba), Palma de Mallorca, Spain
| | - Fiorella Sarubbo
- Research Unit, Son Llàtzer University Hospital, Health Research Institute of the Balearic Islands (IdISba), Palma de Mallorca, Spain; Biology Department, University of the Balearic Islands (UIB), Palma de Mallorca, Spain
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Soontaros S, Leelakanok N, Mepradis Y, Auamnoy T. Factors influencing decision making and antibiotic prescribing patterns for the treatment of carbapenem-resistant Enterobacteriaceae (CRE) among non-infectious physicians in Thailand: a qualitative study. Transl Clin Pharmacol 2022; 30:187-200. [PMID: 36632079 PMCID: PMC9810490 DOI: 10.12793/tcp.2022.30.e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/31/2022] Open
Abstract
The treatment of carbapenem-resistant Enterobacteriaceae (CRE) is diverse in each region due to the difference in local resistant patterns of CRE. We aimed to explore how physicians in Thailand decide on selection options for treating CRE infections. In this study, 25 physicians who were not infectious disease (ID) specialists participated in this semi-structured in-depth interview. We found that they, in general, did not provide empiric antibiotics for the treatment of CRE. However, some patients, e.g., those with prior carbapenems exposure may have brought CRE to physicians' attention. ID specialists played critical roles in both empiric and specific CRE treatment. There were multiple scenarios when CRE management deviated from recommendations, especially when physicians perceived that the evidence that supported the recommendations was weak. Several supportive factors, challenges, and improvements were also suggested. In conclusion, ID specialists, adequate information, and consistent implementation of infectious control policy are crucial to the treatment and prevention of CRE infection.
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Affiliation(s)
- Suluck Soontaros
- Department of Pharmacy, Chonburi Hospital, Chonburi 20000, Thailand.,Faculty of Pharmaceutical Sciences, Burapha University, Chonburi 20131, Thailand.,Graduate School, Burapha University, Chonburi 20131, Thailand
| | - Nattawut Leelakanok
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi 20131, Thailand
| | - Yuttaphum Mepradis
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi 20131, Thailand
| | - Titinun Auamnoy
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi 20131, Thailand
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Branford D, Wilcock M. STOMP and STAMP campaigns: success or failure? Drug Ther Bull 2022; 60:114. [PMID: 35680382 DOI: 10.1136/dtb.2022.000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- David Branford
- Peninsula School of Medicine, Plymouth University, Plymouth, Devon, UK
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Naughton M, Redmond P, Durbaba S, Ashworth M, Molokhia M. Determinants of long-term opioid prescribing in an urban population- a cross sectional study. Br J Clin Pharmacol 2022; 88:3172-3181. [PMID: 35018644 PMCID: PMC9305420 DOI: 10.1111/bcp.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/12/2021] [Accepted: 12/07/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Opioid prescribing has more than doubled in the UK between 1998 and 2016. Potential adverse health implications include dependency, falls and increased health expenditure. AIM To describe the predictors of long-term opioid prescribing (LTOP), (≥3 opioid prescriptions in a 90-day period). DESIGN AND SETTING A retrospective cross-sectional study in 41 General Practices in South London. METHOD Multi-level multivariable logistic regression to investigate the determinants of LTOP. RESULTS 2,679 (0.8%) out of 320,639 registered patients ≥18 years were identified as having LTOP. Patients Were most likely to have LTOP, if: they had ≥5 long term conditions (LTCs) (adjusted odds ratio [AOR] 36.5, 95% confidence interval [CI] 30.4-43.8) or 2-4 LTCs (AOR 13.8, CI 11.9-16.1), in comparison to no LTCs, ≥75 years compared to 18-24 years (AOR 12.31, CI 7.1-21.5), smokers compared to non-smokers (AOR 2.2, CI 2.0-2.5), females compared to males (AOR 1.9, CI 1.7-2.0) and in the most deprived deprivation quintile (AOR 1.6, CI 1.4-1.8) compared to the least deprived. In a separate model examining individual long-term conditions (LTCs), the strongest associations for LTOP were noted for sickle cell disease (SCD) (AOR 18.4, CI 12.8-26.4), osteoarthritis (AOR 3.0, CI 2.8-3.3), rheumatoid arthritis (AOR 2.8, CI 2.2-3.4), depression (AOR 2.6, CI 2.3-2.8) and multiple sclerosis (OR 2.5, CI 1.4-4.4). CONCLUSION LTOP was significantly higher in those aged ≥75 years, with multi-morbidity or specific LTCs: sickle cell disease, osteoarthritis, rheumatoid arthritis, depression, and multiple sclerosis. These characteristics may enable the design of targeted interventions to reduce LTOP.
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Affiliation(s)
- Michael Naughton
- Department of Population Health Sciences & Environmental Sciences, King's College London
| | - Patrick Redmond
- School of Population Health & Environmental Sciences, King's College London
| | - Stevo Durbaba
- Department of Population Health Sciences, King's College London
| | - Mark Ashworth
- Department of Population Health Sciences, King's College London
| | - Mariam Molokhia
- Department of Population Health Sciences, King's College London
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Peixoto S, Almeida A, Caramelo A, Mendes L. [Application of the 2015 Beers Criteria Operationalized for Portugal in Institutionalized Elderly: A Cross-Sectional Study]. ACTA MEDICA PORT 2021; 34:741-748. [PMID: 33159720 DOI: 10.20344/amp.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/22/2019] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The consumption of potentially inappropriate medicines is high among institutionalized elderly, predisposing to potential drug interactions, adverse drug events, risk of iatrogenic cascade, increased morbidity and mortality and health costs. Medication review is a promising strategy for therapeutic optimization, although scarcely documented in Portugal. The aim of this study was to characterize, using explicit criteria, the existence of potentially inappropriate medicines, among institutionalized elderly, and to calculate the eventual cost savings, with their discontinuation. MATERIAL AND METHODS Descriptive and cross-sectional study conducted in three residential homes for the elderly, from different geographic regions, based on a random sample of 33 health records. In order to characterize the existence of potentially inappropriate medicines, we used the 2015 Beers criteria, revised by the American Geriatrics Society and in the Portuguese version. RESULTS On average, 11 drugs are prescribed to elderly residents of three residential structures for the elderly. All health records contain potentially inappropriate medicines (mean 4.8 ± 2.0 per resident), with anxiolytics (17.7%), antidepressants (17.7%) and antipsychotics (15.8%) being the most prevalent. Its reduction would result in an average monthly savings of €9.6 per resident. DISCUSSION The consumption of potentially inappropriate medicines is higher than the literature describes, and the cost of medicines is high. The involvement of nurses in the process of drug management and reconciliation, in coordination with the physician, could be an effective strategy. This is the first study using the latest Portuguese version of the Beers criteria, which makes the comparability of the results difficult. CONCLUSION The consumption of potentially inappropriate medicines is high, which suggest the need for adoption of improvement measures.
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Affiliation(s)
- Sofia Peixoto
- Departamento de Gerontologia e Cuidado Geriátrico. Universidade Católica Portuguesa. Instituto de Ciências da Saúde. Porto. Portugal
| | - Armando Almeida
- Centro de Investigação Interdisciplinar em Saúde. Universidade Católica Portuguesa. Porto. Portugal
| | - Ana Caramelo
- Centro de Investigação Interdisciplinar em Saúde. Universidade Católica Portuguesa. Porto. Portugal
| | - Lígia Mendes
- Departamento de Medicina Geral e Familiar. Assistência Social Adventista. Lisboa. Portugal
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Gaurang N, Priyadharsini R, Balamurugesan K, Prakash M, Reka D. Attitudes and beliefs of patients and primary caregivers towards deprescribing in a tertiary health care facility. Pharm Pract (Granada) 2021; 19:2350. [PMID: 34621447 PMCID: PMC8455127 DOI: 10.18549/pharmpract.2021.3.2350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Good prescribing practices form the essence of drug therapy for better patient care. The major aim of better prescribing is to improve rational prescribing. Deprescribing gained momentum in recent decades. Objective This study aimed to explore the attitude and beliefs of deprescribing among patients and their caregivers forming dyads in a tertiary health care facility. Methods Cross-sectional, questionnaire-based prospective study done for two months. Attitude towards deprescribing was assessed by using validated rPATD (revised Patient attitude towards deprescribing) questionnaire. Cohen's kappa coefficient was used to measure the agreement between the views of people and their caregivers forming dyads about medication cessation. Results 312 patients and caregivers (156 forming dyads) participated in the study. Among 156 patients, 25.6% were hypertensives & 21.2% had diabetes. 41.7% were between 36-50 years of age. Only 16.7% belong to the elderly age group. 2.5% were taking >5 medications. 43.6% of patients and 62.2% of caregivers were female. 51.3% of the patients were willing to stop one or more of their regular medicine(s) under the treating physician's advice, but 62% were satisfied with their current medicine(s). 33.4% were reluctant to stop taking medicines for a long time. Conclusions In our study, more than 50% of people and their caregivers were willing to try medication cessation under their physician's recommendation. There was moderate agreement between patients and their caregivers in the trial of medication cessation. Thus, the results obtained from this study may help towards improving rationalized prescribing practices in the institutional setup.
