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1.
Rev Assoc Med Bras (1992) ; 66(7): 918-923, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844941

RESUMO

OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide "if necessary" [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as "If Necessary", thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.


Assuntos
Prescrição Inadequada , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos
2.
Med Clin North Am ; 104(5): 751-765, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773043

RESUMO

Polypharmacy, the use of five or more medications, is common in older adults. It can lead to the use of potentially inappropriate medications and severe adverse outcomes. Deprescribing is an essential step of the thoughtful prescribing process and it can decrease the use of potentially inappropriate medications. Studies have demonstrated that deprescribing is feasible in the clinical setting, especially when it incorporates patient preferences, shared decision making, and an interdisciplinary team. Medication-specific algorithms can facilitate deprescribing in the clinical setting.


Assuntos
Desprescrições , Prescrição Inadequada/prevenção & controle , Múltiplas Afecções Crônicas/tratamento farmacológico , Idoso , Humanos , Lista de Medicamentos Potencialmente Inapropriados
3.
Sr Care Pharm ; 35(8): 336-337, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32718388

RESUMO

As the number of people taking multiple medications increases, differing approaches to address drug-drug interactions and adverse drug reactions have been debated-but not solved-despite excellent criteria to stop the use of potentially inappropriate medications.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Interações Medicamentosas , Humanos , Farmacêuticos , Lista de Medicamentos Potencialmente Inapropriados , Vigília
5.
Geriatr Gerontol Int ; 20(7): 655-663, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32691925

RESUMO

Many patients in rehabilitation facilities are affected by polypharmacy. Polypharmacy is associated with rehabilitation outcomes and functional recovery. Consequently, a combination of rehabilitation and pharmacotherapy may improve the outcomes of older people undergoing rehabilitation. A recent report described the concept of rehabilitation pharmacotherapy. The concept envisages helping frail older people and people with disabilities to achieve the highest possible body function, activity level and quality of life. There are two key tenets of rehabilitation pharmacotherapy: "pharmacotherapy in consideration of rehabilitation" and "rehabilitation in consideration of pharmacotherapy." "Pharmacotherapy in consideration of rehabilitation" includes use of drugs to treat impairment, activity limitation and participation restriction based on the International Classification of Functioning, Disability, and Health. "Rehabilitation in consideration of pharmacotherapy" refers to tailoring of rehabilitation considering the content of pharmacotherapy. With respect to drugs and motor dysfunction, anticholinergic drugs are associated with dysphagia and fractures. Increased use of potentially inappropriate medications may adversely affect the nutritional status. With respect to activities of daily living, polypharmacy and use of potentially inappropriate medications negatively affect the improvement in motor function during rehabilitation. Potent anticholinergic drugs are more likely to impede the improvement in cognitive function. In this review, we address the concept of rehabilitation pharmacotherapy and discuss its importance from the perspective of polypharmacy, the effect of drugs on disability and disease, nutritional status and activities of daily living. Geriatr Gerontol Int 2020; 20: -.


Assuntos
Pessoas com Deficiência/reabilitação , Idoso Fragilizado , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Atividades Cotidianas , Idoso , Antagonistas Colinérgicos/efeitos adversos , Cognição/efeitos dos fármacos , Feminino , Humanos , Masculino , Estado Nutricional , Qualidade de Vida
6.
J Am Geriatr Soc ; 68(8): 1636-1646, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32441771

