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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Barneto-Soto M, González-Bueno J, Espaulella-Panicot J. Improving individualized prescription in patients with multimorbidity through medication review. BMC Geriatr 2022; 22:417. [PMID: 35549672 PMCID: PMC9096338 DOI: 10.1186/s12877-022-03107-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/17/2021] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background Older patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads to a growing number of prescribed medications. As a result, pharmacological prescription has become a major concern because of the increased difficulties to ensure appropriate prescription in older adults. The study’s main objectives were to characterize a cohort of older adults with multimorbidity, carry out a medication review and compare the pharmacological data before and after the medication review globally and according to the frailty index. Methods This was a quasi-experimental (uncontrolled pre-post) study with a cohort of patients ≥ 65 years old with multimorbidity. Data were collected from June 2019 to October 2020. Variables assessed included demographic, clinical, and pharmacological data, degree of frailty (Frail-VIG index), medication regimen complexity index, anticholinergic and or sedative burden index, and monthly drug expenditure. Finally, a medication review was carried out by an interdisciplinary team (primary care team and a consultant team with a geriatrician and a clinical pharmacist) by applying the Patient-Centered Prescription model to align the treatment with care goals. Results Four hundred twenty-eight patients were recruited [66.6% women; mean age 85.5 (SD 7.67)]. The mean frail index was 0.39 (SD 0.13), corresponding with moderate frailty. Up to 90% of patients presented at least one inappropriate prescription, and the mean of inappropriate prescriptions per patient was 3.14 (SD 2.27). At the three-month follow-up [mortality of 17.7% (n = 76)], the mean chronic medications per patient decreased by 17.96%, varying from 8.13 (SD 3.87) to 6.67 (SD 3.72) (p < 0.001). The medication regimen complexity index decreased by 19.03%, from 31.0 (SD 16.2) to 25.1 (SD 15.1), and the drug burden index mean decreased by 8.40%, from 1.19 (SD 0.82) to 1.09 (SD 0.82) (p < 0.001). A decrease in polypharmacy, medication regimen complexity index, and drug burden index was more frequent among frail patients, especially those with severe frailty (p < 0.001). Conclusions An individualized medication review in frail older patients, applying the Patient-Centered Prescription model, decreases pharmacological parameters related to adverse drug effects, such as polypharmacy, therapeutical complexity, and anticholinergic and, or sedative burden. The benefits are for patients with frailty.
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Affiliation(s)
- Núria Molist-Brunet
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain. .,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Pharmacy, Parc Sanitari Pere Virgili, Vic, Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Epidemiology, Hospital Universitari de Vic, Vic, Barcelona, Spain.,Laboratory of Tissue Repair and Regeneration (TR2Lab), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de La Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Matilde Barneto-Soto
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - Javier González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Pharmacy, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Joan Espaulella-Panicot
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
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Wang CH, Nguyen PA, Jack Li YC, Islam MM, Poly TN, Tran QV, Huang CW, Yang HC. Improved diagnosis-medication association mining to reduce pseudo-associations. Comput Methods Programs Biomed 2021; 207:106181. [PMID: 34052770 DOI: 10.1016/j.cmpb.2021.106181] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Association rule mining has been adopted to medical fields to discover prescribing patterns or relationships among diseases and/or medications; however, it has generated unreasonable associations among these entities. This study aims to identify the real-world profile of disease-medication (DM) associations using the modified mining algorithm and assess its performance in reducing DM pseudo-associations. METHODS We retrieved data from outpatient records between January 2011 and December 2015 in claims databases maintained by the Health and Welfare Data Science Center, Ministry of Health and Welfare, Taiwan. The association rule mining's lift (Q-value) was adopted to quantify DM associations, referred to as Q1 for the original algorithm and as Q2 for the modified algorithm. One thousand DM pairs with positive Q1-values (Q1+) and negative or no Q2-values (Q2- or Q2∅) were selected as the validation dataset, in which two pharmacists assessed the DM associations. RESULTS A total of 3,120,449 unique DM pairs were identified, of which there were 333,347 Q1+Q2- pairs and 429,931 Q1+Q2∅ pairs. Q1+Q2- rates were relatively high in ATC classes C (29.91%) and R (30.24%). Classes L (69.91%) and V (52.52%) demonstrated remarkably high Q1+Q2∅ rates. For the 1000 pairs in the validation, 93.7% of the Q1+Q2- or Q1+Q2∅ DM pairs were assessed as pseudo-associations. However, classes M (5.3%), H (4.5%), and B (4.1%) showed the highest rates of plausible associations falsely given Q2- or Q2∅ by the modified algorithm. CONCLUSIONS The modified algorithm demonstrated high accuracy to identify pseudo-associations regarded as positive associations by the original algorithm and would potentially be applied to improve secondary databases to facilitate research on real-world prescribing patterns and further enhance drug safety.
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Affiliation(s)
- Ching-Huan Wang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Phung Anh Nguyen
- International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Department of Healthcare Information and Management, School of Health Technology, Ming Chuan University, Taipei, Taiwan
| | - Yu Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan; TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
| | - Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Quoc-Viet Tran
- Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chih-Wei Huang
- International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Molist-Brunet N, Sevilla-Sánchez D, González-Bueno J, Garcia-Sánchez V, Segura-Martín LA, Codina-Jané C, Espaulella-Panicot J. Therapeutic optimization through goal-oriented prescription in nursing homes. Int J Clin Pharm 2021; 43:990-997. [PMID: 33247821 PMCID: PMC8352828 DOI: 10.1007/s11096-020-01206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565-9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient's treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.
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Affiliation(s)
- N Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain.
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - J González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | | | | | - C Codina-Jané
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Geriatric and Palliative Care Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
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Comans AL, Sennesael AL, Bihin B, Regnier M, Mullier F, de Saint-Hubert M. Inappropriate low dosing of direct oral anticoagulants in older patients with non-valvular atrial fibrillation: Impact on plasma drug levels. Thromb Res 2021; 201:139-142. [PMID: 33713867 DOI: 10.1016/j.thromres.2021.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Anne-Lore Comans
- Université catholique de Louvain, CHU UCL Namur, Geriatric Department, Yvoir, Belgium
| | - Anne-Laure Sennesael
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Department of Pharmacy, Yvoir, Belgium
| | - Benoît Bihin
- Université catholique de Louvain, CHU UCL Namur, Scientific Support Unit, Yvoir, Belgium
| | - Maxime Regnier
- Université catholique de Louvain, CHU UCL Namur, Scientific Support Unit, Yvoir, Belgium
| | - François Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Hematology Laboratory, Yvoir, Belgium
| | - Marie de Saint-Hubert
- Université catholique de Louvain, CHU UCL Namur, Institut de recherche Santé Société, NARILIS, Geriatric Department, Yvoir, Belgium.
