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1.
Ann Palliat Med ; 10(4): 4678-4686, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33966416

RESUMO

BACKGROUND: Potentially inappropriate medications (PIMs) are associated with increased adverse drug reactions (ADRs), admission rate, and mortality rate in elderly patients. Here, we assessed PIM use in elderly outpatients in the departments of internal medicine in our center by using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. METHODS: The clinical data of 13,221 outpatients aged ≥65 years in the departments of respiratory medicine, endocrinology, neurology, and cardiovascular medicine of a tertiary hospital from January 2016 to March 2016 were retrospectively analyzed. The incidence of PIM in these patients was assessed by using the STOPP criteria (2014 version). Multivariate logistic regression analysis was performed to identify risk factors for PIM use. RESULTS: It was found that 1,040 (7.87%) of 13,221 elderly patients had at least one STOPP-listed PIM, and a total of 1,785 PIMs were identified. The most commonly used PIMs were benzodiazepine, hypnotic Z-drugs (zolpidem), and antipsychotics. Multivariate logistic regression analysis revealed that age [odds ratio (OR) =1.032, 95% confidence interval (CI): 1.022, 1.042], gender (OR =0.783, 95% CI: 0.687, 0.892), number of prescribed medications (OR =1.134, 95% CI: 1.106, 1.163), and number of diagnoses (OR =1.450 95% CI: 1.391, 1.510) were significantly associated with PIM use. The incidence of PIM use was highest in the Department of Neurology (12.75%), followed by the Department of Cardiology (5.90%), Department of Endocrinology (4.94%), and Department of Respiratory Medicine (2.90%). The risk factors for PIMs varied among different departments: except that benzodiazepines and hypnotic Z-drugs (zolpidem) were 2 common PIMs in all departments, the remaining topranked PIMs were department-specific. CONCLUSIONS: PIM use in elderly patients in the outpatient departments of internal medicine is mainly related to age, gender, number of medications, and number of diagnoses. However, it varies among different departments, and the main PIM types are also department-specific. Thus, special attention should be paid to departments with a high incidence and a large number of PIMs, so as to promote rational use of medicines.


Assuntos
Pacientes Ambulatoriais , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Humanos , Prescrição Inadequada , Medicina Interna , Estudos Retrospectivos
2.
Stud Health Technol Inform ; 281: 248-252, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042743

RESUMO

Therapeutic guidelines developed by experts are essential tools for improving therapy and drug prescription. Several guidelines often exist that target the same patient, from different organizations and countries. The case of lists for the detection of potentially inappropriate medications (PIMs) is an example which illustrates how these guidelines can be varied and multiple. In order to have an overview to the divergences and similarities between different lists of PIMs, we propose a visual method to compare PIMs lists, based on set visualization, and we apply it to 5 guidelines.


Assuntos
Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Estudos Transversais , Humanos , Prescrição Inadequada/prevenção & controle
3.
BMC Health Serv Res ; 21(1): 522, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049550

RESUMO

BACKGROUND: A hospitalization phase represents a challenge to medication safety especially for multimorbid patients as acute medical needs might interact with pre-existing medications or evoke adverse drug effects. This project aimed to examine the prevalence and risk factors of potentially inappropriate medications (PIMs) and medication combinations (PIMCs) in the context of hospitalizations. METHODS: Analyses are based on claims data of patients (≥65 years) with basic mandatory health insurance at the Helsana Group, and on data from the Hirslanden Swiss Hospital Group. We assessed PIMs and PIMCs of patients who were hospitalized in 2013 at three different time points (quarter prior, during, after hospitalization). PIMs were identified using the PRISCUS list, whereas PIMCs were derived from compendium.ch. Zero-inflated Poisson regression models were applied to determine risk factors of PIMs and PIMCs. RESULTS: Throughout the observation period, more than 80% of patients had at least one PIM, ranging from 49.7% in the pre-hospitalization, 53.6% in the hospitalization to 48.2% in the post-hospitalization period. PIMCs were found in 46.6% of patients prior to hospitalization, in 21.3% during hospitalization, and in 25.0% of patients after discharge. Additional medication prescriptions compared to the preceding period and increasing age were the main risk factors, whereas managed care was associated with a decrease in PIMs and PIMCs. CONCLUSION: We conclude that a patient's hospitalization offers the possibility to increase medication safety. Nevertheless, the prevalence of PIMs and PIMCs is relatively high in the study population. Therefore, our results indicate a need for interventions to increase medication safety in the Swiss healthcare setting.