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Affiliation(s)
- Narayan Gaurang
- MBBS. Indira Gandhi Medical College and Research Institute (IGMC&RI). Puducherry (India).
| | - Rajendran Priyadharsini
- Assistant Professor. Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Puducherry (India).
| | - Kandan Balamurugesan
- Additional Professor. Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Puducherry (India).
| | - Mathiyalagen Prakash
- Assistant Professor. Department of Community Medicine, Indira Gandhi Medical College and Research Institute (IGMC&RI). Puducherry (India).
| | - Devanathan Reka
- Junior resident. Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Puducherry (India).
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Al-Yaqoubi WS, Al-Maqbali NS. Patterns of Prescribing Co-Amoxiclav to Children in Ibri Polyclinic, Oman. Sultan Qaboos Univ Med J 2021; 21:e72-e76. [PMID: 33777426 PMCID: PMC7968904 DOI: 10.18295/squmj.2021.21.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/17/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to describe patterns of prescribing co-amoxiclav to children aged ≤5 years at a polyclinic in Oman and to assess level of adherence to the antibiotic prescription guidelines outlined by the Omani Ministry of Health (MOH). Methods This cross-sectional retrospective study was conducted between June and December 2017 at Ibri Polyclinic (IPC) in Ibri, Oman. A random sample of 399 children aged ≤5 years who were prescribed a suspension of co-amoxiclav over the four winter months of 2016 were included in the study. The children's electronic medical records were reviewed to determine whether the prescription complied with MOH guidelines. Results The majority of the children were 2-3 years old (52.4%). Overall, 73.9% of prescriptions were written by general practitioners, while 26.1% were written by specialists. Co-amoxiclav therapy was the first line of management in 90.5% of cases, regardless of category of prescriber. Culture tests were ordered in only 43 cases (10.8%), of which five (11.6%) were found to be sensitive to the prescribed co-amoxiclav. Conclusion Unnecessary antibiotics were prescribed to many paediatric patients attending IPC. Strict enforcement of the MOH antibiotic guidelines is needed to reduce irrational or discretionary prescription of this type of antibiotic. Healthcare providers should receive additional training in evidence-based methods of prescribing antibiotics.
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Hajj A, Azzo C, Hallit S, Salameh P, Sacre H, Abdou F, Naaman N, Khabbaz LR. Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study. Pharm Pract (Granada) 2021; 19:2234. [PMID: 33777263 PMCID: PMC7979316 DOI: 10.18549/pharmpract.2021.1.2234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Dentists play an essential role in providing high-quality dental care, taking
into consideration the clinical context and concomitant medications taken by
the patients. Objective: This study aimed to assess drug-prescribing perception and practices in
addition to drug-related educational needs among Lebanese dentists; it also
evaluated the need for interprofessional collaboration between dentists and
pharmacists. Methods: An exploratory cross-sectional study using an online questionnaire targeted a
sample of dentists from all Lebanese districts. Participants gave their
consent by accepting to complete the survey (ethics approval reference:
USJ-2016-63). The questionnaire consisted of closed-ended questions
exploring: 1) drug-prescribing perception, 2) drug-prescribing practice, and
3) collaboration with pharmacists regarding their respective roles in
providing appropriate counseling to patients. Two indexes were created: the
first evaluated self-confidence in prescribing medications, and the second
assessed dentists’ confidence in pharmacists. Logistic regressions
were performed, taking each index as a dependent variable. Results A total of 137 dentists completed the survey (59% females; mean age:
42.17; SD: 13.78 years). The majority had a fair to good perceived knowledge
in pharmacology and therapeutics (80.3%), only 30.7% reported
to be sufficiently equipped to prescribe safely. Dentists exhibited
particularly low perceived knowledge about prescribing in elderly patients,
dosing, medication use in pregnancy, drug interactions, and adverse
reactions. Dentists specialized in periodontics had the lowest odds of
having self-confidence in prescribing drugs (aOR=0.25; p<0.001).
Also, 64.3% declared that they routinely check a reference source
before prescribing, and 78% relied on pharmaceutical companies and
medical representatives to get information on medications. While 61%
declared that pharmacists should provide oral care counseling, only half of
them encouraged their patients to talk to their pharmacists about their
medications. Only 15% considered that patients are getting enough
counseling from the pharmacist, with a global confidence index below the
median value, suggesting the need for more collaboration, especially with
periodontists who exhibited the lowest confidence in pharmacists
(aOR=0.45). Conclusions Lebanese dentists reported some lack of knowledge and confidence in
prescribing practices. Education, training, and close collaboration between
pharmacists and dentists are essential to overcome these problems and avoid
potential harm to patients.
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Affiliation(s)
- Aline Hajj
- PharmD, PhD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
| | - Christel Azzo
- PharmD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
| | - Souheil Hallit
- PharmD, PhD. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK) . Jounieh ( Lebanon ).
| | - Pascale Salameh
- PharmD, PhD. School of Medicine, University of Nicosia . Nicosia ( Cyprus ).
| | - Hala Sacre
- PharmD. National Institute of Public Health, Clinical Epidemiology, and Toxicology-Lebanon (INSPECT-LB) . Beirut ( Lebanon ).
| | - Frederic Abdou
- PharmD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
| | - Nada Naaman
- DDS, PhD. Faculty of Dental medicine, Saint-Joseph University . Beirut ( Lebanon ).
| | - Lydia R Khabbaz
- PharmD, PhD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).
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Rodrigues DA, Herdeiro MT, Thürmann PA, Figueiras A, Coutinho P, Roque F. [Operationalisation for Portugal of the EU(7)-PIM List for Identification of Potentially Inappropriate Medicines in Older Adults]. ACTA MEDICA PORT 2021; 34:194-200. [PMID: 33226323 DOI: 10.20344/amp.13618] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In 2015, the EU(7)-PIM List was published, which identifies potentially inappropriate medicines in older patients and resulted from a consensus of experts from seven European countries. Portugal was not part of this group, so it was not originally adapted to the Portuguese reality. With this work, we intend to elaborate a list of potentially inappropriate medicines adapted to the reality of medicines marketed in Portugal, through the operationalization of the EU(7)-PIM List for the national reality and to evaluate the adequacy of its use for clinical practice. MATERIAL AND METHODS Search, in INFARMED's Infomed database, of drugs that are included in the EU(7)-PIM List that have marketing authorization, and analysis of possible new drugs for inclusion in the list. The tool adapted to the Portuguese reality was applied to a sample of 1089 outpatient, polymedicated older patients from 38 primary care units in Central Portugal. RESULTS The final PIM list adapted to the Portuguese reality includes 184 potentially inappropriate medicines (from these, 178 are active substances, five are classes of drugs, and one corresponds to the sliding scale therapeutic scheme used in insulin therapy). Of 1089 polymedicated older patients, 83.7% took at least one drug included in the final potentially inappropriate medicines list or belonging to one of the groups included in the list, and, on average, each patient took 1.74 (IQR 1 - 2). DISCUSSION Even though the availability of drugs on the market is quite diverse, the EU(7)-PIM List has been used in several European countries. With this study, we operationalized the European list for the Portuguese reality, which will enable its application in clinical practice. CONCLUSION The list drawn up is a useful tool for the identification of potentially inappropriate medicines, easy to use in clinical practice and research.