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Etxeberria A, Iribar J, Vrotsou K, Rotaeche R, Barral I, Barral I, Belzunegui J, Bustinduy A, Caso J, Del Bosque C, Etxeberria A, Frias O, Iribar J, Lekuona A, Lombera L, López B, Núñez J, Olasagasti B, Rotaeche R, Royo I, Vrotsou K, Zapata E, Zubeldia X. [Evaluation of the collaboration between Primary and Hospital Care in order to improve inappropriate prescription]. J Healthc Qual Res 2021; 36:91-97. [PMID: 33495114 DOI: 10.1016/j.jhqr.2020.09.005] [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: 04/27/2020] [Revised: 06/12/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the implementation of a collaborative experience between Primary (PC) and Hospital Care (HC) aimed at reducing potentially inappropriate prescribing (PIP) in patients with polypharmacy. MATERIALS AND METHODS Collaborative experience including a controlled before-after intervention study, carried out in the Donostialdea Integrated Health Organization (IHO), with Bilbao Basurto IHO as control group, Osakidetza, Basque Health Service. Participant were 227 PC physicians and physicians from 7 hospital services, and patients with 5 or more drugs meeting at least one PIP criteria. The intervention consisted of communication and knowledge between professionals, PC-HC consensus, training, identification of patients at risk, medication review, evaluation and feed-back. The collaboration process (agreements, consensus documents, training activities) and the change in the prevalence of PIP in polymedicated patients (using computerised health records) were evaluated. RESULTS A total of 21 PIP criteria and 6 recommendation documents were agreed. An analysis was performed on 15,570 PIP from OSI Donostialdea and 24,866 from the control group. The prevalence of PIP in polymedicated patients was reduced by -4.53% (95% CI: -4.71 to -4.36, P< .0001) in comparison with the control group. The before-after differences were statistically significant across the 7 services. CONCLUSIONS PC-HC collaboration is feasible and, along with other intervention components, reduces inappropriate polypharmacy in the context of a recently integrated healthcare organisation. The collaboration process is complex and requires continuous monitoring, policy involvement, leadership that encourages health professional participation, and intensive use of information systems.
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Affiliation(s)
- A Etxeberria
- Osakidetza, OSI Donostialdea, Farmacia Atención Primaria, Hernani, España; Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, España
| | - J Iribar
- Osakidetza, OSI Donostialdea, Farmacia Atención Primaria, Hernani, España.
| | - K Vrotsou
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto de Investigación en Servicios de Salud Kronikgune, Torre del BEC, Barakaldo, España
| | - R Rotaeche
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Osakidetza, OSI Donostialdea, Centro de Salud de Alza, Donostia-San Sebastián, España
| | - I Barral
- Osakidetza, Hospital Universitario Donostia, Donostia-San Sebastián, España
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, González-Bueno J, Solà-Bonada N, Cruz-Grullón M, Espaulella-Panicot J. Optimizing drug therapy in frail patients with type 2 diabetes mellitus. Aging Clin Exp Res 2020; 32:1551-1559. [PMID: 31494916 DOI: 10.1007/s40520-019-01342-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/11/2019] [Accepted: 08/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits. AIMS To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients' frailty index (FI) with polypharmacy and IP. METHODS This was a prospective, descriptive, observational study of elderly patients. Each patient's antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. RESULTS 210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136). DISCUSSION These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole. CONCLUSIONS There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.
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Affiliation(s)
- N Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain.
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - J González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - N Solà-Bonada
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - M Cruz-Grullón
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
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Santos Garcia T, Simas da Rocha B, De Jezus Castro SM, Heineck I. Potentially inappropriate medications for older adults in a primary healthcare unit in southern Brazil. Int J Clin Pharm 2020; 42:911-922. [PMID: 32390088 DOI: 10.1007/s11096-020-01048-7] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/27/2020] [Indexed: 12/28/2022]
Abstract
Background Potentially inappropriate medications for older adults are those that offer more risks than benefits for this population. Such medications found in older adults' prescriptions across the world are associated with higher rates of comorbidities and hospitalizations, along with high expenditure on healthcare resources. Objectives To estimate the frequency of older adults using potentially inappropriate medications according to four different criteria, to identify factors associated with the use of such medicines and differences between the tools. Setting A primary healthcare unit linked to a university hospital in Porto Alegre, Brazil. Method This was a cross-sectional study conducted via data collection from the electronic medical records of 390 older adults. The information collected comprised sex, age, chronic diseases diagnosed and medications used. The dependent variable of the study was the use of at least one potentially inappropriate medication, according to the following criteria: Beers, Screening Tool of Older Persons' Prescriptions (STOPP), Brazilian consensus and Anticholinergic Risk Scale (ARS). Main outcome measurement Prevalence of inappropriate medication, differences between the tools and associated factors. Results: The use of at least one potentially inappropriate medication was found in 55.1% of the sample according to the Beers criterion, 51.3% according to the Brazilian consensus, 42.6% according to STOPP and 23.6% according to ARS. It was also seen that 14.9% of the studied population was exposed to a very strong anticholinergic risk. Depending on which tools were used, the agreement observed between the criteria was considered high, moderate, or low. Regarding the four criteria, the use of potentially inappropriate medication is associated with polypharmacy, the diagnosis of three or more chronic diseases and the presence of neuropsychiatric and musculoskeletal diseases. Conclusion Among the older adult population studied, the prevalence of potentially anappropriate medication is high, according to the four different classification criteria used. As a more specific tool, the agreement between Anticholinergic Risk Scale and other criteria was lower, but it can be an important complement to other lists.
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Affiliation(s)
- Taiane Santos Garcia
- Programa de Pós-Graduação em Assistência Farmacêutica, School of Pharmacy, Anexo I da Faculdade de Farmácia, Federal University of Rio Grande do Sul, R. São Luís, 150 - Santana, Porto Alegre, RS, 90620-170, Brazil.
| | - Bruno Simas da Rocha
- Graduate Program in Medical Sciences: Endocrinology, Clinical Pharmacy Section, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Bairro Santa Cecília, Porto Alegre, 90035-903, Brazil
| | - Stela Maris De Jezus Castro
- Department of Statistics, Institute of Mathematics and Statistics, Federal University of Rio Grande do Sul, Av. Bento Gonçalves, 9500 Prédio 43-111, Bairro Agronomia, Porto Alegre, 91509-900, Brazil
| | - Isabela Heineck
- Programa de Pós-Graduação em Assistência Farmacêutica, School of Pharmacy, Anexo I da Faculdade de Farmácia, Federal University of Rio Grande do Sul, R. São Luís, 150 - Santana, Porto Alegre, RS, 90620-170, Brazil
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Sattayalertyanyong O, Thitilertdecha P, Auesomwang C. The inappropriate use of proton pump inhibitors during admission and after discharge: a prospective cross-sectional study. Int J Clin Pharm 2019; 42:174-183. [PMID: 31865594 DOI: 10.1007/s11096-019-00955-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/13/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022]
Abstract
Background Proton pump inhibitors are often inappropriately prescribed during hospital admission and after discharge. The inappropriate prescription may be associated with increased and unnecessary healthcare costs. Objective To determine the prevalence of inappropriate prescription of proton pump inhibitors during hospital admission and after discharge at Thailand's largest national tertiary referral center. Setting Medicine wards at Siriraj Hospital (Bangkok, Thailand) during September 2016 to September 2017. Method This prospective observational cross-sectional study in hospitalized patients who were prescribed, or who were already taking proton pump inhibitors. Medical records were reviewed to determine whether proton pump inhibitors were prescribed at discharge and at the 1-month follow-up. Main outcome measure Prevalence of inappropriate prescription of proton pump inhibitors during hospital admission and after discharge, indication of inappropriate prescription. Results Two hundred and sixty-five patients (mean age: 65.8 ± 18.3 years, 50.9% men) were included. Approximately half of patients had proton pump inhibitor treatment initiated in the hospital, and the other 50.6% started treatment earlier. Among all patients, 50.6% were inappropriately prescribed proton pump inhibitors, in which 79.1% resulted from invalid indications. Fifty-two percent and 47.3% of patients who were prescribed proton pump inhibitors at discharge and at the 1-month follow-up had no indications for them. Gastrointestinal ulcer prophylaxis in low-risk patients was the most commonly observed incorrect indication. Aspirin (p = 0.030) and corticosteroids (p = 0.038) were both found to be significantly associated with the inappropriate prescription of proton pump inhibitors. The estimated cost of inappropriate use among inpatients and outpatients was $118,659 and $214,663 per year, respectively. Conclusion Proton pump inhibitors are excessively and inappropriately prescribed during hospital admission and after discharge in Thailand. The cost of this overprescribing is excessive and needs to be controlled.