Assuntos
Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Hospitalização , Humanos , Alta do Paciente , Suíça/epidemiologia
4.
BMC Geriatr ; 21(1): 289, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933030

RESUMO

BACKGROUND: Potentially inappropriate medications (PIMs) are common among nursing homes (NH) residents, as is polypharmacy. Deprescribing has emerged in the past decade as a safe and effective way to reduce the use of PIMs and improve patient outcomes. However, effective deprescribing interventions are expensive, as they require specialised staff and a great amount of time for each resident. The Quality Circle Deprescribing Module (QC-DeMo) intervention was designed to be less resource-intensive than medication reviews, the current deprescribing gold standard. It consists of a QC session in which physicians, nurses, and pharmacists define a local deprescribing consensus for specific PIMs classes, which is then implemented in the NH. The intervention was trialled in a RCT, with the NH as unit of analysis. METHODS: After randomisation, intervention NHs enacted the QC-DeMo at the start of the follow-up year. The primary outcomes were the proportion of PIM galenic units and number of PIM defined daily dose per average resident and per day (DDD/res). PIM status was assessed by a combination of the 2015 Beers list and the Norwegian General Practice-Nursing Home criteria. Secondary outcomes were the number of DDD/res to avoid and to reevaluate; safety outcomes were mortality, hospitalisations, falls, and use of physical restraints. Outcomes were evaluated at follow-up using linear regression models, adjusting for the outcome baseline values. RESULTS: Fifty-eight NHs took part in the trial; no individual residents were recruited. The intervention did not reduce the primary outcomes, but a strong trend towards reduction was seen for the number of PIM DDD/res, which accounts for the doses used. PIM DDD/res to reevaluate were significantly reduced, mostly through a reduction in the use of proton-pump inhibitors. Falls and use of physical restraints were not affected, but a statistical interaction between the mission of the NH (geriatric unit or specialised dementia unit) and the intervention group was seen for mortality and hospitalisations. CONCLUSIONS: The QC-DeMo intervention can reduce the use of some PIM classes, and could usefully complement other deprescribing interventions. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018, retrospectively registered.


Assuntos
Desprescrições , Idoso , Humanos , Prescrição Inadequada/prevenção & controle , Participação nas Decisões , Noruega , Casas de Saúde , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Suíça
5.
Emerg Med Clin North Am ; 39(2): 395-404, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33863467

RESUMO

Increasing prescription drug use trends in the United States affects patients across all ages, but especially the geriatric patient. As patients age, they are at increased risk for adverse events owing to natural changes in body composition and organ function, increased sensitivity to medications, and a higher chance of adverse events from drug-drug interactions and polypharmacy. Falls are common and can increase morbidity and mortality. To mitigate falls, it is imperative to have a comprehensive approach to screening home medication lists, be aware of and avoid high-risk medications, and deprescribe agents that are potentially inappropriate for this patient population.


Assuntos
Envelhecimento , Farmacocinética , Polimedicação , Idoso , Ensaios Clínicos como Assunto , Contraindicações de Medicamentos , Creatinina/análise , Insuficiência Hepática/complicações , Humanos , Prescrição Inadequada , Reconciliação de Medicamentos , Manejo da Dor , Lista de Medicamentos Potencialmente Inapropriados , Insuficiência Renal Crônica/complicações
6.
BMC Geriatr ; 21(1): 218, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789589