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Affiliation(s)
- Daniela A Rodrigues
- Unidade de Investigação para o Desenvolvimento do Interior. Instituto Politécnico da Guarda (UDI-IPG). Guarda. Portugal
| | - Maria T Herdeiro
- Departamento de Ciências Médicas e Instituto de Biomedicina. Universidade de Aveiro (iBIMED-UA). Aveiro. Portugal
| | - Petra A Thürmann
- Department of Clinical Pharmacology. Helios University Hospital Wuppertal. University Witten/Herdecke. Wuppertal. Alemanha. Germany
| | - Adolfo Figueiras
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP). Santiago de Compostela. Espanha. Spain
| | - Paula Coutinho
- Unidade de Investigação para o Desenvolvimento do Interior. Instituto Politécnico da Guarda (UDI-IPG). Guarda. Centro de Investigação em Ciências da Saúde. Universidade da Beira Interior (CICS-UBI). Covilhã. Portugal
| | - Fátima Roque
- Unidade de Investigação para o Desenvolvimento do Interior. Instituto Politécnico da Guarda (UDI-IPG). Guarda. Centro de Investigação em Ciências da Saúde. Universidade da Beira Interior (CICS-UBI). Covilhã. Portugal
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Waleekhachonloet O, Rattanachotphanit T, Limwattananon C, Thammatacharee N, Limwattananon S. Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand. Pharm Pract (Granada) 2021; 19:2201. [PMID: 33628347 PMCID: PMC7886315 DOI: 10.18549/pharmpract.2021.1.2201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: This study examined the effects of a national policy advocating rational drug
use (RDU), namely, the ‘RDU Service Plan’, starting in fiscal
year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on
trends in antibiotic prescribing rates for outpatients. The policy was
implemented subsequent to a voluntary campaign involving 136 hospitals,
namely, the ‘RDU Hospital Project’, which was implemented
during fiscal years 2014-2016. Methods: Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for
respiratory infections, acute diarrhea, and fresh wounds were aggregated for
two hospital groups using equally weighted averages: early adopters of RDU
activities through the RDU Hospital Project and late adopters under the RDU
Service Plan. Pre-/post-policy annual changes in the prescribing levels and
trends were compared between the two groups using an interrupted time-series
analysis. Results: In fiscal years 2014-2016, decreases in antibiotic prescribing rates for
respiratory infections and acute diarrhea in both groups reflected a trend
that existed before the RDU Service Plan was implemented. The immediate
effect of the RDU Service Plan policy occurred in fiscal year 2017, when the
prescribing level among the late adopters dropped abruptly for all three
conditions with a greater magnitude than in the decrease among the early
adopters, despite nonsignificant differences. The medium-term effect of the
RDU Service Plan was identified through a further decreasing trend during
fiscal years 2017-2019 for all conditions in both groups, except for acute
diarrhea among the early adopters. Conclusions: The national policy on rational drug use effectively reduced antibiotic
prescribing for common but questionable outpatient conditions.
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Affiliation(s)
| | | | | | | | - Supon Limwattananon
- PhD. Faculty of Pharmaceutical Sciences, Khon Kaen University. Khon Kaen (Thailand).
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Horodnycha O, Zimenkovsky A. Antibiotic allergy as a cause of hospitalization in adults: a hospital-based study in Ukraine. Pharm Pract (Granada) 2021; 19:2055. [PMID: 33520036 PMCID: PMC7819703 DOI: 10.18549/pharmpract.2021.1.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Antibiotic allergy is an important clinical and social-economical issue. Objective:
The main objectives of this study were to determine the incidence, causative
drugs, and risk groups of antibiotic allergy as a reason for
hospitalization. The secondary objective was to evaluate the treatment of
antibiotic allergy through the identification of drug related problems
(DRPs).
Methods:
This retrospective hospital-based study was carried out in one of Lviv city
hospitals (Ukraine) from January 2015 to December 2017. Patients with
antibiotic allergy as a cause for hospitalization were included in this
study.
Results:
In this study the incidence of antibiotic allergy was 2.0%
(95%CI 1.6:2.4) of all admissions to the Unit that provides special
medical care for adult inpatients with allergy diseases and allergy
reactions. The mean age of patients was 48.5 years (SD=17.0; range 18-83
years) with female predominance (78.2%; 95%CI 68.9:85.2).
Antibiotic hypersensitivity reactions manifested as urticaria with
angioedema (52.5%; 95%CI 42.3:62.5), urticaria (36.6%;
95%CI 27.8:46.8) or angioedema (10.9%; 95%CI 5.6:18.7).
Beta-lactams (48.5%; 95%CI 38.5:58.7), fluoroquinolones
(13.9%; 95%CI 7.8%:22.2%) and macrolides
(7.9%; 95%CI 3.5:15.0) were specified as the main causative
drugs. All patients during hospitalization (a mean of 8.2 days; SD=2.2;
range 2-13 days) took at least 3 medicines (a mean of 5.4 medicines per
patient; SD=1.2; range 3-12 medicines). The total number of identified DRPs
was 400, a mean of 4.0 DRPs per patient (SD=1.8). The most frequently
identified type of DRPs was inappropriate route of drug administration
(25.0%; 95%CI 20.8:29.5). This was followed by duplicate
prescriptions (23.5%; 95%CI 19.4:28.0) and insufficient
frequency of drug administration (19.0%; 95%CI 15.3:23.2).
Potential drug-drug interactions and inappropriate drug prescriptions each
accounted for 16.0% (95% CI 12.6:20.0) of all DRPs. Comparing
all above items in 2015, 2016 and 2017 showed no statistically significant
changes (p>0.05).
Conclusions:
Antibiotic allergy is a common reason for admissions. The treatment of
antibiotic allergy is associated with numerous DRPs. Our results could be
useful for development of strategies for improving the safety and quality of
pharmacotherapy.
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Affiliation(s)
- Oksana Horodnycha
- PhD. Assistant professor. Department of Clinical Pharmacy, Pharmacotherapy and Medical Standardization, Danylo Halytsky Lviv National Medical University . Lviv ( Ukraine ).
| | - Andriy Zimenkovsky
- MD, PhD, DSc. Professor, Chief of Department. Clinical Pharmacy, Pharmacotherapy and Medical Standardization, Danylo Halytsky Lviv National Medical University . Lviv ( Ukraine ).
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Simões PA, Santiago LM, Simões JA. [Letter to the Editor concerning the Letter to the Editor "Polypharmacy and the Use of Potentially Inappropriate Medication in the Elderly Aged 75 and Over: The Case of a Family Health Unit"]. ACTA MEDICA PORT 2021; 34:66. [PMID: 33105098 DOI: 10.20344/amp.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Pedro Augusto Simões
- Unidade de Saúde Familiar Pulsar. Agrupamento de Centros de Saúde do Baixo Mondego. Coimbra; Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal
| | - Luiz Miguel Santiago
- Unidade de Saúde Familiar Caminhos do Cértoma. Agrupamento de Centros de Saúde do Baixo Mondego. Coimbra. Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal
| | - José Augusto Simões
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Clínica Universitária de Medicina Geral e Familiar. Universidade de Coimbra. Coimbra. Portugal
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Alkadhimi A, Dawood OT, Hassali MA. Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study. Pharm Pract (Granada) 2020; 18:2095. [PMID: 33343772 PMCID: PMC7739513 DOI: 10.18549/pharmpract.2020.4.2095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/29/2020] [Indexed: 11/14/2022] Open
Abstract
Objective This study aimed to understand the dispensing practice of antibiotics in community pharmacy in Iraq, in addition to explore the community pharmacists' perception about dispensing antibiotics without prescription. Methods A qualitative design was conducted on community pharmacists in Baghdad, Iraq. Pharmacists were selected conveniently from different gender, age group, pharmacy type and years of experience. Face-to-face semi-structure interview was used with all the pharmacists to get in-depth understanding about their dispensing practice of antibiotics without prescription in community pharmacy. The data was coded and classified for thematic analysis. Results This study found that dispensing of antibiotics without prescription was a common practice in community pharmacy. Pharmacists' perception towards dispensing antibiotics without prescription was associated with the medical condition, safety and efficacy of antibiotics, patients request antibiotics by name, emergency cases, regular customer, promotions from pharmaceutical companies, saving time and cost, brand medications, and poor healthcare services. In addition, there were inadequate knowledge about antibiotic resistance and lack of awareness about antibiotic stewardship leading to inappropriate dispensing practice. Conclusions Community pharmacists have poor perception towards dispensing antibiotics without prescription. Educational interventions about antibiotics use focusing on community pharmacists are needed. This will help to optimize the practice of dispensing of antibiotics in the community. In addition, training programs about antibiotic resistance are important to enhance pharmacists' understanding about antibiotic stewardship.