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Affiliation(s)
- Onuma Sattayalertyanyong
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Premrutai Thitilertdecha
- Research Group in Immunobiology and Therapeutic Sciences, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chonticha Auesomwang
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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9
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Bonful HA, Awua AK, Adjuik M, Tsekpetse D, Adanu RMK, Nortey PA, Ankomah A, Koram KA. Extent of inappropriate prescription of artemisinin and anti-malarial injections to febrile outpatients, a cross-sectional analytic survey in the Greater Accra region, Ghana. Malar J 2019; 18:331. [PMID: 31558149 PMCID: PMC6764136 DOI: 10.1186/s12936-019-2967-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/21/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background Febrile children seen in malaria hypo-endemic settings, such as the Greater Accra region (GAR) of Ghana are more likely to be suffering from a non-malarial febrile illness compared to those seen in hyper-endemic settings. The need for prescribers to rely on malaria test results to guide treatment practices in the GAR is even greater. This study was designed to investigate the factors associated with inappropriate artemisinin-based combination therapy (ACT) prescription. Methods A survey was conducted in six health facilities in the region in 2015. Treatment practices for febrile outpatient department (OPD) patients were obtained from their records. Prescribers were interviewed and availability of malaria commodities were assessed. The primary outcome was the proportion of patients prescribed ACT inappropriately. Independent variables included patient age and access to care, prescriber factors (professional category, work experience, access to guidelines, exposure to training). Data were analysed using Stata at 95% CI (α-value of 0.05). Frequencies and means were used to describe the characteristics of patients and prescribers. To identify the predictors of inappropriate ACT prescription, regression analyses were performed accounting for clustering. Results Overall, 2519 febrile OPD records were analysed; 45.6% (n = 1149) were younger than 5 years. Only 40.0% of patients were tested. The proportion of patients who were prescribed ACT inappropriately was 76.4% (n = 791 of 1036). Of these 791 patients, 141 (17.8%) were prescribed anti-malarial injections. Patients seen in facilities with rapid diagnostic tests (RDT) in stock were less likely to be prescribed ACT inappropriately, (AOR: 0.04, 95% CI 0.01–0.14, p < 0.001) compared to those seen in facilities with RDT stock-outs. Prescribers who had been trained on malaria case management within the past year were 4 times more likely to prescribe ACT inappropriately compared to those who had not been trained (AOR: 4.1; 95% CI (1.5–11.6); p < 0.01). Patients seen by prescribers who had been supervised were 8 times more likely to be prescribed ACT inappropriately. Conclusion Inappropriate ACT prescription to OPD febrile cases was high. Training and supervision of health workers appears not to be yielding the desired outcomes. Further research is needed to understand this observation.
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Affiliation(s)
- Harriet Affran Bonful
- Ghana College of Pharmacists, Cantonments, P. O. Box CT 10740, Accra, Ghana. .,Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana.
| | - Adolf Kofi Awua
- Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Kwabenya, Accra, Ghana
| | - Martin Adjuik
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Doris Tsekpetse
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Richard Mawuko Kofi Adanu
- Department of Population and Family Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Pricillia Awo Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Augustine Ankomah
- Department of Population and Family Health, School of Public Health, University of Ghana, Accra, Ghana.,Population Council, Yiyiwa Drive, Accra, Ghana
| | - Kwadwo Ansah Koram
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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10
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Vivanco MV, Formiga F, Mundet Riera I, San José Laporte A, Curto Prieto D. [Very elderly institutionalised population of Barcelona: Evaluation of frailty according to the Frail-VIG index and analysis of therapeutic appropriateness according to the STOPP-frail criteria]. Rev Esp Geriatr Gerontol 2019; 54:334-338. [PMID: 31362844 DOI: 10.1016/j.regg.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/01/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION As frailty and multiple drug therapy often coexists in institutionalised elderly patients, it is important to assess the level of frailty and therapeutic appropriateness in this population group. The aim of the study is to: assess the frailty level of institutionalised elderly patients and to analyse their prescriptions. MATERIAL AND METHODS An observational and cross-sectional study of a geriatric population of 85 years or older, institutionalised in a nursing home in Barcelona. Frailty was assessed using the Frail-VIG index, and the adequacy of the prescription of each group was done according to the STOPP-Frail Criteria. RESULTS The study included 79 patients, with a mean age of 90.9±4.2 years. Most of them (96.2%) had some degree of frailty. Slight frailty was observed in 21.5%, moderate in 37.7%, and advanced in 38%. The patients were prescribed a median of 7 drugs. No statistically significant differences were found in the majority of the prescriptions of the frailty groups. Differences were only found for those who had difficulty taking the medication, those who took medication for prostatic hypertrophy, and nutritional supplements. In all 3 groups, it was found that up to one third of the prescription was inappropriate, and some were even contraindicated in the most frail patients. CONCLUSION The elderly study population has a high frailty index with a high prevalence of multiple drug therapy with inappropriate prescription. The poor individualisation of these prescriptions in relation to the level of frailty, especially in those with short life prognosis, is a situation that should be improved.
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Affiliation(s)
| | - Francesc Formiga
- Unidad de Geriatría, Servicio Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Imma Mundet Riera
- Equipos de Atención a Residencias Geriátricas, Grup Mutuam, Barcelona, España
| | - Antonio San José Laporte
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España
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11
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Delgado-Silveira E, Mateos-Nozal J, Muñoz García M, Rexach Cano L, Vélez-Díaz-Pallarés M, Albeniz López J, Cruz-Jentoft AJ. [Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)]. Rev Esp Geriatr Gerontol 2019; 54:151-155. [PMID: 30606497 DOI: 10.1016/j.regg.2018.11.008] [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: 11/15/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty.
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Affiliation(s)
| | - Jesús Mateos-Nozal
- Servicio de Geriatría (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - Maria Muñoz García
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Lourdes Rexach Cano
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Jana Albeniz López
- Servicio de Geriatría (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
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12
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Fernández Regueiro R, Estrada Menéndez C, Morís de la Tassa J. Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients. Rev Clin Esp 2019; 219:375-385. [PMID: 31030886 DOI: 10.1016/j.rce.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND OBJECTIVES Potentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. METHOD A quasi-experimental before-after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. RESULTS 174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p=0.005), presented cognitive impairment (p=0.001) and were more institutionalized (p=0.039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p<0.001), odds ratio 242.5 (CI95%: 56.9-1023.6). CONCLUSIONS Review of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders.
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Affiliation(s)
- R Fernández Regueiro
- Servicio de Medicina Interna, Hospital Universtario de Cabueñes, Gijón, Asturias, España.
| | | | - J Morís de la Tassa
- Servicio de Medicina Interna, Hospital Universtario de Cabueñes, Gijón, Asturias, España; Facultad de Medicina y Ciencias de la Salud. Universidad de Oviedo, Oviedo, Asturias, España
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13
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Berthe-Aucejo A, Nguyen NPKK, Angoulvant F, Boulkedid R, Bellettre X, Weil T, Alberti C, Bourdon O, Prot-Labarthe S. Interrater reliability of a tool to assess omission of prescription and inappropriate prescriptions in paediatrics. Int J Clin Pharm 2019; 41:734-740. [PMID: 30972535 DOI: 10.1007/s11096-019-00819-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/28/2019] [Indexed: 12/01/2022]
Abstract
Background Potentially inappropriate medication (PIM) and potential prescription omission (PPO) are common issues in pharmacotherapy in vulnerable populations. A first tool to assess PIM's and PPO's targeting pediatric populations: POPI «Pediatrics Omission of Prescriptions and Inappropriate Prescriptions» was created in 2014. Objective This study aimed to evaluate inter-rater reliability between healthcare professionals who apply POPI. Setting: Mother and child emergency ward of a university hospital. Method Twenty cases with or without PIM or PPO were identified in a previous retrospective PIM-PPO prevalence study on 15,973 patients. One doctor and one pharmacist, who participated in the creation of POPI tool, identified PIM and PPO ("gold standard response"). These cases were reviewed independently by eleven clinicians (generalists, pediatricians, pharmacists, residents), with no previous experience of this tool. Interrater agreement was calculated by using the Kappa agreement test. Main outcome measure: Inter-clinician agreement. Results A high level of agreement of PIM and PPO detection was recorded (PIM: median = 0.80; PPO: median = 0.71). Conclusion POPI demonstrated a good interrater reliability. This validation by many clinicians proves that POPI is a reliable tool. Other multicenter and prospective studies should be conducted to evaluate economical and clinical impacts of POPI.