RESUMO

BACKGROUND/OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes high morbidity and mortality in older adults with chronic illnesses. Several trials are currently underway evaluating the antimalarial drug hydroxychloroquine as a potential treatment for acute infection. However, polypharmacy predisposes patients to increased risk of drug-drug interactions with hydroxychloroquine and may render many in this population ineligible to participate in trials. We aimed to quantify the degree of polypharmacy and burden of potentially inappropriate medications (PIMs) that older hospitalized adults are taking that would interact with hydroxychloroquine. METHODS: We reanalyzed data from the cohort of patients 65 years and older enrolled in the MedSafer pilot study. We first identified patients taking medications with potentially harmful drug-drug interactions with hydroxychloroquine that might exclude them from participation in a typical 2019 coronavirus disease (COVID-19) therapeutic trial. Next, we identified medications that were flagged by MedSafer as potentially inappropriate and crafted guidance around medication management if contemplating the use of hydroxychloroquine. RESULTS: The cohort contained a total of 1,001 unique patients with complete data on their home medications at admission. Of these 1,001 patients, 590 (58.9%) were receiving one or more home medications that could potentially interact with hydroxychloroquine, and of these, 255 (43.2%) were flagged as potentially inappropriate by the MedSafer tool. Common classes of PIMs observed were antipsychotics, cardiac medications, and antidiabetic agents. CONCLUSION: The COVID-19 pandemic highlights the importance of medication optimization and deprescribing PIMs in older adults. By acting now to reduce polypharmacy and use of PIMs, we can better prepare this vulnerable population for inclusion in trials and, if substantiated, pharmacologic treatment or prevention of COVID-19. J Am Geriatr Soc 68:1636-1646, 2020.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Desprescrições , Hidroxicloroquina/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Lista de Medicamentos Potencialmente Inapropriados/normas , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pandemias , Seleção de Pacientes , Projetos Piloto , Polimedicação
7.
Eur J Ophthalmol ; 30(4): 795-804, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389030

RESUMO

Wet age-related macular degeneration is a chronic condition culminating, in most cases, in blindness. The introduction of anti-angiogenic agents in 2006 has represented a major breakthrough in the treatment of the disease, but timely and effective treatment with regular follow-up and monitoring is mandatory to stabilize and preserve visual acuity. In clinical practice, however, appropriate therapy provision is frequently challenged by economic and organizational issues that result in suboptimal visual outcomes and increased incidence of legal blindness. International Guidelines have defined a diagnostic and therapeutic pathway to ensure the best practice in wet age-related macular degeneration management, but reference parameters to evaluate and compare the performance of Retina Centers are lacking. To address the appropriateness of wet age-related macular degeneration management in Italy, a multidisciplinary panel of ten experts gathered in three meetings. They defined three sets of indicators and relative benchmark values that each Center should comply with to ensure patients optimal care already from the first access: (a) clinical intervention indicators, to determine the possible Center's deviation from the diagnostic and therapeutic pathway; (b) outcome indicator, to evaluate the socioeconomic impact of the healthcare systems' performance; (c) management indicators, to test the size of the gap between the Center's supply and demand. Once the indicators have been analyzed, healthcare systems can plan actions to improve appropriateness and monitor their effects. However, to put this in practice, a concerted effort by all parts involved in healthcare provision is required, together with adequate systems to analyze clinical and administrative documentation.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Benchmarking , Prova Pericial , Feminino , Humanos , Injeções Intravítreas , Masculino , Lista de Medicamentos Potencialmente Inapropriados , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
8.
rev. cuid. (Bucaramanga. 2010) ; 11(2): e1260, 1 de Mayo de 2020.
Artigo em Português | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1118411

RESUMO

Objetivo: Relatar a experiência de uma estratégia implementada para aumentar a segurança na administração dos medicamentos potencialmente perigosos preconizados na intubação de sequência rápida dos pacientes com COVID-19. Materiais e Métodos: Estudo descritivo do tipo relato de experiência, ancorado nos princípios do Programa Nacional de Segurança do Paciente, que descreve uma adaptação na bandeja para administrar medicamentos potencialmente perigosos na intubação de sequência rápida, organizada por cores, separando os medicamentos de acordo com suas classes terapêuticas, conforme sequência de administração. A estratégia foi implementada com a equipe multiprofissional das unidades de terapia intensiva de um hospital público especializado em Cardiologia do Rio de Janeiro. Resultados: A bandeja organizada por cores, foi utilizada em três situações de intubação de sequência rápida e a partir dessa estratégia foi elaborado um quadro com as características farmacológicas e cuidados de enfermagem referente aos medicamentos potencialmente perigosos utilizados, disposto na sala de preparo de medicação para consulta. Discussão: O uso seguro de medicamentos faz parte do terceiro desafio global de segurança do paciente, proposto pela organização mundial de saúde. Dentre os fatores que contribuem para incidentes com danos está o uso de medicamentos potencialmente perigosos. Estima-se que a implementação de barreiras de segurança como a estratégia apresentada neste relato é necessária para prevenção de eventos adversos. Conclusões: O uso de da bandeja com identificação colorida adotada, consistiu em barreira para possível ocorrência de potenciais incidentes decorrentes do uso de medicamentos potencialmente perigosos na intubação de sequência rápida nos pacientes com COVID-19.