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Affiliation(s)
- Akram Alkadhimi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia. Penang (Malaysia).
| | - Omar T Dawood
- Department of Medical Services, Ministry of Science and Technology. Baghdad (Iraq).
| | - Mohamed A Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University of Science Malaysia. Penang (Malaysia).
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Forgerini M, Schiavo G, Lucchetta RC, Mastroianni PC. Drug interactions for elderly people with mental and behavioral disorders: a systematic scoping review. Arch Gerontol Geriatr 2021; 93:104283. [PMID: 33227533 DOI: 10.1016/j.archger.2020.104283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools. METHODOLOGY A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications. RESULTS 36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines. CONCLUSION Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.
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Jubraj B, Morris S, Wilcock M. How do your patients use their medicines at home and why is it important to know? Drug Ther Bull 2020; 59:3-4. [PMID: 33132207 DOI: 10.1136/dtb.2020.000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Castilho I, Rocha É, Magalhães S, Vaz Z, Costa ALG. [Polypharmacy and the Use of Potentially Inappropriate Medication in the Elderly Aged 75 and Over: The Case of a Family Health Unit]. ACTA MEDICA PORT 2020; 33:632. [PMID: 32893783 DOI: 10.20344/amp.13320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/15/2020] [Indexed: 11/05/2023]
Affiliation(s)
- Inês Castilho
- Unidade de Saúde Familiar AlphaMouro. Sintra. Portugal
| | - Érica Rocha
- Unidade de Saúde Familiar Bombarral. Bombarral. Portugal
| | | | - Zélia Vaz
- Unidade de Saúde Familiar AlphaMouro. Sintra. Portugal
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Whyte J, Winiecki S, Hoffman C, Patel K. FDA collaboration to improve safe use of fluoroquinolone antibiotics: an ex post facto matched control study of targeted short-form messaging and online education served to high prescribers. Pharm Pract (Granada) 2020; 18:1773. [PMID: 32377279 PMCID: PMC7194042 DOI: 10.18549/pharmpract.2020.2.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/05/2020] [Indexed: 11/18/2022] Open
Abstract
Objective: This ex post facto matched control study was conducted to
evaluate the effect of targeted short-form messages or continuing medical
education (CME) on fluoroquinolone prescribing among high prescribers. Methods: A total of 11,774 Medscape healthcare provider (HCP) members prescribing high
volumes of fluoroquinolones were randomized into three segments to receive
one of three unique targeted short-form messages, each delivered via email,
web alerts, and mobile alerts. Some HCPs receiving targeted short-form
messages also participated in CME on fluoroquinolone prescribing. A fourth
segment of HCPs participated in CME only. Test HCPs were matched to
third-party-provider prescriber data to identify control HCPs. We used
prescriber data to determine new prescription volume; percentage (%)
of HCPs with reduced prescribing; new prescription volume for acute
bacterial sinusitis (ABS), uncomplicated urinary tract infection (uUTI), and
acute bacterial exacerbations of chronic bronchitis in those with chronic
obstructive pulmonary disease (ABECB-COPD). Open rates for emailed targeted
short-form messages were also measured. Results: Targeted short-form messages and CME each resulted in significant new
prescription volume reduction versus control. Combining targeted short-form
messages with CME yielded the greatest percentage of test HCPs with reduced
prescribing (80.1%) versus controls (76.2%; p<0.0001).
New prescription volume decreased significantly for uUTI and ABS following
exposure to targeted short-form messages, CME, or both. Targeted short-form
messages containing comparative prescribing information with or without
clinical context were opened at slightly higher rates (10.8% and
10.6%, respectively) than targeted short-form messages containing
clinical context alone (9.1%). Conclusions: Targeted short-form messages and CME, alone and in combination, are
associated with reduced oral fluoroquinolone prescribing among high
prescribers.
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Affiliation(s)
- John Whyte
- MD, MPH. Chief Medical Officer, WebMD. New York, NY (United States).
| | - Scott Winiecki
- MD. Director. Safe Use Initiative, U.S. Food and Drug Administration. Silver Spring, MD (United States).
| | - Christina Hoffman
- MS. Group Vice President. Quality and Strategy, Medscape Education. New York, NY (United States).
| | - Kaushal Patel
- MBA. Group Vice President. Marketing Sciences, WebMD. New York, NY (United States).
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Vazin A, Mirjalili M, Asadi S. Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran. Pharm Pract (Granada) 2019; 17:1523. [PMID: 31592293 PMCID: PMC6763303 DOI: 10.18549/pharmpract.2019.3.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate. Objective: The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran. Methods: In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated. Results: Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital. Conclusions: Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz (Iran).
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz (Iran).
| | - Sara Asadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz (Iran).
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Yaacoub SG, Koyess V, Lahoud N, Rahme D, Francis N, Saleh N, Maison P. Antibiotic prescribing for acute uncomplicated cystitis in Lebanese community pharmacies using a simulated patient. Pharm Pract (Granada) 2019; 17:1604. [PMID: 31897255 PMCID: PMC6935547 DOI: 10.18549/pharmpract.2019.4.1604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Urinary tract infections are considered as one of the most frequent bacterial infections in the community and hospital settings. In this era of increasing antimicrobial resistance, antimicrobial stewardship has become highly important in the struggle to preserve the effectiveness of available drugs. One the main causes of antibiotic resistance is the inappropriate prescribing of antibiotics; which evidence show that community pharmacists contribute to. OBJECTIVE This study aims to evaluate antibiotic prescribing rate and responses of the contact persons in community pharmacies and to assess the conformity of the prescribed antibiotics with international guidelines. It also aims to evaluate the responses with sociodemographic characteristics. METHODS A cross-sectional, nationwide study conducted between February and May 2017 using a simulated patient case of acute uncomplicated cystitis. Two hundred fifty pharmacies were included. Descriptive data was reported for the medications prescribed, conformity, questions asked and counseling. Bivariate analysis using the Pearson chi-squared, Fisher's exact and Student's t-tests were used to identify possible factors affecting the prescribing rates and responses in community pharmacies. RESULTS The prescribing rate of antibiotics was 83.6% (n=209) with ciprofloxacin being the most prescribed (50.2%, n=105). The global conformity to international guidelines was 3.8% (n=8) with the highest conformity rate for the antibiotic choice (91.4%, n=191). Counseling about what to do in case symptoms persist was 12.8% (n=32) and that of non-pharmacological management was 53.6% (n=134). Male participants (88.1%) had a higher prescribing rate than female participants (77.6%) (p<0.05). The number of questions asked was higher in pharmacists and in female participants (p<0.05). Other results showed non-significant differences in diagnosis, antibiotic prescribing, conformity rates, referral rates and counseling points between the pharmacists and assistants. CONCLUSIONS The high antibiotic prescribing rate in Lebanese community pharmacies is alarming and calls for action. This should be tackled by legislative bodies, which should enforce laws that restrict such practices.