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Affiliation(s)
- Aurore Berthe-Aucejo
- Department of Pharmacy, Robert-Debré Hospital AP-HP, Paris, France. .,U1123, INSERM ECEVE, Paris, France.
| | | | - François Angoulvant
- U1123, INSERM ECEVE, Paris, France.,Department of Pediatric Emergency, Necker-Enfants Malades Hospital AP-HP, Paris Descartes University, Paris, France
| | - Rym Boulkedid
- U1123, INSERM ECEVE, Paris, France.,Clinical Epidemiology Unit, Robert-Debré Hospital AP-HP, Paris, France
| | | | - Thomas Weil
- Department of Pharmacy, Robert-Debré Hospital AP-HP, Paris, France
| | - Corinne Alberti
- U1123, INSERM ECEVE, Paris, France.,Clinical Epidemiology Unit, Robert-Debré Hospital AP-HP, Paris, France
| | - Olivier Bourdon
- Department of Pharmacy, Robert-Debré Hospital AP-HP, Paris, France.,Groupe Pédiatrie de la Société Française de Pharmacie Clinique, Paris, France.,Clinical Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Laboratoire Educations et Pratiques de Santé, Paris XIII University, Bobigny, France
| | - Sonia Prot-Labarthe
- Department of Pharmacy, Robert-Debré Hospital AP-HP, Paris, France.,U1123, INSERM ECEVE, Paris, France.,Groupe Pédiatrie de la Société Française de Pharmacie Clinique, Paris, France
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14
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Mannucci PM, Nobili A, Pasina L. Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med 2018; 13:1191-1200. [PMID: 30171585 DOI: 10.1007/s11739-018-1941-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/27/2018] [Indexed: 01/24/2023]
Abstract
As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, Via Pace, 9, 20122, Milan, Italy.
| | - Alessandro Nobili
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
| | - Luca Pasina
- Neuroscience Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy
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15
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Etxeberria A, Iribar J, Rotaeche R, Vrotsou K, Barral I. [Evaluation of an educational intervention and a structured review of polypharmacy in elderly patients in Primary Care]. Rev Esp Geriatr Gerontol 2018; 53:319-325. [PMID: 30097319 DOI: 10.1016/j.regg.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/04/2017] [Revised: 05/10/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Several interventions have been shown to reduce polypharmacy and potentially inappropriate prescription (PIP). The objective of the study was to evaluate the number of drugs and PIP before and after an educational intervention with the Primary Care physician (PCP), with electronic identification of PIP and structured medication review, in elderly patients with excessive polypharmacy (≥10 drugs). MATERIAL AND METHODS A before-after intervention study was conducted in the Gipuzkoa district of Osakidetza (Basque Country Health System), in a random sample of patients older than 80 years taking ≥ 10 drugs, and whose PCP attended training sessions. Primary outcomes: change in the number of drugs and PIP, registered in computerised health records. SECONDARY OUTCOMES benefit/risk ratio assessed by the PCP, safety problems, and therapeutic decision. RESULTS Of the 591 eligible patients, 88 were excluded (41: PCP did not attend training sessions, 47: death/transfer/admission), including a total of 503 patients with mean age of 84.9 years, with 67.7% women. The mean number of drugs and PIP per patient decreased significantly, -0.88 (95% CI: -1.04 to -0.72) and -0.19 (95% CI: -0.29 to -0.09), respectively (p<.0001), with a 25.8% reduction in the number of patients with excessive polypharmacy. SECONDARY OUTCOMES data collection sheets of 365 patients and 4,168 prescriptions were collected. The benefit-risk ratio was favourable for 75% of the prescriptions, with the most frequent decision being to maintain them (83%). Among the 911 prescriptions with an unfavourable/uncertain benefit/risk ratio, 47.3% were maintained. CONCLUSIONS The intervention is associated with a reduction in excessive polypharmacy and PPI under real-world conditions.
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Affiliation(s)
- Arritxu Etxeberria
- Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Josune Iribar
- Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España.
| | - Rafael Rotaeche
- Centro de Salud de Alza, San Sebastián, OSI Donostialdea, San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria - OSIS Gipuzkoa , San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Vizcaya, España; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Vizcaya, España
| | - Iosu Barral
- Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
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16
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Mokhar A, Topp J, Härter M, Schulz H, Kuhn S, Verthein U, Dirmaier J. Patient-centered care interventions to reduce the inappropriate prescription and use of benzodiazepines and z-drugs: a systematic review. PeerJ 2018; 6:e5535. [PMID: 30345166 PMCID: PMC6190800 DOI: 10.7717/peerj.5535] [Citation(s) in RCA: 4] [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: 01/17/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022] Open
Abstract
Background Benzodiazepines (BZDs) and z-drugs are effective drugs, but they are prescribed excessively worldwide. International guidelines recommend a maximum treatment duration of 4 weeks. Although these drugs are effective in the short-term, long-term BZD therapy is associated with considerable adverse effects, the development of tolerance and, finally, addiction. However, there are different interventions in terms of patient-centered care that aim to reduce the use of BZDs and z-drugs as well as assist health care professionals (HCPs) in preventing the inappropriate prescription of BZDs. Aim The aim of this systematic review was to identify interventions that promote patient-centered treatments for inappropriate BZD and z-drug use and to analyze their effectiveness in reducing the inappropriate use of these drugs. Methods To identify relevant studies, the PubMed, EMBASE, PsycINFO, Psyndex, and Cochrane Library databases were searched. Studies with controlled designs focusing on adult patients were included. Trials with chronically or mentally ill patients were excluded if long-term BZD and z-drug use was indicated. Study extraction was performed based on the Cochrane Form for study extraction. To assess the quality of the studies, we used a tool based on the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials. Results We identified 7,068 studies and selected 20 for systematic review. Nine interventions focused on patients, nine on HCPs, and two on both patients and HCPs. Intervention types ranged from simple to multifaceted. Patient-centered interventions that provided patient information effectively increased the appropriate use of BZDs. The educational approaches for HCPs that aimed to achieve appropriate prescription reported inconsistent results. The methods that combined informing patients and HCPs led to a significant reduction in BZD use. Conclusions This is the first review of studies focused on patient-centered approaches to reducing the inappropriate prescription and use of BZDs and z-drugs. The patient-centered dimension of patient information was responsible for a decrease in BZD and z-drug consumption. Further, in some studies, the patient-centered dimensions responsible for reducing the prescription and use of BZDs and z-drugs were the clinician’s essential characteristics and clinician-patient communication.