Objetive: To describe the experience regarding the strategy implemented to enhance safety during the administration of hazardous drugs recommended for rapid sequence intubation in patients with COVID-19. Materials and Methods: A descriptive experience-reporting study was conducted based on the principles of the National Patient Safety Policy, which describe the adequacy of color-coded trays for administering hazardous drugs during the rapid sequence intubation. According to the sequence of drug administration, drugs are classified into their therapeutic class in color-coded trays. The strategy was implemented in partnership with the ICU multidisciplinary team from a public cardiovascular hospital in Rio de Janeiro. Results: Color-coded trays were used three times during the rapid sequence intubation. A table was prepared based on this strategy which contained pharmacological and nursing care characteristics of hazardous drugs available in the medication preparation room for consultations. Medication Without Harm is included in the third WHO Global Patient Safety Challenge. Among the factors that contribute to the incidence of adverse effects is the use of hazardous drugs. The application of safety barriers is the strategy outlined in this report, which is necessary for the prevention of adverse effects. Conclusions: The use of color-coded trays set up barriers to the occurrence of possible incidents derived from the use of hazardous drugs during the rapid sequence intubation in patients with COVID-19.


Objetivo: Describir la experiencia de la estrategia implementada para reforzar la seguridad durante la administración de medicamentos potencialmente peligrosos recomendados para la intubación de secuencia rápida en pacientes con COVID-19. Materiales y métodos: Estudio descriptivo tipo relato de experiencias con base en los principios del Programa Nacional de Seguridad del Paciente, en los que se describe la adecuación de la bandeja de administración de medicamentos potencialmente peligrosos durante la intubación de secuencia rápida. La bandeja se codifica por colores y por clases terapéuticas de acuerdo con la secuencia de administración de medicamentos. La estrategia se implementó en conjunto con el equipo multidisciplinar de las unidades de cuidados intensivos de un hospital público cardiovascular en Río de Janeiro. Resultados: Las bandejas con código de color se utilizaron en tres ocasiones durante la intubación de secuencia rápida. Con base en esta estrategia, se elaboró una tabla con las características farmacológicas y de cuidado de enfermería de los medicamentos potencialmente peligrosos disponibles en la sala de preparación de medicamentos para consulta. Discusión: El uso seguro de medicamentos hace parte del tercer reto mundial por la seguridad del paciente propuesto por la Organización Mundial de la Salud. Uno de los factores que contribuye a la incidencia de acontecimientos adversos es el uso de medicamentos potencialmente peligrosos. La aplicación de barreras de seguridad es la estrategia planteada en este relato que se hace necesaria para la prevención de eventos adversos. Conclusiones: La adopción del uso de bandejas codificadas por colores constituyó una barrera frente a la ocurrencia de posibles incidentes derivados del uso de medicamentos potencialmente peligrosos durante la intubación de secuencia rápida en pacientes con COVID-19.