RESUMO

BACKGROUND: A multimodal general practitioner-focused intervention in the Local Health Authority (LHA) of Parma, Italy, substantially reduced the prevalence of potentially inappropriate medication (PIM) use among older adults. Our objective was to estimate changes in hospitalization rates associated with the Parma LHA quality improvement initiative that reduced PIM use. METHODS: This population-based longitudinal cohort study was conducted among older residents (> 65 years) using the Parma LHA administrative healthcare database. Crude and adjusted unplanned hospitalization rates were estimated in 3 periods (pre-intervention: 2005-2008, intervention: 2009-2010, post-intervention: 2011-2014). Multivariable negative binomial models estimated trends in quarterly hospitalization rates among individuals at risk during each period using a piecewise linear spline for time, adjusted for time-dependent and time-fixed covariates. RESULTS: The pre-intervention, intervention, and post-intervention periods included 117,061, 107,347, and 121,871 older adults and had crude hospitalization rates of 146.2 (95% CI: 142.2-150.3), 146.8 (95% CI: 143.6-150.0), and 140.8 (95% CI: 136.9-144.7) per 1000 persons per year, respectively. The adjusted pre-intervention hospitalization rate was declining by 0.7% per quarter (IRR = 0.993; 95% CI: 0.991-0.995). The hospitalization rate declined more than twice as fast during the intervention period (1.8% per quarter, IRR = 0.982; 95% CI: 0.979-0.985) and was nearly constant post-intervention (IRR: 0.999; 95% CI: 0.997-1.001). Contrasting model predictions for the intervention period (Q1 2009 to Q4 2010), the intervention was associated with 1481 avoided hospitalizations. CONCLUSION: In a large population of older adults, a multimodal general practitioner-focused intervention to decrease PIM use was associated with a decline in the unplanned hospitalization rate. Such interventions to reduce high risk medication use among older adults warrant consideration by health systems seeking to improve health outcomes and reduce high-cost acute care utilization.


Assuntos
Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Estudos de Coortes , Hospitalização , Humanos , Prescrição Inadequada/prevenção & controle , Itália/epidemiologia , Estudos Longitudinais
7.
BMC Geriatr ; 21(1): 258, 2021 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865310

RESUMO

BACKGROUND: Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty. METHODS: The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists. RESULTS: Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79-87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72-91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving. CONCLUSION: There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations. TRIAL REGISTRATION: The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367 .


Assuntos
Desprescrições , Fragilidade , Idoso , Idoso de 80 Anos ou mais , Humanos , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Qualidade de Vida
8.
BMJ Case Rep ; 14(4)2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33875501

RESUMO

We demonstrate the utility of risk stratification for postoperative delirium in geriatric patients and show that postoperative delirium can be prevented in high-risk patients when potentially inappropriate medications (PIMs) (medications that are best avoided in older adults) are avoided. In this case, a 65-year-old woman underwent two debridement procedures with similar presurgical risk for postoperative delirium. There was no risk stratification or preoperative cognitive assessment in the first procedure, she received PIMs and developed postoperative delirium. In the second procedure, PIMs were intentionally avoided and postoperative delirium did not occur. This case supports recent recommendations from the European Society of Anaesthesiology, the American Society of Anesthesiologists and the American Geriatrics Society that providers assess a patient's cognitive function and delirium risk profile preoperatively to appropriately guide perioperative management.


Assuntos
Delírio , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Delírio/induzido quimicamente , Delírio/prevenção & controle , Feminino , Humanos , Pacientes , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Estados Unidos
9.
Drugs Aging ; 38(4): 341-346, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33646509

RESUMO

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) are often elderly, with comorbidities, and receiving polypharmacy, all of which are known factors for potentially severe drug-drug interactions (DDIs) and the prescription of potentially inappropriate medications (PIMs). OBJECTIVE: The aim of this study was to assess the risk of DDIs and PIMs in COVID-19 patients at hospital discharge. METHOD: Patients with a proven diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were hospitalized between 21 February and 30 April 2020, treated with at least two drugs, and with available information regarding pharmacological treatments upon admission and at discharge were considered. The appropriateness of drug prescriptions was assessed using INTERcheck®. RESULTS: A significant increase in the prescription of proton pump inhibitors and heparins was found when comparing admission with hospital discharge (from 24 to 33% [p < 0.05] and from 1 to 17% [p < 0.01], respectively). The increased prescription of heparins at discharge resulted in a highly significant increase in the potentially severe DDIs mediated by this class of drugs. 51% of COVID-19 patients aged > 65 years had at least one PIM upon admission, with an insignificant increment at discharge (58%). CONCLUSION: An increased number of prescribed drugs was observed in COVID-19 patients discharged from our hospital. The addition of heparins is appropriate according to the current literature, while the use of proton pump inhibitors is more controversial. Particular attention should be paid to the risk of bleeding complications linked to heparin-based DDIs.