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Affiliation(s)
- Aliaksandra Mokhar
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janine Topp
- Department of Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Kuhn
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Garay-Bravo C, Peña A, Molina M, Sanfeliu J, Piles P, Blasco P, Salazar J. Application of the STOPP criteria in hospitalised elderly patients to detect and optimise inappropriate psychopharmaceutical prescriptions. Eur Geriatr Med 2018; 9:597-602. [PMID: 34654224 DOI: 10.1007/s41999-018-0091-x] [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: 03/12/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychotropic drugs are frequently used in the elderly population, but their inappropriate prescription can cause numerous adverse effects and interactions. OBJECTIVE To evaluate the impact of a multidisciplinary intervention to detect and optimise inappropriate prescriptions of psychotropic drugs in patients aged over 75 years in a hospital setting. DESIGN, SETTING, SUBJECTS AND METHODS A prospective study which included every patient aged over 75 years admitted to the Consorcio Hospital General in Valencia, Spain, and who had been prescribed psychotropic drugs inappropriately, carried out over 1 year. The intervention was to detect inappropriate prescriptions of psychotropic drugs using the STOPP criteria, treatment optimisation by a team of psychiatrists, readjustment of the electronic prescription register, and communication to the primary care physician. The impact of the intervention was assessed by measuring the persistence of the changes made 3 months after discharge and by quarterly assessment of inappropriate prescriptions. RESULTS Of 4571 admissions, 378 inappropriate prescriptions were detected in 346 patients. The drugs most frequently used were long half-life benzodiazepines (70%), which were substituted in 62% of the cases, withdrawn in 32%, and maintained in 6%. At 3 months follow-up, the changes had been maintained by the patients' primary care physician in 67%. Evaluation of the prescriptions during the subsequent quarters of the year showed a significant decrease in the inappropriate prescriptions, especially benzodiazepines. CONCLUSIONS Coordinated intervention by pharmacologists and psychiatrists in hospital settings, and communication between these professionals and primary care teams, can reduce psychotropic drugs inappropriately prescribed to the elderly.
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Affiliation(s)
- Claudio Garay-Bravo
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain.
| | - A Peña
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
| | - M Molina
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
| | - J Sanfeliu
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - P Piles
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
| | - P Blasco
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - J Salazar
- Department of Psychiatry, University General Hospital Consortium, Valencia, Spain
- CIBERSAM, Valencia, Spain
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Martínez Gorostiaga J, Echevarría Orella E, Calvo Hernáez B. [Analysis of proton pump inhibitors anti-ulcer drugs use in the Araba district primary care area]. Rev Esp Salud Publica 2018; 92:e201808047. [PMID: 30100604] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 07/12/2018] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. METHODS Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23® statistic software. RESULTS IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. CONCLUSIONS There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole.
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Affiliation(s)
| | - Enrique Echevarría Orella
- Departamento de Fisiología. Facultad de Farmacia. Universidad del País Vasco (UPV/EHU). Vitoria-Gasteiz. España
| | - Begoña Calvo Hernáez
- Área de Farmacia y Tecnología Farmacéutica. Facultad de Farmacia. Universidad del País Vasco (UPV/EHU). Vitoria-Gasteiz. España
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Pastor Cano J, Aranda García A, Sánchez Ruiz JF, Rausell Rausell VJ, Tobaruela Soto M, Gascón Cánovas JJ. [Gastrointestinal bleeding and potentially inappropriate medication by NSAIDs]. Rev Esp Salud Publica 2018; 92:e201805020. [PMID: 29806660] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/10/2018] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are widely used but they increase the risk of gastrointestinal haemorrage among other adverse effects. The objective of this study was to compare potentially inappropriate medications (PIM) by NSAIDs using the original Beers Criteria, a global reference for evaluating elderly people's prescriptions, and the Spanish adaptation of the same; and the relation between PIM of NSAIDs and gastrointestinal bleeding. METHODS The study was a retrospective observational study carried out located in a primary care district in the province of de Murcia, south-eastern Spain. The study population (n=7.856) were citizens aged 65 and above, with at least one drug prescribed in a Spanish health district during the study period . We analized illnesses and treatments registered in the primary care's electronic medical history of patients and hospital admissions, during the 12 month study period (2012). The original Beers Criteria and their Spanish adaptation were used to evaluate PIM of NSAIDs in patients considering the medication globally and also each active substance. Gastrointestinal bleeding events recorded in the data bases studied were evaluated. RESULTS Detection of PIM of NSAIDs was 5,6% with the original version and 7,0% (Δ=25,5%; p less than 0,001) with the adapted one. PIM of NSAIDs was related with an increased incidence of gastrointestinal bleeding without significant differences between PIM exposed and NSAID exposed patients AINE (RR=1,6; IC:0,2-14,5). CONCLUSIONS The Spanish adaptation of the Beers criteria identified a greater degree of PIM of NSAIDs than the original version, and in both versions the detection of PIM was not related with a significant increase of gastrointestinal bleeding compared to patients exposed to NSAIDs.
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Affiliation(s)
- Josep Pastor Cano
- Servicio de Gestión Farmacéutica. Dirección General Asistencia Sanitaria. Servicio Murciano de Salud. Murcia. España
| | - Ana Aranda García
- Servicio de Gestión Farmacéutica. Dirección General Asistencia Sanitaria. Servicio Murciano de Salud. Murcia. España
| | - José Francisco Sánchez Ruiz
- Subdirección General de Tecnologías de la Información. Dirección General Asistencia Sanitaria. Servicio Murciano de Salud. Murcia. España
| | - Víctor José Rausell Rausell
- Servicio de Gestión Farmacéutica. Dirección General Asistencia Sanitaria. Servicio Murciano de Salud. Murcia. España
| | - Mariana Tobaruela Soto
- Servicio de Farmacia Hospitalaria. Hospital Morales Meseguer (Facultativo Responsable R.P.M. San Basilio). Hospital Morales Meseguer. Murcia. España
| | - Juan José Gascón Cánovas
- Área de Medicina Preventiva y Salud Pública Facultad de Medicina (Universidad de Murcia). Grupo de Investigación de Metodología de Investigación en Ciencias de la Salud (IMIB-Arrixaca). Murcia. España
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20
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Delgado-Silveira E, Albiñana-Pérez MS, Muñoz-García M, García-Mina Freire M, Fernandez-Villalba EM. Pharmacist comprehensive review of treatment compared with STOPP-START criteria to detect potentially inappropriate prescription in older complex patients. Eur J Hosp Pharm 2018; 25:16-20. [PMID: 31156979 DOI: 10.1136/ejhpharm-2016-001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/24/2016] [Accepted: 11/02/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives To compare potentially inappropriate prescribing (PIP) according to the clinical judgement of the pharmacist with PIP according to explicit STOPP-START criteria in institutionalised and hospitalised patients with multiple pathologies. To describe and compare the main pharmacological groups involved and determine the factors associated with the detection of PIP in these patients. Method A prospective multicentre observational study of institutionalised and hospitalised multipathology patients aged >65 years. A specialised pharmacist used his best clinical judgement to detect PIP based on a comprehensive review of the complete chronic treatment of patients, which is an essential activity in interdisciplinary care. STOPP-START criteria were used as an aid tool to detect PIP. The main variable was the number of PIP incidents detected. Results Detected PIP incidents were analysed in 338 patients. Clinical judgement detected more PIP incidents (35%) than did STOPP-START criteria. More PIP incidents unrelated to these criteria were detected in institutionalised patients than in hospitalised patients. Clinical judgement mainly detected PIP incidents related to incorrect doses and drug interactions (p<0.001); however, STOPP-START criteria mainly detected PIP incidents related to drug duplication and insufficiently treated diagnosis or symptoms (p=0.001 and p<0.001). In total, 93.8% of the PIP incidents were detected in polypharmacy patients (≥5 drugs). Institutionalised and high-level polypharmacy (≥10 drugs) patients were at the highest risk of PIP. Conclusions A large number of PIP incidents were detected in institutionalised and hospitalised patients with multiple pathologies. The inclusion of a pharmacist in the multidisciplinary team facilitated the detection of PIP incidents, particularly in the institutionalised population and patients treated with high-level polypharmacy which were not detected by explicit STOPP-START criteria.
