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1.
Int J Clin Pharm ; 39(4): 867-873, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28550348

RESUMO

Background There is a relative paucity of information to characterise potential changes in medication regimen complexity and prevalence of prescribing of potentially inappropriate medications after hospitalisation, both in Australia and elsewhere. Objective To evaluate medication regimen complexity and the prevalence of potentially inappropriate medications before and after admission to hospital. Setting General medical units of a tertiary care hospital in Australia. Methods Retrospective cohort study of patients aged 65 years and above. Medication complexity was measured by using the Medication Regimen Complexity Index (MRCI). Main outcome measure The primary outcome was the change in the Medication Regimen Complexity Index for all prescribed medications after hospitalization. Results A convenience sample of 100 patients was included in the study. There was a significant change in the mean medication complexity score (as measured using the MRCI), increasing from 29 at the time of admission to 32 at the time of discharge (p < 0.05). Factors such as baseline medication regimen complexity (pre-admission MRCI) and length of stay in the hospitals appear to influence the change in medication complexity. However, the proportion of patients prescribed at least one potentially inappropriate medicine (PIM) decreased significantly, from 52% pre-hospitalization to 42% at discharge (p = 0.04). Conclusions Relative to the time of admission, overall medication complexity increased and the proportion of patients who were prescribed PIMs decreased after hospitalisation.


Assuntos
Prescrição Inadequada/tendências , Reconciliação de Medicamentos/tendências , Alta do Paciente/tendências , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hospitalização/tendências , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Reconciliação de Medicamentos/métodos , Reconciliação de Medicamentos/normas , Alta do Paciente/normas , Lista de Medicamentos Potencialmente Inapropriados/normas , Prevalência , Estudos Retrospectivos
2.
Pharmacogenomics ; 14(16): 2013-21, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24279856

RESUMO

AIMS: This study aims to assess the cost-effectiveness in Australia of screening CYP2C19 loss-of-function (LoF) alleles to guide selection of clopidogrel or ticagrelor for individuals with acute coronary syndrome who are likely to undergo coronary stenting. METHODS: Three treatment strategies were compared: universal clopidogrel therapy, universal ticagrelor therapy and genotyping CYP2C19 with use of ticagrelor for individuals with a LoF allele and clopidogrel for individuals without a LoF allele. Lifetime costs and quality-adjusted life years for each treatment strategy were estimated using a Markov model. The risks of events were primarily derived from the genetic substudy of the pivotal randomized controlled trial. RESULTS: CYP2C19 genotyping resulted in greater effectiveness and was cost-effective when compared with universal use of clopidogrel. However, universal use of ticagrelor was the most effective strategy overall and the incremental cost-effectiveness compared with the genotyping strategy was generally within what is considered acceptable. CONCLUSION: Ticagrelor is likely to be cost-effective even for individuals not carrying a CYP2C19 LoF allele.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/genética , Hidrocarboneto de Aril Hidroxilases/genética , Análise Custo-Benefício/economia , Síndrome Coronariana Aguda/patologia , Adenosina/análogos & derivados , Adenosina/uso terapêutico , Alelos , Austrália , Clopidogrel , Citocromo P-450 CYP2C19 , Genótipo , Humanos , Cadeias de Markov , Ticagrelor , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico
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