Assuntos
Humanos , Masculino , Feminino , Infecções por Coronavirus , Indução e Intubação de Sequência Rápida , Enfermagem Baseada em Evidências , Segurança do Paciente , Lista de Medicamentos Potencialmente Inapropriados
9.
Int J Clin Pharmacol Ther ; 58(6): 299-309, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32301700

RESUMO

BACKGROUND: Potentially inappropriate medications (PIMs) for older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available. PIMs represent an important public health problem. AIM: The study aimed to investigate the prevalence of PIM at admission and discharge identified by the Beers 2019 and 2015 criteria in older patients in China and to identify the correlates of PIMs. MATERIALS AND METHODS: This was a cross-sectional study conducted in a tertiary hospital in China. Hospitalized patients in the internal medicine department aged ≥ 60 years were enrolled from June 2018 to October 2018. Information on medications at admission and discharge was collected and evaluated regarding PIMs using Beers 2019 and 2015 criteria. The concordance between PIM use according to Beers 2019 and 2015 criteria was calculated using κ tests. Multivariate logistic regressions were used to evaluate the factors associated with PIM use. RESULTS: Totally, 604 patients aged ≥ 60 years were included. The prevalence of PIM at admission was 53.3 and 55.0% according to the Beers 2015 and 2019 criteria, whereas the prevalence of PIM at discharge was 32.0 and 33.4% according to both criteria. The most frequent PIMs at admission and discharge were both diuretics according to the Beers 2019 criteria. PIMs at admission and discharge identified by the Beers 2019 criteria were both associated with the number of prescribed medications, acute heart failure, and chronic heart failure. CONCLUSION: The Beers 2019 and 2015 criteria showed good accordance in our study.


Assuntos
Alta do Paciente , Lista de Medicamentos Potencialmente Inapropriados/normas , Idoso , China , Estudos Transversais , Humanos , Prescrição Inadequada , Pessoa de Meia-Idade
10.
BMC Health Serv Res ; 20(1): 220, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183810

RESUMO

BACKGROUND: Several approaches to medication optimisation by identifying drug-related problems in older people have been described. Although some interventions have shown reductions in drug-related problems (DRPs), evidence supporting the effectiveness of medication reviews on clinical and economic outcomes is lacking. Application of the STOPP/START (version 2) explicit screening tool for inappropriate prescribing has decreased inappropriate prescribing and significantly reduced adverse drug reactions (ADRs) and associated healthcare costs in older patients with multi-morbidity and polypharmacy. Therefore, application of STOPP/START criteria during a medication review is likely to be beneficial. Incorporation of explicit screening tools into clinical decision support systems (CDSS) has gained traction as a means to improve both quality and efficiency in the rather time-consuming medication review process. Although CDSS can generate more potential inappropriate medication recommendations, some of these have been shown to be less clinically relevant, resulting in alert fatigue. Moreover, explicit tools such as STOPP/START do not cover all relevant DRPs on an individual patient level. The OPERAM study aims to assess the impact of a structured drug review on the quality of pharmacotherapy in older people with multi-morbidity and polypharmacy. The aim of this paper is to describe the structured, multi-component intervention of the OPERAM trial and compare it with the approach in the comparator arm. METHOD: This paper describes a multi-component intervention, integrating interventions that have demonstrated effectiveness in defining DRPs. The intervention involves a structured history-taking of medication (SHiM), a medication review according to the systemic tool to reduce inappropriate prescribing (STRIP) method, assisted by a clinical decision support system (STRIP Assistant, STRIPA) with integrated STOPP/START criteria (version 2), followed by shared decision-making with both patient and attending physician. The developed method integrates patient input, patient data, involvement from other healthcare professionals and CDSS-assistance into one structured intervention. DISCUSSION: The clinical and economical effectiveness of this experimental intervention will be evaluated in a cohort of hospitalised, older patients with multi-morbidity and polypharmacy in the multicentre, randomized controlled OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multi-morbid elderly), which will be completed in the last quarter of 2019. TRIAL REGISTRATION: Universal Trial Number: U1111-1181-9400 Clinicaltrials.gov: NCT02986425, Registered 08 December 2016. FOPH (Swiss national portal): SNCTP000002183. Netherlands Trial Register: NTR6012 (07-10-2016).