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Affiliation(s)
- E Delgado-Silveira
- Department of Pharmacy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M S Albiñana-Pérez
- Department of Pharmacy, Complejo hospitalario Arquitecto Marcide, Ferrol, Spain
| | - M Muñoz-García
- Department of Pharmacy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - E M Fernandez-Villalba
- Department of Pharmacy, Residencia para mayores dependientes La Cañada, Paterna, Valencia, Spain
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Rodríguez Del Río E, Perdigones J, Fuentes Ferrer M, González Del Castillo J, González Armengol J, Borrego Hernando MI, Arias Fernández ML, Martín-Sánchez FJ. [Impact of medium-term outcomes of inappropriate prescribing in older patients discharged from a short stay unit]. Aten Primaria 2017; 50:467-476. [PMID: 29079010 PMCID: PMC6837115 DOI: 10.1016/j.aprim.2017.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/21/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022] Open
Abstract
Objetivo Estudiar la asociación entre prescripciones potencialmente inapropiadas (PPI) y eventos adversos a los 30 y 180 días tras el alta de una unidad de corta estancia (UCE). Material y método Estudio analítico observacional de cohortes retrospectivo que incluyó pacientes ≥ 75 años al alta de una UCE. Se utilizó la versión 2 de los criterios STOPP-START. La variable resultado fue la presencia de algún evento adverso a 30 y 180 días. Resultados Se incluyeron 179 pacientes con una media de 84 (DE: 5) años. La presencia de ≥ 1PPI al alta no se asoció con la aparición de algún evento adverso a los 30 ni a los 180 días de manera global. La presencia de ≥ 1PPI al alta de fármacos del proceso cardiovascular tuvo mayor riesgo de presentar algún evento adverso a los 30 días del alta (OR ajustada 2,1; IC 95%: 1,0-3,2; p = 0,045), los fármacos del proceso «neuropsiquiátrico y riesgo de caídas» se relacionaron con deterioro funcional a los 30 días del alta (OR ajustada 6,3; IC 95%: 1,7-22,5; p = 0,005), y la omisión de fármacos del sistema cardiovascular se asoció con el reingreso a los 180 días (OR ajustada 3,6; IC 95%: 1,5-8,3, p = 0,003). Conclusiones La presencia de eventos adversos de pacientes ancianos dados de alta de una UCE podría relacionarse con PPI detectadas por algunos criterios STOPP-START, y concretamente con los fármacos de los procesos cardiovasculares, neuropsiquiátrico y relacionado con las caídas.
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Affiliation(s)
- Elena Rodríguez Del Río
- Servicio de Farmacia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - Javier Perdigones
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Manuel Fuentes Ferrer
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan González Armengol
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - M Isabel Borrego Hernando
- Servicio de Farmacia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - M Lourdes Arias Fernández
- Servicio de Farmacia, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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22
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Rattanaumpawan P, Chuenchom N, Thamlikitkul V. Individual feedback to reduce inappropriate antimicrobial prescriptions for treating acute upper respiratory infections in an outpatient setting of a Thai university hospital. J Glob Antimicrob Resist 2017; 12:11-14. [PMID: 28887290 DOI: 10.1016/j.jgar.2017.08.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Excessive use of antimicrobial agents for acute upper respiratory infections (URIs) is one of the most common problems in clinical practice. Interventions are required to reduce antimicrobial overuse in these common infections. METHODS During a 9-month study period (June 2014-February 2015), a quasi-experimental (pre-/post-) study was conducted among internal medicine residents and fellows in an outpatient setting of Siriraj Hospital, Thailand. The aim of the study was to determine the effectiveness of individual feedback to reduce inappropriate antimicrobial prescriptions for treating URIs. The administrative ICD-10 database was used to identify index physicians with at least one outpatient experience of URI. Data on antimicrobial prescriptions were extracted from the hospital pharmacy database. A confidential letter and SMS were sent to all index physicians about the extent of antimicrobial therapy they prescribed for treating URIs during the pre-intervention period. RESULTS The proportion of antimicrobial use among the index encounters showed a significant reduction from 34.7% in the pre-intervention period to 26.1% in the post-intervention period (P=0.02). Segmented logistic regression analysis confirmed the significant impact of the intervention on reducing antimicrobial prescriptions (P=0.02). CONCLUSION This integrated intervention is simple and non-labour intensive and may therefore be used sustainably in resource-limited settings.
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Affiliation(s)
- Pinyo Rattanaumpawan
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Nuttagarn Chuenchom
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Espaulella-Panicot J, Molist-Brunet N, Sevilla-Sánchez D, González-Bueno J, Amblàs-Novellas J, Solà-Bonada N, Codina-Jané C. [Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders]. Rev Esp Geriatr Gerontol 2017; 52:278-281. [PMID: 28476211 DOI: 10.1016/j.regg.2017.03.002] [Citation(s) in RCA: 7] [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: 01/05/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity.
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Affiliation(s)
- Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España.
| | - Núria Molist-Brunet
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | - Daniel Sevilla-Sánchez
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | | | - Jordi Amblàs-Novellas
- Hospital Universitari de la Santa Creu, Vic, Barcelona, España; Hospital Universitari de Vic, Vic, Barcelona, España
| | | | - Carles Codina-Jané
- Hospital Universitari de Vic, Vic, Barcelona, España; Hospital Clínic de Barcelona, Barcelona, España
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Garasto S, Fusco S, Onder G, Sganga F, Mammarella F, Volpato S, Ruggiero C, Abbatecola AM, Lattanzio F, Corsonello A. Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients. Aging Clin Exp Res 2017; 29:483-490. [PMID: 27114077 DOI: 10.1007/s40520-016-0571-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/22/2015] [Accepted: 04/11/2016] [Indexed: 01/09/2023]
Abstract
AIM To investigate the prevalence and clinical correlates of overprescribing and underprescribing of low molecular weight heparins (LMWHs) for thromboprophylaxis among older medical inpatients. METHODS Eight hundred seventy six patients (mean age 81.5 ± 7.6 years, female gender 57.2 %) enrolled in a multicenter observational study of seven acute care wards of geriatric medicine in Italy. The risk of venous thromboembolism was ascertained by calculating the Padua score for each patient. Patients receiving appropriate prescription of LMHW during stay were compared to those receiving LMHW with a Padua score <4 (overprescribing group). Similarly, patients with a high thromboembolic risk (Padua score ≥4) but not receiving LMHW (underprescribing group) were compared to patients appropriately not receiving LMHW during stay. Independent correlates of overprescribing and underprescribing were investigated by logistic regression analysis. RESULTS Overall, 42.8 % of patients had a Padua score ≥4. LMWHs were overprescribed in 7.3 % and underprescribed in 25.2 % of patients. The number of lost basic activities of daily living (BADL) (OR = 0.25; 95 % CI 0.15-0.41) and the number of diagnoses (OR = 0.76; 95 % CI 0.61-0.95) were inversely associated with LMWH overprescription. Conversely, older age (75-84 years: OR = 2.39; 95 % CI 1.10-5.19-85 years or more: OR = 3.25, 95 % CI 1.40-7.61), anemia (OR = 1.80, 95 % CI 1.05-3.16), pressure sores (OR = 4.15, 95 % CI 1.20-14.3), number of lost BADL at the admission (OR = 3.92, 95 % CI 2.86-5.37) and number of diagnoses (OR = 1.29, 95 % CI 1.15-1.44) qualified as significant correlates of LMWH underprescription. DISCUSSION Underprescription and, to a lesser extent, overprescription still represent an issue among older medical inpatients. CONCLUSION Implementing risk-stratifying scores into clinical practice may improve appropriateness of LMWHs prescribing during hospitalization.