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Affiliation(s)
- Sally G Yaacoub
- Faculty of Public Health, Lebanese University. Fanar (Lebanon).
| | - Valerie Koyess
- Faculty of Public Health, Lebanese University. Fanar (Lebanon).
| | - Nathalie Lahoud
- Clinical Epidemiology and Toxicology, National Institute of Public Health (INSPECT-LB); & Faculty of Pharmacy, Lebanese University. Hadat (Lebanon).
| | - Deema Rahme
- Department of Pharmacy Practice, Faculty of Pharmacy, Beirut Arab University. Beirut (Lebanon).
| | - Nicole Francis
- Faculty of Public Health, Lebanese University. Fanar (Lebanon).
| | - Nadine Saleh
- Clinical Epidemiology and Toxicology, National Institute of Public Health (INSPECT-LB); & Faculty of Pharmacy, Lebanese University. Hadat (Lebanon).
| | - Patrick Maison
- Paris-Est Health-Work Institute (IST-PE), Créteil Intercommunal Hospital Center (CHIC). Créteil (France).
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Vatcharavongvan P, Puttawanchai V. Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria. Pharm Pract (Granada) 2019; 17:1494. [PMID: 31592037 PMCID: PMC6763309 DOI: 10.18549/pharmpract.2019.3.1494] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/05/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: The primary objective was to examine potentially inappropriate medications
(or PIMs) in the elderly using three different criteria: Beers 2015, STOPP
version 2, and Winit-Watjana (for Thai elderly patients). The secondary
objective was to examine PIM-related factors. Methods: This is a retrospective cross-sectional study. Eligible patients were aged
≥65 years in a primary care unit. Demographic data, medical
prescriptions in the past year, clinical data and diagnoses were collected
from electronic medical records. PIMs, including the use of ≥2
medications, were identified using the three criteria. Descriptive and
analytical statistics were conducted. The type I error was 0.05. Multiple
logistic regression analysis was used to examine associations between PIMs
and other factors. Results: A total of 400 patients were recruited, and 1,640 prescriptions were
reviewed. The median age was 70.5 years, and the median numbers of diseases,
medications, and prescriptions were 3 (interquartile range or IQR=2), 11
(IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213
(53.3%) showed a use of ≥5 medications, and 301 (75.3%)
were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least
one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2
identified 66.8%, 59.0% and 40.3% of the patients
receiving PIMs, respectively. Approximately 16% of the patients
showed at least one potential drug-drug interaction. The use of duplicate
drug classes accounted for the highest proportion of potential drug-drug
interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95%
confidence interval or 95%CI 2.17-71.2) and the presence of ≥4
diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs. Conclusions: PIMs are common among the elderly patients in primary care in Thailand.
Prescriptions of the elderly with polypharmacy or multiple concurrent
diagnoses should be reviewed for PIMs because they have a high chance of
receiving PIMs.
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Affiliation(s)
- Pasitpon Vatcharavongvan
- Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University. Pathum-Thani (Thailand).
| | - Viwat Puttawanchai
- Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University. Pathum-Thani (Thailand).
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Al-Azayzih A, Alamoori R, Altawalbeh SM. Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study. Pharm Pract (Granada) 2019; 17:1439. [PMID: 31275497 PMCID: PMC6594439 DOI: 10.18549/pharmpract.2019.2.1439] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/26/2019] [Indexed: 11/14/2022] Open
Abstract
Background Due to aging, along with its associated physiological changes, older adults are extremely vulnerable to be afflicted with multiple chronic conditions (multimorbidity). Accordingly, prescribing a large number of drugs to older adults would be inevitable. Resulted complex drug regimens can lead to prescribing of Potentially Inappropriate Medications (PIMs) with subsequent negative health and economic outcomes. Objectives The main objective of this study is to investigate the prevalence and predictors of PIMs prescribing among Jordanian elderly outpatients, using the last updated version of the American Geriatrics Society (AGS) Beers Criteria (2015 version). Methods A Unicenter, cross-sectional study were data was assessed using medical records of included study subjects conducted over three months period from beginning of October to the end of December 2016 at King Abdullah University Hospital, Al Ramtha, Jordan. Our study included patients aged 65 years or above who visited the outpatient clinics at King Abdullah University hospital (KAUH) and were prescribed at least one oral medication during the study period. PIMs were identified for these patients and further classified according to the 2015 AGS Beers Criteria. We measured the prevalence of PIMs prescribed among elderly outpatients in Jordan. Results A total of 4622 eligible older adults were evaluated in this study, of whom 62.5% (n=2891) were found to have at least one PIM prescribed during the three months study period. 69% of identified PIMs were medications to be used with caution in elderly, 22% were medications to avoid in many or most older adults, 6.3% were medications to be avoided or have their dosage adjusted based on kidney function in older adults, 2.04% medications were to avoid in older adults with specific diseases/syndromes, and 1.6% were potentially clinically important non-anti-infective drug-drug interactions to be avoided in older adults. Female gender and polypharmacy were found to be significant predictors of PIMs use among elderly. Conclusions Potentially Inappropriate Medication prescribing is common among Jordanian elderly outpatients. Female gender and polypharmacy are associated with more PIMs prescribing and so need further attention.
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Affiliation(s)
- Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid, (Jordan).
| | - Rawan Alamoori
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid, (Jordan).
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid, (Jordan).
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Simões PA, Santiago LM, Simões JA. Letter to the Editor Regarding the Article: " Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward". ACTA MEDICA PORT 2019; 32:409. [PMID: 31166905 DOI: 10.20344/amp.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Pedro Augusto Simões
- Unidade de Saúde Familiar Pulsar. Agrupamento de Centros de Saúde do Baixo Mondego. Coimbra; Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal
| | - Luiz Miguel Santiago
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Clínica Universitária de Medicina Geral e Familiar. Universidade de Coimbra. Coimbra. Portugal
| | - José Augusto Simões
- Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Unidade de Saúde Familiar Caminhos do Cértoma. Agrupamento de Centros de Saúde do Baixo Mondego. Coimbra. Portugal
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Urzal JI. Reply to the Letter to the Editor Regarding the Article: " Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward" Mariana Alves, Marco Ribeiro Narciso, Teresa Fonseca, João Gorjão Clara" [Acta Med Port.2019;32:249-249]. ACTA MEDICA PORT 2019; 32:408. [PMID: 31166904 DOI: 10.20344/amp.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Joana Isabel Urzal
- Departamento Medicina Interna. Hospital Fernando Fonseca. Amadora. Portugal
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Gauci M, Wirth F, Azzopardi LM, Serracino-Inglott A. Clinical pharmacist implementation of a medication assessment tool for long-term management of atrial fibrillation in older persons. Pharm Pract (Granada) 2019; 17:1349. [PMID: 31015870 PMCID: PMC6463411 DOI: 10.18549/pharmpract.2019.1.1349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 02/24/2019] [Indexed: 11/14/2022] Open
Abstract
Background: Optimisation of drug therapy is important in the older population and may be facilitated by medication assessment tools (MATs). Objective: The purpose of the study was to evaluate whether appropriateness of drug therapy and clinical pharmacist intervention documentation improved following implementation of a previously developed MAT for the long-term management of atrial fibrillation (MAT-AF). Methods: Adherence to MAT-AF review criteria and clinical pharmacist intervention documentation was assessed by the researcher pre-MAT implementation in 150 patients aged ≥60 years admitted to a rehabilitation hospital with a diagnosis of atrial fibrillation. MAT-AF was introduced as a clinical tool in the hospital for identification of pharmaceutical care issues in atrial fibrillation patients. Adherence to MAT-AF and pharmacist intervention documentation were assessed by the researcher post-MAT implementation for a further 150 patients with the same inclusion criteria. Logistic regression analysis and measurement of odds ratio was used to identify differences in adherence to MAT-AF pre- and post-MAT implementation. The differences between two population proportions z-test was used to compare pharmacist intervention documentation pre- and post-MAT implementation. Results: Adherence to MAT-AF criteria increased from 70.9% pre-implementation to 89.6% post-implementation. MAT-AF implementation resulted in a significant improvement in prescription of anticoagulant therapy (OR 4.07, p<0.001) and monitoring of laboratory parameters for digoxin (OR 10.40, p<0.001). Clinical pharmacist intervention documentation improved significantly post-implementation of MAT-AF (z-score 20.249, p<0.001). Conclusions: Implementation of MAT-AF within an interdisciplinary health care team significantly improved the appropriateness of drug therapy and pharmacist intervention documentation in older patients with atrial fibrillation.