Assuntos
Sistemas de Apoio a Decisões Clínicas , Hospitalização , Prescrição Inadequada/prevenção & controle , Reconciliação de Medicamentos/métodos , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Doença Crônica/tratamento farmacológico , Estudos de Coortes , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Multimorbidade , Polimedicação , Projetos de Pesquisa
12.
Sr Care Pharm ; 35(3): 113-119, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32070459

RESUMO

A 62-year-old patient living in a rural community was referred to participate in a pharmacist-led home visit program because of concerns with the patient's increasing falls and medication complexity. The patient reported experiencing an increasing number of falls over the past few months, resulting in a recent hospitalization and mild head trauma. The patient's past medical history included diabetes mellitus type 2, hypertension, hyperlipidemia, gastroesophageal reflux disease, paroxysmal atrial fibrillation, unspecified back pain, and benign prostatic hyperplasia. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/ diphenhydramine combination medication, rather than his usual acetaminophen. According to the 2019 Beers criteria, use of acetaminophen/diphenhydramine for back pain without insomnia is not the best option and may contribute to falls. With an estimated four to eight tablets per day, the patient was taking 200-400 mg of diphenhydramine daily. Pharmacist recommendations included contacting the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk of the patient inadvertently purchasing an inappropriate product is reduced. After removing the diphenhydramine from the patient's regimen, the falls ceased. This case demonstrates the effects of inappropriate diphenhydramine use in an especially vulnerable population. It also highlights the critical role that rural community pharmacists can play in improving their patients' health care.


Assuntos
Difenidramina/efeitos adversos , Humanos , Pessoa de Meia-Idade , Assistência Farmacêutica , Lista de Medicamentos Potencialmente Inapropriados
13.
Nurse Pract ; 45(3): 40-43, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32068656

RESUMO

The American Geriatrics Society Beers Criteria, designed to prevent the prescription of potentially inappropriate medications to older adult patients, were updated in 2019. This article provides a stepwise protocol on how to incorporate the Beers Criteria guidelines into NP practice using a case study model.


Assuntos
Profissionais de Enfermagem , Lista de Medicamentos Potencialmente Inapropriados , Guias de Prática Clínica como Assunto , Padrões de Prática em Enfermagem/organização & administração , Idoso , Geriatria , Humanos , Sociedades Médicas , Estados Unidos
14.
Sr Care Pharm ; 35(2): 68-74, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32019641

RESUMO

OBJECTIVE: To compare the 2015 and 2019 AGS Beers Criteria® of potentially inappropriate medications in the elderly.
DATA SOURCES: American Geriatrics Society 2015 and 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults published literature.
STUDY SELECTION/DATA EXTRACTION: The literature was reviewed, compared, and summarized to identify pertinent changes and updates to the AGS Beers Criteria of PIMs in the elderly.
DATA SYNTHESIS: The AGS Beers Criteria® contains a list of potentially inappropriate medications that should be used with caution, avoided, notable drug-drug interactions, and drugs that should be dose-adjusted based on kidney function in the older adult. The updated AGS Beers Criteria® also includes removal of medications that are no longer sold in the United States, have a low usage rate, provide low evidence of harm, and/or the potential harm is not unique to the older adult.
CONCLUSION: The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations.


Assuntos
Lista de Medicamentos Potencialmente Inapropriados , Idoso , Interações Medicamentosas , Geriatria , Humanos , Registros , Estados Unidos
15.
BMC Geriatr ; 20(1): 28, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992215

RESUMO

BACKGROUND: Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Maori (the indigenous population of New Zealand) and non-Maori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. METHODS: PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs). RESULTS: Full demographic data were obtained for 267 Maori and 404 non-Maori at baseline, 178 Maori and 332 non-Maori at 12-months, and 122 Maori and 281 non-Maori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Maori at baseline, 12-months and 24-months, respectively. In non-Maori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Maori were exposed to a significantly greater proportion of PPOs compared to non-Maori (p = 0.02). In Maori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Maori, PIMs were associated with a double risk of mortality. CONCLUSIONS: PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Maori in predicting hospitalisations, and PIMs were more important in non-Maori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.