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Affiliation(s)
- Sabrina Garasto
- Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy
| | - Sergio Fusco
- Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy.
| | - Graziano Onder
- Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy
| | - Federica Sganga
- Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy
| | - Federica Mammarella
- Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy
| | - Stefano Volpato
- Department of Science and Medicine, University of Ferrara, Ferrara, Italy
| | - Carmelinda Ruggiero
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | | | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy
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Pastor Cano J, Aranda García A, Gascón Cánovas JJ, Sánchez Ruiz JF, Rausell Rausell VJ, Tobaruela Soto M. [Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation]. Aten Primaria 2017; 50:106-113. [PMID: 28506569 PMCID: PMC6836936 DOI: 10.1016/j.aprim.2017.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/27/2016] [Accepted: 02/24/2017] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. DESIGN Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain. PARTICIPANTS A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. METHOD Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. RESULTS The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. CONCLUSIONS PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied.
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Affiliation(s)
- Josep Pastor Cano
- Servicio de Gestión Farmacéutica, Dirección General Asistencia Sanitaria, Servicio Murciano de Salud, Murcia, España.
| | - Ana Aranda García
- Servicio de Gestión Farmacéutica, Dirección General Asistencia Sanitaria, Servicio Murciano de Salud, Murcia, España
| | | | - José Francisco Sánchez Ruiz
- Subdirección General de Tecnologías de la Información, Dirección General Asistencia Sanitaria, Servicio Murciano de Salud, Murcia, España
| | - Víctor José Rausell Rausell
- Servicio de Gestión Farmacéutica, Dirección General Asistencia Sanitaria, Servicio Murciano de Salud, Murcia, España
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Martin P, Tannenbaum C. Use of the EMPOWER brochure to deprescribe sedative-hypnotic drugs in older adults with mild cognitive impairment. BMC Geriatr 2017; 17:37. [PMID: 28143413 PMCID: PMC5282809 DOI: 10.1186/s12877-017-0432-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 08/10/2016] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background Evidence-based mailed educational brochures about the harms of sedative-hypnotic use lead to discontinuation of chronic benzodiazepine use in older adults. It remains unknown whether patients with mild cognitive impairment (MCI) are able to understand the information in the EMPOWER brochures, and whether they achieve similar rates of benzodiazepine discontinuation. Methods Post-hoc analysis of the EMPOWER randomized, double-blind, wait-list controlled trial that assessed the effect of a direct-to-consumer educational intervention on benzodiazepine discontinuation. 303 community-dwelling chronic users of benzodiazepine medication aged 65–95 years were recruited from general community pharmacies in the original trial, 261 (86%) of which completed the trial extension phase. All participants of the control arm received the EMPOWER brochure during the trial extension. Normal cognition (n = 139) or MCI (n = 122) was determined during baseline cognitive testing using the Montreal Cognitive Assessment questionnaire. Changes in knowledge pre- and post-intervention were assessed with a knowledge questionnaire and changes in beliefs were calculated using the Beliefs about Medicines Questionnaire. Logistic regression was used to compare knowledge gained, change in beliefs and benzodiazepine cessation rates between participants with and without MCI. Results Complete discontinuation of benzodiazepines was achieved in 39 (32.0% [24.4,40.7]) participants with MCI and in 53 (38.1% [30.5,46.4]) with normal cognition (adjusted OR 0.79, 95% CI [0.45–1.38]). Compared to individuals with normal cognition, MCI had no effect on the acquisition of new knowledge, change in beliefs about benzodiazepines or elicitation of cognitive dissonance. Conclusions The EMPOWER brochure is effective for reducing benzodiazepines in community-dwelling older adults with mild cognitive impairment. Trial registration Our ClinicalTrials.gov identifier is NCT01148186, June 21st 2010.
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Affiliation(s)
- Philippe Martin
- Institut Universitaire de Gériatrie de Montréal, Université de Montréal, 4545 Queen Mary Road, Montreal, QC, H3W 1W5, Canada. .,Faculty of Pharmacy, University of Montreal, Quebec, Canada.
| | - Cara Tannenbaum
- Institut Universitaire de Gériatrie de Montréal, Université de Montréal, 4545 Queen Mary Road, Montreal, QC, H3W 1W5, Canada.,Faculty of Pharmacy, University of Montreal, Quebec, Canada.,Faculty of Medicine, University of Montreal, Quebec, Canada
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Lertxundi U, Isla A, Solinís MÁ, Echaburu SD, Hernandez R, Peral-Aguirregoitia J, Medrano J, García-Moncó JC. Medication errors in Parkinson's disease inpatients in the Basque Country. Parkinsonism Relat Disord 2017; 36:57-62. [PMID: 28065403 DOI: 10.1016/j.parkreldis.2016.12.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) medication errors, including both missing dopaminergic drug doses and antidopaminergic usage, have been suggested as risk factors for prolonged hospital stays. The objective of this study was to evaluate the prevalence of such errors in PD patients admitted to public acute-care hospitals in the Basque Country over a two year period and their association with clinically relevant adverse health outcomes, such as length of hospital stay and mortality. METHODS All PD patients admitted to any of the 11 public acute-care hospitals in the Basque Country in 2011-2012 were included. Medication errors involved incorrect timing or the complete omission of administration for dopaminergic drugs, and the administration of centrally acting antidopaminergics. A logistic regression and a competing risk analysis were applied to verify whether those errors affected intrahospital mortality and length of stay. RESULTS The study included 1628 patients admitted 2546 times. Medication errors, affecting almost one third of admissions and half of patients, were associated with higher mortality: inappropriately omitted dopaminergic drug doses OR = 1.92 CI 95% (1.34-2.76); inappropriate antiemetic administration OR = 2.15 CI 95% (1.36-3.39); and inappropriate antipsychotic administration OR = 1.91 CI 95% (1.33-1.73). Inappropriately omitted doses and both inappropriate antipsychotic and antiemetic administration were associated with a significant 4-day increase in median hospital stay. CONCLUSION Medication errors (missing dopaminergic drug doses and centrally acting antidopaminergic use) are not only associated with increased length of hospital stays in PD patients, but also with a higher mortality rate.
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Affiliation(s)
- Unax Lertxundi
- Pharmacy Service, Araba Mental Health Network, C/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain.
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Lascaray Research Center, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - Saioa Domingo- Echaburu
- Pharmacy Service, Alto Deba Integrated Health Organization, Avda. Nafarroa 16, 20500 Arrasate Gipuzkoa, Spain
| | - Rafael Hernandez
- Internal Medicine Service, Araba Mental Health Network, C/Alava 43, 01006 Vitoria-Gasteiz, Alava, Spain
| | | | - Juan Medrano
- Psychiatry Service, Bizkaia Mental Health Network, Portugalete, Bizkaia, Spain
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Etxeberria A, Iribar J, Hernando J, Idarreta I, Vergara I, Mozo C, Vrotsou K, Belzunegui J, Lekuona A. [Deprescribing long-term treatments with bisphosphonates for osteoporosis in primary care in the Basque Country (Spain)]. Gac Sanit 2017; 31:35-9. [PMID: 27568171 DOI: 10.1016/j.gaceta.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/27/2016] [Accepted: 07/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the impact of a multifactorial intervention to promote bisphosphonate deprescription after over 5 years of use (BF5y) in a health care organisation (HCO) in Gipuzkoa (Spain) and to compare it with the standard intervention in other HCOs in the Basque Health Service-Osakidetza. METHODS An 8-month follow-up study (results from before and after) to assess the impact of two interventions. All patients from Osakidetza receiving BF5y treatment (electronic prescription) in July 2013 were included. The standard intervention (9 HCOs) consisted of mailing a consensus statement on BF5y deprescribing and facilitating patient identifiers with BF5y prescription for review by the primary care physician. The multifactorial intervention (Gipuzkoa) also included a local consensus with leading specialists and training sessions in health centres. RESULTS 18,725 patients were included; 94.7% were women. Standard intervention deprescribing rates ranged from 26.4% (Bilbao) to 49.4% (Araba), being 37.2% overall. The multifactorial intervention deprescribing rate was 44.6%, 7.4% (p <0.0001; 95% confidence interval [95%CI]: 5.4-9.4) higher than standard intervention. Changes to other treatments were less common with the multifactorial intervention, with a difference of 3.7% (p <0.0001; 95%CI: -2.2 to -5.2). CONCLUSIONS Standard and multifactorial interventions are very effective in reducing unnecessary treatments with bisphosphonates. The multifactorial intervention is more effective than the standard one, although more complex to implement.