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Affiliation(s)
- Marise Gauci
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta; & Senior Principal Pharmacist, Department of Pharmacy, Karin Grech Hospital, Pieta (Malta).
| | - Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta. Msida (Malta).
| | - Lilian M Azzopardi
- Head of the Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta. Msida (Malta).
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Alves M, Narciso MR, Fonseca T, Gorjão Clara J. Letter to the Editor Regarding the Article: " Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward". ACTA MEDICA PORT 2019; 32:249. [PMID: 30946802 DOI: 10.20344/amp.12078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Mariana Alves
- Serviço de Medicina III. Hospital Pulido Valente. Centro Hospitalar Lisboa Norte. Lisboa; Instituto de Medicina Molecular. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Unidade Universitária de Geriatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa.; Centro Académico Médico de Lisboa. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Marco Ribeiro Narciso
- Serviço de Medicina III. Hospital Pulido Valente. Centro Hospitalar Lisboa Norte. Lisboa. Unidade Universitária de Geriatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Centro Académico Médico de Lisboa. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Teresa Fonseca
- Serviço de Medicina III. Hospital Pulido Valente. Centro Hospitalar Lisboa Norte. Lisboa. Unidade Universitária de Geriatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Centro Académico Médico de Lisboa. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - João Gorjão Clara
- Unidade Universitária de Geriatria. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Centro Académico Médico de Lisboa. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
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Andrade JV, Vasconcelos P, Campos J, Camurça T. [Antibiotic Prescribing in Ambulatory Care of Pediatric Patients with Respiratory Infections]. ACTA MEDICA PORT 2019; 32:101-110. [PMID: 30896390 DOI: 10.20344/amp.11111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/22/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Respiratory tract infections represent the most frequent conditions in pediatric clinical practice that motivate antibiotic prescribing. The objective was to identify the frequency and pattern of antibacterial prescribing in respiratory diseases. MATERIAL AND METHODS Over a period of two years (divided by the presentation of the clinical guideline standards) data was collected from clinical records of children with respiratory disease. Chi-square tests or Fisher's exact test were used to test associations between variables, statistical significance p < 0.05. RESULTS There were 547 visits (mean age 6 years ± 5.3, 55% male gender). Analysis for Group A Streptococcus of the oropharynx was most frequently requested by pediatric residents (p = 0.005). Chest x-rays were more frequently requested by the Family Physician (p = 0.033). An antibiotic was prescribed in 87% of pneumonias, 84% acute otitis media, 68% acute tonsillitis, 25% laryngitis, 17% upper respiratory infections, 16% acute bronchiolitis. The Family Physician prescribed antibiotics more often than the Pediatrics resident in acute tonsillitis (p = 0.003) and in acute otitis media (p = 0.013). The most frequently prescribed antibiotic was amoxicillin (61%). There were no significant differences between the two periods studied regarding the number of prescriptions and antibiotic choice of the conditions studied. DISCUSSION Antibiotic prescribing in pediatric acute respiratory infections was high and the choice of antibiotic therapy could be adjusted. We found no difference in antibiotic prescribing after the presentation of the clinical guideline standards. CONCLUSION An improvement in the antibiotic prescription in children and adolescents in the outpatient clinic is considered necessary.
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Affiliation(s)
| | - Pedro Vasconcelos
- Departamento de Medicina Geral e Familiar. Unidade de Saúde Familiar Viseu-Cidade. Agrupamento Centros de Saúde Dão Lafões. Viseu. Portugal
| | - Joana Campos
- Serviço Pediatria. Centro Hospitalar Tondela-Viseu. Viseu. Portugal
| | - Teresa Camurça
- Departamento de Medicina Geral e Familiar. Unidade de Saúde Familiar Viseu-Cidade. Agrupamento Centros de Saúde Dão Lafões. Viseu. Portugal
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Urzal J, Pedro AB, Oliveira IF, Romero I, Achega M, Correia I, Aldomiro F, Augusto J. Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward. ACTA MEDICA PORT 2019; 32:141-148. [PMID: 30896395 DOI: 10.20344/amp.10683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Polypharmacy is often observed in elderly patients and is associated with an increased risk of adverse drug reactions, side effects and interactions. Clinicians should be alert to inappropriate drug prescribing and reduce polypharmacy. MATERIAL AND METHODS Observational, longitudinal, retrospective and descriptive study in an internal medicine ward in a Portuguese hospital. Polypharmacy was defined as the use of five or more different medicines. The purpose of this study was to describe the prevalence of polypharmacy and inappropriate prescribing at admission and discharge in an internal medicine ward, according to deprescribing.org guidelines/algorithms. A total of 838 consecutive patients were admitted between January and July 2017. All patients were aged under 65 years old, and those who died before discharge were excluded. Patients' medications were reviewed from a medical database at hospital admission and discharge. We examined whether patients were taking anticoagulants, proton pump inhibitors, benzodiazepines, antipsychotics and/or antihyperglycemic medication. RESULTS A total of 483 patients were included, mean age was 79.2 ± 8.0 years, and 42% of patients were male. Median number of medications at admission and discharge was six. Polypharmacy was present in more than 70% of admitted patients. Proton pump inhibitors were the most common inappropriate prescription at discharge (17.2%). DISCUSSION This study demonstrated a low use of inappropriate medicine (11.2% - 17.2%) in older people discharged from hospital, when compared to other studies. CONCLUSION Our study shows that polypharmacy is present in more than 70% of elderly admitted patients. Nevertheless, the drug inappropriateness rate was not significantly affected by polypharmacy at both admission and discharge, being overall lower than published data.
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Affiliation(s)
- Joana Urzal
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Ana Bárbara Pedro
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Inês Ferraz Oliveira
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Inês Romero
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Miguel Achega
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Iuri Correia
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Fernando Aldomiro
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - João Augusto
- Departamento de Medicina Interna. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
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Lawson K, Vinluan CM, Oganesyan A, Gonzalez EC, Loya A, Strate JJ. A retrospective analysis of prescription medications as it correlates to falls for older adults. Pharm Pract (Granada) 2019; 16:1283. [PMID: 30637029 PMCID: PMC6322985 DOI: 10.18549/pharmpract.2018.04.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/14/2018] [Indexed: 11/02/2022] Open
Abstract
Objectives To determine the correlation between falls and two medication factors: the class of medications and potentially inappropriate medications (PIMs) prescribed to community-dwelling older adults aged 55 and older. Methods Retrospective, cross-sectional study. Home health patients residing in a Texas/Mexico border community and reporting at least one fall within the past month. Medication use, medication classification, and potentially inappropriate medications (PIM) recorded by level of falls; non-fallers and recurrent fallers. Results Of 99 participants, 13.1% reported falling once and 86.9% reported two or more falls. Participant's average number of medications used was 10.51 (SD 5.75) with 93.9% having four or more prescribed medications. Average number of PIMs prescribed per participant was 1.42 (SD 1.51) with at least one PIM prescribed to 65.6% of participants. Twenty three out of 83 identified classes of prescribed medications met criteria for the study's analyses but resulted in no significant association to falls when comparing NF to RF. Agents acting on the renin-angiotensin system and lipid modifying agents were the most frequently prescribed medication classes (N=55, 55.6%). Ibuprofen was the PIM most frequently prescribed (n=13, 13.1%). The correlation between use of a prescribed PIM and number of falls was not statistically significant (p=0.128). Conclusions There was no correlation between classes of medication and level of falls. Recurrent fallers were more likely to have been prescribed a PIM than non-fallers (not significant). Although the analyses conducted for this study did not result in statistical significance, the high prevalence of polypharmacy and prescribed PIMs observed in these participants warrants a thorough review of medications to reduce fall risks among older adults.