Assuntos
Prescrição Inadequada/mortalidade , Admissão do Paciente/tendências , Lista de Medicamentos Potencialmente Inapropriados/tendências , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Previsões , Hospitalização/tendências , Humanos , Prescrição Inadequada/tendências , Estudos Longitudinais , Masculino , Mortalidade/tendências , Nova Zelândia/epidemiologia
16.
Hosp Pract (1995) ; 48(sup1): 56-62, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31900000

RESUMO

Patients over the age 65 are a quickly expanding segment of the US population and represent a large percentage of patients requiring inpatient care. Older adults are more likely to experience polypharmacy and adverse drug effects. This review explains the risks of polypharmacy and potentially inappropriate medications in the elderly. Specific classes of medications frequently used in older adults in acute care settings are examined, including anticholinergic, sedative hypnotics, and antipsychotic medications. We discuss strategies aimed at addressing polypharmacy in this population including a drug regimen review (which is distinct from medication reconciliation), screening tools, pharmacist-led interventions, and computer-based strategies in the context of current literature and research findings. We provide a summary of general guidelines that may be helpful for geriatricians and hospitalists in improving patient care and clinical outcomes.


Assuntos
Avaliação Geriátrica/métodos , Equipe de Assistência ao Paciente/organização & administração , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Papel Profissional , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/efeitos adversos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Reconciliação de Medicamentos/métodos , Farmacêuticos/organização & administração , Fatores de Risco
17.
Am J Nurs ; 120(2): 36-42, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31977416

RESUMO

Polypharmacy, the use by a patient of multiple medications, contributes to adverse drug events, hospitalizations, geriatric syndromes, and increased health care costs. In the United States, polypharmacy is increasingly widespread, particularly among community-dwelling adults over age 62. In 2005-2006, 31% of such adults used five or more prescription drugs and 8.4% used medication combinations associated with potential interactions. By 2010-2011, 36% used five or more prescription drugs and 15% used potentially problematic drug combinations. Reducing the dangers of polypharmacy, however, requires clinicians to broaden their focus, considering not only the number of drugs a patient takes, but also the prescription of potentially inappropriate medications and potential prescribing omissions. This article explores the factors that contribute to polypharmacy and discusses its negative physiological, psychological, and economic effects. It also describes strategies for reducing polypharmacy, including both "explicit" approaches, which are grounded in the findings of literature reviews and expert opinion, and "implicit" approaches, which are based on the provider's interpretation of clinical data and the patient's medication regimen.


Assuntos
Desprescrições , Vida Independente/estatística & dados numéricos , Polimedicação , Padrões de Prática Médica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Múltiplas Afecções Crônicas/tratamento farmacológico , Conhecimento do Paciente sobre a Medicação/enfermagem , Lista de Medicamentos Potencialmente Inapropriados , Estados Unidos
18.
Drugs Aging ; 37(2): 115-123, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31782128

RESUMO

INTRODUCTION: Older people are prone to drug-related harm. Clinical decision support systems (CDSSs) in community pharmacies may improve appropriate prescribing in this population. OBJECTIVE: This study investigated (persistent) drug therapy changes and its determinants to reduce potentially inappropriate medication (PIM) in older patients based on CDSS alerts and to investigate barriers and facilitators for implementation of drug therapy changes based on these CDSS alerts. METHODS: Five clinical decision rules based on national guidelines for inappropriate drugs in older patients were incorporated in a web-based CDSS in 31 community pharmacies between February and April 2017. The CDSS generated alerts for patients aged > 70 years who had prescriptions for one of the following drugs: alprazolam, amitriptyline, barnidipine, duloxetine, fluoxetine, trazodone, quetiapine and olanzapine. The registered alert management data and medication dispensing histories were analysed to find potential determinants of persistent drug therapy changes. Ten pharmacists were interviewed about the barriers and facilitators for implementing drug therapy changes based on CDSS alerts. An inductive thematic analysis of the transcripts was performed. RESULTS: The pharmacists recorded the management of 1810 of the 2589 generated alerts, and 158 (8.7%) alerts were associated with a persistent drug therapy change. A logistic regression analysis found that the drug triggering the alert and the type of prescription [first dispensing vs. repeat; odds ratio 2.1 (95% confidence interval 1.4-3.2)] were significantly associated with persistent drug therapy changes. No association was found between persistent changes and age, sex, number of medicines in use, or recent clinical medication review. Analysis of the interviews revealed nine barriers and facilitators associated with drug therapy change. CONCLUSION: When community pharmacists implemented CDSS alerts to reduce inappropriate drug use in older patients, they registered a persistent drug therapy change in 8.7% of the cases. Alerts triggered by a first prescription were two times more likely to be associated with a persistent drug therapy change than alerts triggered by repeat prescriptions. This study found that clinical rules can be used to detect inappropriate drug use in older patients and that drug therapy can change based on the alerts. This suggests that CDSS alerts are a useful tool for implementing guidelines on PIM in older patients in daily practice.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Prescrição Inadequada/tendências , Farmácias/normas , Farmacêuticos/normas , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos
19.
Expert Rev Clin Pharmacol ; 13(1): 15-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31790317