Assuntos
/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Interações Medicamentosas , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Alta do Paciente , Lista de Medicamentos Potencialmente Inapropriados
11.
BMC Geriatr ; 21(1): 163, 2021 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676398

RESUMO

BACKGROUND: The use of potentially inappropriate medications (PIMs) is common in older adults and is associated with potential negative consequences, such as falls and cognitive decline. Our objective was to investigate measurable patient factors associated with new outpatient prescribing of potentially inappropriate medications in older multimorbid adults already using multiple medications. METHODS: In this retrospective US cohort study, we used linked Medicare pharmacy and medical claims and electronic health record data from a large healthcare system in Massachusetts between 2007 and 2014. We identified patients aged ≥65 years with an office visit who had not been prescribed or used a PIM in the prior 180 days. PIMs were defined using 2019 Beers criteria of the American Geriatrics Society. To specifically evaluate factors in patients with polypharmacy and multimorbidity, we selected those who filled medications for ≥90 days (i.e., chronic use) from ≥5 pharmaceutical classes in the prior 180 days and had ≥2 chronic conditions. Multivariable Cox regression analysis was used to estimate the association between baseline demographic and clinical characteristics on the probability of being prescribed a PIM in the 90-day follow-up period. RESULTS: In total, we identified 17,912 patients aged ≥65 years with multimorbidity and polypharmacy who were naïve to a PIM in the prior 180 days. Of those, 10,497 (58.6%) were female, and mean age was 78 (SD = 7.5). On average, patients had 5.1 (SD = 2.3) chronic conditions and previously filled 6.1 (SD = 1.4) chronic medications. In total, 447 patients (2.5%) were prescribed a PIM during the 90-day follow-up. Male sex (adjusted hazard ratio (HR) = 1.29; 95%CI: 1.06-1.57), age (≥85 years: HR = 0.75, 95%CI: 0.56-0.99, 75-84 years: HR = 0.87, 95%CI: 0.71-1.07; reference: 65-74 years), ambulatory visits (18-29 visits: HR = 1.42, 95%CI: 1.06-1.92; ≥30 visits: HR = 2.12, 95%CI: 1.53-2.95; reference: ≤9 visits), number of prescribing orders (HR = 1.02, 95%CI: 1.01-1.02 per 1-unit increase), and heart failure (HR = 1.38, 95%CI: 1.07-1.78) were independently associated with being newly prescribed a PIM. CONCLUSION: Several demographic and clinical characteristics, including factors suggesting lack of care coordination and increased clinical complexity, were found to be associated with the new prescribing of potentially inappropriate medications. This knowledge could inform the design of interventions and policies to optimize pharmacotherapy for these patients.


Assuntos
Multimorbidade , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Prescrição Inadequada , Masculino , Medicare , Polimedicação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
12.
BMC Geriatr ; 21(1): 197, 2021 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743582