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Fajreldines A, Insua J, Schnitzler E. [Prevalence of potentially inappropriate drug prescription in the elderly]. ACTA ACUST UNITED AC 2016; 31:279-84. [PMID: 26970837 DOI: 10.1016/j.cali.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/14/2015] [Revised: 12/12/2015] [Accepted: 12/20/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. MATERIAL AND METHODS cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. RESULTS 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. CONCLUSIONS results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM.
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Affiliation(s)
- A Fajreldines
- Departamento de Calidad y seguridad del paciente, Hospital Austral, Buenos Aires, Argentina.
| | - J Insua
- Sistema de Información Hospitalario (HIS), Hospital Austral, Buenos Aires, Argentina
| | - E Schnitzler
- Dirección Médica, Hospital Austral, Buenos Aires, Argentina
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Navarro-Martínez A, Vidal-Martínez M, García-Rosa I, Lázaro-Gómez MJ, Brotons-Román J. [Profile of prescription and adequacy of treatment with non-steroidal anti-inflammatory drugs in diabetic patients]. ACTA ACUST UNITED AC 2015; 30:256-64. [PMID: 26346581 DOI: 10.1016/j.cali.2015.06.007] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/05/2015] [Accepted: 06/29/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to quantify and describe the prescription profile, as well as to assess the adequacy of treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in the diabetic population of a health district. MATERIAL AND METHODS This is a descriptive, cross-sectional study aimed at a target population of 2,795 diabetic patients. Data were collected from the computerised clinical records of a sample of 380 individuals. The adequacy of treatment was assessed using the recommendations proposed by the Spanish societies of Rheumatology, Cardiology and Gastroenterology. RESULTS More than one-quarter (28%) of the diabetic patients received treatment with NSAIDs. The most commonly used ones were ibuprofen, naproxen, and dexketoprofen, with a defined daily dose per 1,000 inhabitants per day of 35.3, 17.2, and 13.2, respectively. In patients with a history of chronic kidney disease and cardiovascular high risk, fewer NSAIDs were prescribed, while they were used most frequently in patients with a risk for gastrointestinal adverse events. The prescription was considered adequate in 46.5% of diabetic patients. The main causes of inappropriate use were the inadequate prescription of NSAIDs (25.2%), and the use of any NSAID other than naproxen (20.6%). CONCLUSIONS The most prescribed NSAIDs were those showing a low cardiovascular risk profile. Treatment with NSAIDs was inadequate in more than half of the patients. Risk factors for cardiovascular, and especially gastrointestinal, events must be considered in order to avoid its use when not indicated, as well as the use of any NSAIDs other than naproxen.
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Affiliation(s)
| | | | - I García-Rosa
- Centro de Salud Infante D. Juan Manuel, Murcia, España
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Orlando V, Menditto E, Guerriero F, Rotunno R. Effectiveness of the CardioPain initiative in reducing inappropriate NSAID prescriptions in pain therapy among high cardiovascular risk patients: an informative Italian survey. Heart Int 2015; 10:e20-4. [PMID: 27672433 DOI: 10.5301/heartint.5000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/23/2022] Open
Abstract
Aims Non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (COXIBs) may be associated with increased cardiovascular (CV) risk and mortality in CV patients. After the release of Note 66 by Agenzia Italiana del Farmaco (AIFA) to reduce inappropriate prescribing of NSAIDs and COXIBs, the CARDIOPAIN initiative was started in Italy to include such recommendations into the hospital discharge letter of patients with high CV risk. We evaluated the effect of the CARDIOPAIN initiative on the prescription of analgesic drugs by general practitioners (GPs). Methods An online interview was proposed to 414 Italian GPs. A descriptive statistic was reported. Results Three groups of GPs were identified: those who found the Note 66 recommendations in most hospital discharge letters (the “MOST” group), those who found them in only few cases (the “FEW” group) and those who never found the recommendations (the “NO” group). In patients with high CV risk, the percentage of GPs prescribing NSAIDs as first choice in pain management was lower in the MOST group compared with the “FEW” or “NO” groups. GPs belonging to the “MOST” group prescribed NSAIDs in 28% of cases, compared with 50% of cases observed for GPs belonging to the “NO” group. The more severe the pathology the fewer the NSAID prescriptions, in favor of opioid agents administration. Conclusions Our results suggest that the inclusion of the AIFA Note 66 in the discharge documents of high CV risk patients may have contributed to lower inappropriate NSAID prescriptions in Italian GPs. Presumably, a wider diffusion of the CARDIOPAIN initiative might improve the prescription appropriateness of analgesic drugs.
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Syed-Abdul S, Nguyen A, Huang F, Jian WS, Iqbal U, Yang V, Hsu MH, Li YC. A smart medication recommendation model for the electronic prescription. Comput Methods Programs Biomed 2014; 117:218-224. [PMID: 25092226 DOI: 10.1016/j.cmpb.2014.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The report from the Institute of Medicine, To Err Is Human: Building a Safer Health System in 1999 drew a special attention towards preventable medical errors and patient safety. The American Reinvestment and Recovery Act of 2009 and federal criteria of 'Meaningful use' stage 1 mandated e-prescribing to be used by eligible providers in order to access Medicaid and Medicare incentive payments. Inappropriate prescribing has been identified as a preventable cause of at least 20% of drug-related adverse events. A few studies reported system-related errors and have offered targeted recommendations on improving and enhancing e-prescribing system. OBJECTIVE This study aims to enhance efficiency of the e-prescribing system by shortening the medication list, reducing the risk of inappropriate selection of medication, as well as in reducing the prescribing time of physicians. METHOD 103.48 million prescriptions from Taiwan's national health insurance claim data were used to compute Diagnosis-Medication association. Furthermore, 100,000 prescriptions were randomly selected to develop a smart medication recommendation model by using association rules of data mining. RESULTS AND CONCLUSION The important contribution of this model is to introduce a new concept called Mean Prescription Rank (MPR) of prescriptions and Coverage Rate (CR) of prescriptions. A proactive medication list (PML) was computed using MPR and CR. With this model the medication drop-down menu is significantly shortened, thereby reducing medication selection errors and prescription times. The physicians will still select relevant medications even in the case of inappropriate (unintentional) selection.
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Affiliation(s)
- Shabbir Syed-Abdul
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Alex Nguyen
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Frank Huang
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Wen-Shan Jian
- Taipei Medical University, School of Health Care Administration, Taiwan.
| | - Usman Iqbal
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Vivian Yang
- College of Medical Science and Technology, Institute of Biomedical Informatics, Taiwan.
| | - Min-Huei Hsu
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Yu-Chuan Li
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
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