RESUMO

Introduction: STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) are explicit criteria that facilitate medication review in multi-morbid older people in most clinical settings. This review examines the clinical trial evidence pertaining to STOPP/START criteria as an intervention.Areas covered: The literature was searched for registered clinical trials that used STOPP/START criteria as an intervention. In single-center trials, applying STOPP/START criteria improved medication appropriateness, reduced polypharmacy, reduced adverse drug reactions (ADRs), led to fewer falls, and lower medication costs. Two large-scale multi-center trials (SENATOR and OPERAM) examined the impact of computer-generated STOPP/START criteria on incident ADRs (SENATOR) and drug-related hospitalizations (OPERAM) in multi-morbid older people. Results of these trials will be publicized in 2020.Expert opinion: Applying STOPP/START criteria improves clinical outcomes in multi-morbid older people. Electronic deployment of STOPP/START criteria is a substantial technical challenge; however, recent clinical trials of software prototypes demonstrate feasibility. Even with well-functioning software for the application of STOPP/START criteria, the need remains for face-to-face interaction between attending clinicians and appropriately trained personnel (likely pharmacists) to explain and qualify specific STOPP/START recommendations in individual multi-morbid older patients. Such interaction is essential for the implementation of relevant STOPP/START recommendations.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Prescrição Inadequada/prevenção & controle , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Polimedicação , Padrões de Prática Médica/normas
20.
Sr Care Pharm ; 35(1): 38-46, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883544

RESUMO

OBJECTIVE: To describe recommendations made by geriatric clinical pharmacists within an innovative care model focusing on patients with dementia living at home. DESIGN: Retrospective chart review. SETTING: Outpatients in a tertiary care Veterans Affairs health care system. PARTICIPANTS: Veterans who underwent a Caring for Older Adults and Caregivers at Home (COACH) Program assessment and had at least one medicationrelated recommendation made by a geriatric clinical pharmacist. MAIN OUTCOME MEASURES: The primary endpoint was the number and category of medication-related recommendations made by a geriatric clinical pharmacist at the initial COACH program assessment. Secondary endpoints were recommendation acceptance rates and change in potentially inappropriate medications (PIMs) at six months. RESULTS: There were 104 patients included. The mean age was 81 years and the majority of patients were male and Caucasian. At baseline, patients were receiving a mean of 12 medications/person, and 59% of patients were receiving at least one PIM. There were 248 total medication recommendations made, with a mean of 2.4 recommendations/person (range 1-5). The three most common recommendation categories were to discontinue a drug, decrease the dose, and switch to a potentially safer alternative. Providers accepted 110 (44%) recommendations within six months. Patients were receiving a mean of one PIM/person at baseline, and no change was observed at six months.CONCLUSION: This study describes recommendations made through medication reviews by geriatric clinical pharmacists within an innovative care model for patients with dementia living at home. These data may provide information to other clinical pharmacists implementing consult services in similar settings.


Assuntos
Cuidadores , Farmacêuticos , Idoso de 80 Anos ou mais , Empatia , Feminino , Humanos , Masculino , Lista de Medicamentos Potencialmente Inapropriados , Estudos Retrospectivos
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