RESUMO

BACKGROUND: A precondition for developing strategies to reduce polypharmacy and its well-known harmful consequences is to study its epidemiology and associated factors. The objective of this study was to analyse the prevalence of polypharmacy (defined as ≥8 prescribed drugs), of potentially inappropriate medications (PIMs) and major drug-drug interactions (DDIs) among community-dwelling general practice patients aged ≥75 years and to identify characteristics being associated with polypharmacy. METHODS: This cross-sectional study is derived from baseline data (patients' demographic/biometric characteristics, diagnoses, medication-related data, cognitive/affective status, quality of life) of a northern-Italian cluster-RCT. PIMs and DDIs were assessed using the 2012 Beers criteria and the Lexi-Interact® database. Data were analysed using descriptive methods, Wilcoxon rank-sum tests, Fisher's exact tests and Spearman correlations. RESULTS: Of the eligible patients aged 75+, 13.4% were on therapy with ≥8 drugs. Forty-three general practitioners and 579 patients participated in the study. Forty five point nine percent of patients were treated with ≥1 Beers-listed drugs. The most frequent PIMs were benzodiazepines/hypnotics (19.7% of patients) and NSAIDs (6.6%). Sixty seven point five percent of patients were exposed to ≥1 major DDI, 35.2% to ≥2 major DDIs. Antithrombotic/anticoagulant medications (30.4%) and antidepressants/antipsychotics (23.1%) were the most frequently interacting drugs. Polypharmacy was significantly associated with a higher number of major DDIs (Spearman's rho 0.33, p < 0.001) and chronic conditions (Spearman's rho 0.20, p < 0.001), higher 5-GDS scores (thus, lower affective status) (Spearman's rho 0.12, p = 0.003) and lower EQ-5D-5L scores (thus, lower quality of life) (Spearman's rho - 0.14, p = 0.001). Patients' age/sex, 6-CIT scores (cognitive status), BMI or PIM use were not correlated with the number of drugs. CONCLUSIONS: The prevalence of polypharmacy, PIMs and major DDIs was considerable. Results indicate that physicians should particularly observe their patients with multiple conditions, reduced health and affective status, independently from other patients' characteristics. Careful attention about indication, benefit and potential risk should be paid especially to patients on therapy with specific drug classes identified as potentially inappropriate or prone to major DDIs in older persons (e.g., benzodiazepines, NSAIDs, protonic pump inhibitors, antithrombotics/anticoagulants, antidepressants/antipsychotics). TRIAL REGISTRATION: The cluster-RCT on which this cross-sectional analysis is based was registered with Current Controlled Trials Ltd. (ID ISRCTN: 38449870 ) on 2013-09-11.


Assuntos
Prescrição Inadequada , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Itália/epidemiologia , Lista de Medicamentos Potencialmente Inapropriados , Atenção Primária à Saúde , Qualidade de Vida
13.
Internist (Berl) ; 62(4): 363-372, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33630097

RESUMO

Polypharmacy, i.e. the prescription of five or more different drugs for medicinal treatment, is a typical problem in older and geriatric patients. Polypharmacy predisposes to different negative health sequelae, such as undesired side effects, drug interactions, potentially inappropriate medication, reduced functional abilities, increased hospitalization and increased mortality. Various consensus groups and specialist societies have developed recommendations on how to handle polypharmacy in geriatric patients. Although concepts to reduce the number of drugs are considered necessary, in many areas there is a lack of evidence on how to limit polypharmacy in geriatric patients and to reduce and discontinue medication. This article presents examples of recent studies dealing with potentially inappropriate medication, vitamin D substitution and antipsychotic drugs, which show how to critically appraise a prescribed medication, to critically check the indications for drugs and to discontinue drug use.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Prescrição Inadequada , Idoso , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Prescrição Inadequada/prevenção & controle , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados
14.
BMC Geriatr ; 21(1): 117, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568102

RESUMO

BACKGROUND: The use of potentially inappropriate medication (PIM) in population of older adults may result in adverse drug events (ADE) already after short term exposure, especially when it is prescribed to patients with chronic kidney disease (CKD). In order to limit ADE in the treatment of older adults PIM lists have been constructed as a source of information for healthcare professionals. The aim of this study was to estimate the utilization of PIM and incidence of ADE in older adults (≥70 years) with CKD. METHODS: We conducted a retrospective population-wide cohort study including patients from Lower Austria who were 70 years or older and diagnosed with CKD in the period from 2008 to 2011. Utilization of PIM was estimated from prescriptions filled by target population. We estimated risks of hospitalization due to ADE within 30 days after incident PIM prescription and compared them to a PIM-free control group by using marginal structural models (MSM). RESULTS: We identified 11,547 patients (women: 50.6%, median age in 2008: 78 years) who fulfilled the inclusion criteria. In total 24.7 and 8.1% of all prescriptions from that period contained a medication with a substance listed in the EU (7)-PIM and AT-PIM list, respectively. Proton pump inhibitors and Ginkgo biloba were the most often prescribed PIMs in this population. 94.6 and 79.3% patients filled at least one EU(7)-PIM and AT-PIM prescription, respectively. Despite the relatively high utilization of PIM there was only a low incidence of clinically relevant ADE. No event type exceeded the threshold level of 1% in the analysis of risks of ADE after filling a prescription for PIM. Nevertheless, MSM analysis showed an increased risk for 11 drugs and reduced risk for 4 drugs. CONCLUSIONS: PIM prescription was common among older adults with CKD, however, only a small number of these drugs eventually led to hospitalization due to ADE within 30 days after incident PIM was filled. In the absence of a clinically important PIM-related increase in risk, an assessment of potential ADE severity to a PIM list by using a warning score system seems prudent.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Insuficiência Renal Crônica , Minorias Sexuais e de Gênero , Idoso , Áustria , Estudos de Coortes , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Homossexualidade Masculina , Humanos , Prescrição Inadequada , Masculino , Lista de Medicamentos Potencialmente Inapropriados , Insuficiência Renal Crônica/induzido quimicamente , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Estudos Retrospectivos
15.
Ann Palliat Med ; 10(2): 2072-2079, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33615816