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Affiliation(s)
| | | | | | | | - Amanda Loya
- University of Texas at El Paso. El Paso, TX (United States).
| | - Justin J Strate
- University of Texas at El Paso. El Paso, TX (United States).
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Voelker KA, Schauberger C. Academic Detailing for Postpartum Opioid Prescribing. J Am Board Fam Med 2018; 31:944-6. [PMID: 30413551 DOI: 10.3122/jabfm.2018.06.180071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Overprescribing opioid pain medications has become a major concern in our society due to the increasing rates of substance use disorders and the rate of accidental overdoses. The widespread availability of opioid medications suggests that patients are being prescribed opioids in amounts larger than they require for pain control. Efforts are now being made on a variety of fronts to decrease overprescribing. MATERIAL AND METHODS A quality-improvement model was applied to address this concern at one medical center in women being discharged from the hospital following childbirth. The rates and amounts at which opioids were prescribed to this population before and after an academic detailing intervention were compared. RESULTS The overall percentage of women who received prescriptions for opioid medications decreased from 100% to 93% in cesarean sections (P = .054) and 15% to 9% in vaginal deliveries (P = .03). The average prescription size decreased by 5 tablets (P < .0001). IMPLICATIONS Simple quality-improvement methods may have a positive impact on opioid prescribing patterns, including decreasing the percentage of opioids postdelivery or the quantity of opioids per prescription.
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Mansour H, Feghali M, Saleh N, Zeitouny M. Knowledge, practice and attitudes regarding antibiotics use among Lebanese dentists. Pharm Pract (Granada) 2018; 16:1272. [PMID: 30416630 PMCID: PMC6207361 DOI: 10.18549/pharmpract.2018.03.1272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/20/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives: Explore antibiotic use, assess conformity with evidence-practice guidelines, and describe knowledge and attitudinal factors among Lebanese dentists. Methods: National cross-sectional telephonic survey, using a standardized questionnaire addressing demographic, educational and professional data, usual antibiotics prophylactic and curative prescription pattern and influential factors, knowledge concerning antibiotics use in selected patient-populations, and attitude regarding antimicrobial resistance. Analyses used descriptive statistics, and bivariate analysis to observe predictors of higher knowledge. Results: the overall response rate for the study was around 21%. 322 dentists participated. On average, 17.51% of consultations resulted in antibiotic use; previous antibiotic experience mostly influenced prescriptions (81.3%). Referral of pregnant and lactating women and cardiac patients, when antibiotics are needed, was high (26.9%, 28.5% and 79.4%, respectively). Macrolides were the dominant first-line antibiotics in penicillin allergy (47.4%). Penicillins were most common for pregnant and lactating women. Penicillins (95.0%), 2g (63.9%), and 1 hour pre-procedure (34%) were the main components of prophylaxis for cardiac patients. Prophylactic and curative use varied widely; few dentists exhibited guideline-conform prescriptions. Mean knowledge scores of prophylaxis for cardiac and non-cardiac patients, and antibiotics’ side effects were predominantly poor (46.75±14.82, 39.21±33.09 and 20.27±18.77, respectively over 100). Practicing outside Beirut, undergraduate qualification in Lebanon, and post-graduate qualification predicted higher knowledge. 75.9% acknowledged the contribution of dentistry-based prescribing to antibiotic resistance and 94.7% knew at least one cause of resistance. Conclusions: Dentists show positive attitude towards antimicrobial resistance. Yet, they lack uniformity in antibiotic stewardship. Poor knowledge and guideline-incongruent prophylactic and therapeutic prescribing are observed. Development of targeted interventions is needed to promote judicious antibiotic use within Lebanese dentistry.
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Affiliation(s)
- Hicham Mansour
- Department of Restorative and Esthetic, Faculty of Dentistry, Lebanese University. Beirut (Lebanon).
| | - Mireille Feghali
- Department of Restorative and Esthetic, Faculty of Dentistry, Lebanese University. Beirut (Lebanon).
| | - Nadine Saleh
- Division of epidemiology and biostatistics - Faculty of Public Health - Lebanese University, Beirut (Lebanon).
| | - Mona Zeitouny
- Department of Restorative and Esthetic, Faculty of Dentistry, Lebanese University. Beirut (Lebanon).
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Akande-Sholabi W, Adebusoye LA, Olowookere OO. Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria. Pharm Pract (Granada) 2018; 16:1235. [PMID: 30416626 PMCID: PMC6207359 DOI: 10.18549/pharmpract.2018.03.1235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 09/01/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients. Methods Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer's criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05. Results Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080-2.725)] and being physically active [OR =1.879 (1.026-3.436)] as the most significantly associated with PIMs use. Conclusions The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists', working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.
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Affiliation(s)
- Wuraola Akande-Sholabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan. Ibadan (Nigeria).
| | - Lawrence A Adebusoye
- Family Physician and Geriatrician. Chief Tony Anenih Geriatric Centre, University College Hospital. Ibadan (Nigeria).
| | - Olufemi O Olowookere
- Family Physician and Geriatrician. Chief Tony Anenih Geriatric Centre, University College Hospital. Ibadan (Nigeria).
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Abstract
Nephrotoxin-induced AKI is an iatrogenic form of AKI that can be potentially avoided or ameliorated by prompt recognition and appropriate prescriber actions. Drug-targeted alerts, either for patients at risk of AKI or patients with existing AKI, may lead to more appropriate drug dosing and management and improved clinical outcomes. However, alerts of this type are complicated to create, have a high potential for error and off-target effects, and may be difficult to evaluate. Although many studies have shown that these alerts can reduce the rate of inappropriate prescribing, few studies have examined the utility of such alerts in terms of patient benefit. In this review, we examine the current state of the literature in this area, identify key technical challenges, and suggest methods of evaluation for drug-targeted AKI alerts.
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Affiliation(s)
- Melissa Martin
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut; and
| | - F Perry Wilson
- Program of Applied Translational Research, Yale School of Medicine, New Haven, Connecticut; and .,Veterans Affairs Medical Center, Department of Medicine, West Haven, Connecticut
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Gauci M, Wirth F, Camilleri L, Azzopardi LM, Serracino-Inglott A. Assessing appropriateness of drug therapy in older persons: Development and application of a medication assessment tool for long-term management of atrial fibrillation. Pharm Pract (Granada) 2018; 15:1021. [PMID: 29317917 PMCID: PMC5741994 DOI: 10.18549/pharmpract.2017.04.1021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Atrial fibrillation (AF) is highly prevalent in older persons and is associated with considerable morbidity and mortality. Assessing appropriateness of drug therapy in AF may be facilitated by application of medication assessment tools (MATs). Objective: To develop, psychometrically evaluate and apply an innovative MAT for the long-term management of AF with particular relevance to older persons. Methods: Key recommendations from clinical practice guidelines for the long-term management of AF were selected and review criteria defining appropriate drug therapy were constructed as a ‘qualifying statement’ followed by a ‘standard’. The developed MAT was given the designation MAT-AF. An application guide was compiled where justifications for non-adherence were specified. Content validity was tested by an expert group using a three-round Delphi process. Inter- and intra-observer reliability testing was conducted with agreement expressed by Cohen’s kappa and application time measured to assess feasibility. MAT-AF was applied to 150 patients with a diagnosis of AF admitted to a rehabilitation hospital. Results: MAT-AF consists of 15 criteria sectioned into antithrombotic, rate control and rhythm control therapy. Content validity was demonstrated for all criteria. Reliability was confirmed with kappa values of 0.84 and 0.91 for inter- and intra-observer agreements. Mean application time for the two observers was 3.9 and 2.4 minutes, which decreased significantly in the second application conducted after a four-week interval (p<0.001). Overall adherence to applicable criteria was 59.8%. Non-adherence was evident for prescription of anticoagulation in patients with a CHA2DS2VASc score ≥1 (29.5%). Monitoring of laboratory parameters for digoxin was suboptimal. Ophthalmic and pulmonary monitoring and patient counselling regarding amiodarone therapy could not be assessed since relevant records were not readily available. Conclusion: MAT-AF application highlighted key aspects which need to be addressed to improve patient care.