RESUMO

BACKGROUND: To assess the prevalence and associated risk of potentially inappropriate medications (PIMs) prescribing in community-dwelling elderly patients in China and to examine the most frequently used PIMs. This will provide a reference for the formulation of medication manuals for the community-dwelling elderly and further standardize the use of medications in elderly patients. METHODS: We conducted a cross-sectional retrospective study from April 1, 2020 to April 30, 2020. Data from elderly patients aged ≥65 years were collected from the Hengjie (N=2,294), Loujiang (N=3,972), and Tongxing communities (N=1,969) in Suzhou. The frequency of PIMs was detected using the 2019 Beers criteria and the 2017 Chinese criteria. Chi-square (for categorical variables), ANOVA (for continuous variables as applicable), and logistic regression were used to describe and identify potential predictors of PIMs. RESULTS: A total of 8,235 elderly patients were examined. Using the Chinese criteria, the prevalence of PIMs was 37.07%, which was slightly higher than that found using the 2019 Beers criteria (32.16%). The most prescribed PIMs were estazolam (21.53%) and insulin (4.60%) based on the Chinese criteria. Logistic regression analysis showed that advanced age, polypharmacy, and comorbid disease of patients were associated with a high risk of PIMs. Furthermore, the educational background and professional title of physicians were also associated with PIMs. CONCLUSIONS: Given the high prevalence of PIMs in the Chinese community-dwelling elderly population, the implementation of evidence-based interventions to promote rational clinical drug use could improve their quality of life.


Assuntos
Lista de Medicamentos Potencialmente Inapropriados , Qualidade de Vida , Idoso , China , Estudos Transversais , Humanos , Prescrição Inadequada , Prevalência , Estudos Retrospectivos
16.
BMC Geriatr ; 21(1): 98, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530943

RESUMO

BACKGROUND: Potentially inappropriate medication (PIM) use has adverse effects on health, particularly in elder patients. Various country-specific explicit criteria have been developed to measure the appropriateness of prescribing worldwide. However, it is difficult to apply the criteria developed from other regions to measure and guide the local prescribing practice in Hong Kong. This study aims to develop a Hong Kong-specific PIM assessing tool from previously published criteria and validate this tool using the modified Delphi method. METHODS: A disease-oriented Hong Kong-specific preliminary PIM list was developed based on nine sets of reference criteria selected from a literature review. Any medication or medication class appeared in at least two sets of the reference criteria as well as its related medical conditions were selected as PIM candidates. After examining the availability of PIM candidates by the Hong Kong Hospital Authority drug formulary, the Hong Kong-specific preliminary PIM list was validated by a two-round of modified Delphi process. Eight experts from different specialties were invited to rate the degree of inappropriateness of each PIM candidate using a five-point Likert scale. The experts were also encouraged to propose therapeutic alternatives and new PIM candidates not covered by the preliminary PIM list. The PIM candidates that the expert panel didn't reach consensus on were excluded from the final Hong Kong-specific PIM list. RESULTS: After two rounds of the Delphi process, eight PIM candidates remained questionable and thus were excluded from the PIM list. The final Hong Kong-specific PIM list included a total of 164 statements applicable to older adults aged 65 years or above, among which 77 were under PIMs independent of diagnoses, and 87 were under PIMs considering specific medical conditions. CONCLUSIONS: The Hong Kong-specific PIM list can be used as a quality measure and an educational tool to improve the local prescribing quality. Further studies should validate its association with adverse health outcomes in clinical and research settings.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Consenso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hong Kong/epidemiologia , Humanos , Prescrição Inadequada
17.
Arch Gerontol Geriatr ; 93: 104326, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33516154

RESUMO

BACKGROUND: The utilization of potentially inappropriate medications (PIMs) in older adults can lead to adverse events and increased healthcare costs. Polypharmacy, the concurrent utilization of multiple medications, is common in older adults with multiple chronic conditions. OBJECTIVE: To investigate the utilization and costs of PIMs in multimorbid older adults with polypharmacy over time. METHODS: This retrospective cross-sectional study used linked Medicare claims and electronic health records from seven hospitals/medical centers in Massachusetts (2007-2014). Participants were ≥65 years old, had ≥2 chronic conditions (to define multimorbidity), and used drugs from ≥5 pharmaceutical classes for ≥90 days (to define polypharmacy). Chronic conditions were defined using the Chronic Conditions Indicator from the Agency for Health Research and Quality. PIMs were defined using the American Geriatrics Society 2019 version of the Beers criteria. We calculated the percentage of patients with ≥1 PIMs and the percentages of patients using different types of PIMs. We used logistic regression analyses to test the odds of taking ≥1 PIMs. We calculated mean costs spent on PIMs by dividing the costs spent on PIMs by the total medication cost. RESULTS: ≥69% of patients used ≥1 PIM. After adjusting for healthcare utilization, chronic conditions, medication intake, and demographic factors, female sex (2014: Odds ratio (OR)=1.27, 95%CI 1.25-1.30), age (2014: OR=0.92, 95%CI 0.90-0.93), and Hispanic ethnicity (2014: OR=1.41, 95%CI 1.27-1.56) were associated with PIM use. Gastrointestinal drugs and central nervous system drugs were the most commonly-used PIMs. In patients using ≥1 PIM, >10% of medication costs were spent on PIMs. CONCLUSION: The utilization of PIMs in US older adults with multimorbidity and polypharmacy is high.


Assuntos
Múltiplas Afecções Crônicas , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Estudos Transversais , Feminino , Humanos , Prescrição Inadequada , Medicare , Polimedicação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
19.
Artigo em Inglês | MEDLINE | ID: mdl-33499419

RESUMO

Aging is accompanied by changes in organ degeneration, and susceptibility to multiple diseases, leading to the frequent occurrence of adverse drug reactions resulting from polypharmacy (PP) and potentially inappropriate medications (PIM) in older patients. This study employs a retrospective cohort design and investigates the association of PP with PIM among older patients with high rates of medical utilization. Using records from a national pharmaceutical care database, an experimental group is formed from patients meeting these criteria, who are then offered home pharmaceutical care. Correspondingly, a control group is formed by identifying older patients with regular levels of use of medical services who had been dispensed medications at community pharmacies. Multivariate logistic regression is performed to assess the association between the rate of PIM and variables, including age, gender, and PP. The study finds that experimental PP participants had a higher rate of PIM prescription (odds ratio (OR) = 5.4) than non-PP control participants (all p < 0.001). In clinical practice, additional caution is required to avoid PIMs. Patients engaged in continuously using long-term medication should take precautions in daily life to alleviate related discomforts. Pharmacists should serve as a bridge between patients and physicians to enhance their health and improve their quality of life.


Assuntos
Lista de Medicamentos Potencialmente Inapropriados , Qualidade de Vida , Idoso , Assistência Ambulatorial , Humanos , Prescrição Inadequada , Estudos Retrospectivos , Fatores de Risco
20.
Rev Med Suisse ; 16(714): 2169-2171, 2020 Nov 11.
Artigo em Francês | MEDLINE | ID: mdl-33174699

RESUMO

Deprescribing, in order to reduce both polypharmacy and the use of potentially inappropriate medications, remains a challenge, especially in nursing homes. Healthcare professionals perceive residents of these homes as wary of change and reluctant to take part in such endeavours. The results of two studies, one qualitative and the other quantitative, show that, on the contrary, nursing home residents and their relatives would be ready to consider a treatment reduction, provided that time is invested to explain the expected benefits of such changes.


Assuntos
Atitude Frente a Saúde , Desprescrições , Família/psicologia , Pessoal de Saúde/psicologia , Casas de Saúde , Pacientes/psicologia , Humanos , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados
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