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Affiliation(s)
- Marise Gauci
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida; & Senior Principal Pharmacist, Department of Pharmacy, Rehabilitation Hospital Karin Grech. Pieta, (Malta).
| | - Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta. Msida (Malta).
| | - Liberato Camilleri
- Associate Professor and Head. Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida (Malta).
| | - Lilian M Azzopardi
- Professor and Head. Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida (Malta).
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Hammond DA, Killingsworth CA, Painter JT, Pennick RE, Chatterjee K, Boye B, Meena N. Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults. Pharm Pract (Granada) 2017; 15:948. [PMID: 28943978 PMCID: PMC5597806 DOI: 10.18549/pharmpract.2017.03.948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/24/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Acid suppression therapy (AST) is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB). Objective: Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST. Methods: A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU) at an academic medical center between January to June of 2014 (no intervention) and January to June of 2015 (intervention) was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests. Results: Patients in the intervention group (n=118) were 5 years older than patients in the no intervention group (n=101). AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012). Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively). Conclusion: Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.
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Affiliation(s)
- Drayton A Hammond
- Assistant Professor of Pharmacy Practice. Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy. Little Rock, AR (United States).
| | | | - Jacob T Painter
- Assistant Professor of Pharmacy Practice. Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy. Little Rock, AR (United States).
| | - Rose E Pennick
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy. Little Rock, AR (United States).
| | - Kshitij Chatterjee
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences College of Medicine. Little Rock, AR (United States).
| | - Bradley Boye
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences College of Medicine. Little Rock, AR (United States).
| | - Nikhil Meena
- Assistant Professor of Medicine. Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences College of Medicine. Little Rock, AR (United States).
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Hernandez Martin J, Merino-Sanjuán V, Peris-Martí J, Correa-Ballester M, Vial-Escolano R, Merino-Sanjuán M. Applicability of the STOPP/START criteria to older polypathological patients in a long-term care hospital. Eur J Hosp Pharm 2017; 25:310-316. [PMID: 31157048 DOI: 10.1136/ejhpharm-2017-001262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/09/2017] [Accepted: 07/06/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives To analyse the applicability of the STOPP/START criteria as a tool to identify patients with potentially inappropriate medications (PIM) during pharmaceutical validation of prescriptions in a long-term care hospital, to identify risk factors for PIM and to characterise the physiological systems and drugs more frequently associated with these PIM. Methods An interventional, prospective and longitudinal study was conducted in polypathological patients aged >65 years. Usual pharmaceutical care and the STOPP/START criteria were used to identify PIM and to plan pharmaceutical interventions at admission. At discharge, the discharge summaries were reviewed using the STOPP/START criteria. Results 112 patients were included. The prevalence of patients with PIM at admission was 76.8%. The STOPP criteria identified a high number of PIM and almost all entailed pharmaceutical intervention. On the other hand, most of the START criteria identified did not entail pharmaceutical intervention. Usual pharmaceutical care detected a different type of PIM; a high percentage of pharmaceutical interventions to resolve them were accepted. At discharge, the prevalence of patients with PIM was 61.3%. At admission, none of the analysed variables was associated with the PIM identified using any of the tools. At discharge STOPP criteria identified a higher percentage of patients with PIM in the geriatric outpatient consultation group. Conclusions The prevalence of PIM in older polypathological patients is high. The STOPP criteria are useful for reducing inappropriate prescribing during the pharmaceutical validation process. In contrast, routine incorporation of the START criteria in the pharmaceutical validation may be not necessary in a hospital of this type.
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Affiliation(s)
| | - Virginia Merino-Sanjuán
- Instituto Interuniversitario Reconocimiento Molecular y Desarrollo Tecnológico, Departamento de Farmacia y Tecnología Farmacéutica y Parasitología de la Universidad de Valencia., Valencia, Spain
| | - Juan Peris-Martí
- Servicio de Farmacia, Residencia Personas Mayores Dependientes La Cañada., Valencia, Spain
| | | | | | - Matilde Merino-Sanjuán
- Instituto Interuniversitario Reconocimiento Molecular y Desarrollo Tecnológico, Departamento de Farmacia y Tecnología Farmacéutica y Parasitología de la Universidad de Valencia., Valencia, Spain
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Galli TB, Reis WC, Andrzejevski VM. Potentially inappropriate prescribing andthe risk of adverse drug reactions in critically ill older adults. Pharm Pract (Granada) 2016; 14:818. [PMID: 28042352 PMCID: PMC5184374 DOI: 10.18549/pharmpract.2016.04.818] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Potentially inappropriate medication (PIM) use in the elderly is associated with increased risk of adverse drug reactions (ADRs), but there is limited information regarding PIM use in the intensive care unit (ICU) setting. Objective: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. Methods: This study enrolled all critically ill older adults (60 years or more) admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. Results: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599), of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. Conclusions: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.
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Affiliation(s)
- Thamires B Galli
- Multiprofessional Residency Program of Cinics Hospital, Clinical Hospital of the Federal University of Paraná. Curitiba, PR ( Brazil ).
| | - Wálleri C Reis
- Laboratory of Clinical Services and Evidence Based Health (LASCES), Pharmacy Department, Federal University of Paraná , Curitiba, PR ( Brazil ). E-mail:
| | - Vânia M Andrzejevski
- Hospital Pharmacy Unit, Clinical Hospital of the Federal University of Paraná. Curitiba, PR ( Brazil ).
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Wang Y, Singh S, Bajorek B. Old age, high risk medication, polypharmacy: a 'trilogy' of risks in older patients with atrial fibrillation. Pharm Pract (Granada) 2016; 14:706. [PMID: 27382425 PMCID: PMC4930859 DOI: 10.18549/pharmpract.2016.02.706] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/01/2016] [Indexed: 12/21/2022] Open
Abstract
Background: The safety of pharmacotherapy in atrial fibrillation (AF) is compounded by a trilogy of risks old age, high-risk medications (e.g., antithrombotics, antiarrhythmics), polypharmacy due to multiple patient comorbidities. However, to date, scarce study has investigated the use of polypharmacy (including potentially inappropriate medication (PIM)) in AF patients, and how this may contribute to their overall risk of medication misadventure. Objectives: To review the extent of polypharmacy and PIM use in older patients (65 years or older) with AF. Methods: Information was extracted from a database characterising a cohort of older AF patients treated in general practice in New South Wales, Australia. Patient characteristics, number and types of drugs, the degree of PIM use were recorded. The predictors for the use of polypharmacy in older AF patients were identified. Results: Overall, 367 patients (mean age 77.8 years) were reviewed, among which 94.8% used 5 medications or more and over half used 10 medications or more. Cardiovascular agents were most commonly used (98.9%), followed by antithrombotics (90.7%). Among agents deemed PIMs, digoxin (30.2%) was the most frequently used, followed by benzodiazepines (19.6%), and sotalol (9.8%). AF patients using polypharmacy were more likely to have low bleeding risk (OR=10.97), representing those patients in whom high-risk antithrombotics are mostly indicated. Patients with major-polypharmacy (5-9 medications) are more likely to have obstructive pulmonary diseases (OR=2.32), upper gastrointestinal diseases (OR=2.02) and poor physical function (OR=1.04), but less likely to have cognitive impairment (OR=0.27). Conclusion: Polypharmacy affects oldest AF patients, comprising medications that are indicated for AF, yet regarded as PIMs. Patients with lower risk of bleeding, obstructive pulmonary diseases, upper gastrointestinal diseases and poor physical function are also at higher risk of using higher number of medications. This may lead to an increased risk for medication misadventure due to the concomitant use of polypharmacy and medications for AF.
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Affiliation(s)
- Yishen Wang
- Graduate School of Health- Pharmacy, University of Technology Sydney . Sydney, NSW ( Australia ).
| | - Shamsher Singh
- Graduate School of Health- Pharmacy, University of Technology Sydney . Sydney, NSW ( Australia ).
| | - Beata Bajorek
- Graduate School of Health- Pharmacy, University of Technology Sydney ; & Department of Pharmacy, Royal North Shore Hospital. Sydney, NSW ( Australia ).
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