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1.
JAMA ; 324(16): 1651-1669, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33052386

RESUMO

Importance: Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. Objective: To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. Evidence Review: New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. Findings: From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. Conclusion and Relevance: Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Fatores Etários , Antirretrovirais/economia , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Esquema de Medicação , Custos de Medicamentos , Farmacorresistência Viral/genética , Substituição de Medicamentos/normas , Quimioterapia Combinada/métodos , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Humanos , Agências Internacionais , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Polimedicação , Profilaxia Pré-Exposição/métodos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , RNA Viral/sangue , Sociedades Médicas , Estados Unidos , Carga Viral/genética
4.
Bull Cancer ; 107(11): 1108-1117, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33012503

RESUMO

INTRODUCTION: Cancer patients are particularly at risk for drug interactions. However, in oncology, this risk has not been studied in depth in France. The main objective of this study was to describe the proportion of drug interactions in patients with lung or digestive cancer. METHODS: The drug prescriptions of 93 patients were analyzed from may 27th, 2019 to July 07th, 2019 using two software programs (Thériaque™ and DDI Predictor™) in oncology patients hospitalized in our comprehensive cancer center. RESULTS: Of the 88 patients included in the study, 544 drug interactions were identified, in 66 patients (75.0%, 95% CI: 64.6-83.6). For 20/88 patients (22.7% CI: 14.5-32.9) a non-recommended combination or a theoretical contraindication was reported. Etoposide was the anticancer molecule most involved in combinations that are contraindicated or not recommended. No combinations defined as not recommended or contraindicated were observed in any of the 49 patients treated with chemotherapy during their hospitalization. The most common toxicities were alertness and metabolic disorders, including hyperkalemia. The use of three or more drugs was a risk factor for drug interactions (83 vs. 23%, P<0.001). CONCLUSION: Drug interactions remain a major concern in cancer hospitalized patients. It is important to continue and strengthen the collaboration between physicians and pharmacists in order to better prevent their occurrence.


Assuntos
Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Sistema Digestório/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contraindicações de Medicamentos , Interações Medicamentosas , Etoposídeo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Estudos Retrospectivos , Adulto Jovem
7.
Emerg Med Clin North Am ; 38(4): 919-930, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981626

RESUMO

The geriatric population is growing and is the largest utilizer of emergency and critical care services; the emergency clinician should be comfortable in the management of the acutely ill geriatric patient. There are important physiologic changes in geriatric patients, which alters their clinical presentation and management. Age alone should not determine the prognosis for elderly patients. Premorbid functional status, frailty, and severity of illness should be considered carefully for the geriatric population. Emergency clinicians should have honest conversations about goals of care based not only a patient's clinical presentation but also the patient's values.


Assuntos
Envelhecimento/fisiologia , Estado Terminal , Ressuscitação , Idoso , Cuidados Críticos , Tomada de Decisão Compartilhada , Delírio/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Serviço Hospitalar de Emergência , Fragilidade/classificação , Humanos , Farmacocinética , Polimedicação , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal , Triagem
8.
Harefuah ; 159(9): 683-688, 2020 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-32955812

RESUMO

INTRODUCTION: Improved medical technology is associated with rapidly growing sub-populations suffering from incurable co-morbidities for prolonged periods of time before death. Although there is no evidence based medicine (EBM) proving positive benefit/risk ratios for most medications in these sub-populations, it is evident that they are attended by an increased number of specialists, each of whom add medications based on "their" guidelines. Eventually, more people suffer from inappropriate medication use and polypharmacy (IMUP); IMUP's negative medical, economic and social consequences represent the 21st-century iatrogenic pandemic. Many barriers interfere with attempts to de-prescribe: The myth "drugs=health" is a deep-rooted value; de-prescribing is automatically perceived negatively; physicians are not trained to de-prescribe; and discussing de-prescribing with the patient/family is time consuming. In an era of defensive medicine, physicians have fears of lawsuits, of patient/family's reactions, fears of not following all guideline recommendations, despite the age-related decrease in their benefit/risk ratio. Like other pandemics, combined international efforts are required in order to manage IMUP effectively. The International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP) was established and has begun sowing the seeds of global collaboration. Partnership with patients/families in decision-making is essential in geriatric-palliative ethical approaches, to overcome barriers to de-prescribing. Borrowing the language of epidemics, several approaches of "curing the infected" (reducing polypharmacy) were suggested; Israeli studies have proven improved functional, mental and cognitive status and patient/family satisfaction, following massive de-prescribing, compared with those who adhered to standard recommendations. "Immunization" (prevention), should concentrate on early education of professionals and laymen about IMUP and de-prescribing. Rational de-prescribing represents "a triple-win-win game"- improves life quality in the last years of life and has huge economic benefits.


Assuntos
Doença Iatrogênica , Prescrição Inadequada , Polimedicação , Idoso , Comorbidade , Epidemias , Humanos
9.
Rev Assoc Med Bras (1992) ; 66(8): 1087-1092, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32935803

RESUMO

OBJECTIVE: To identify the use of Potentially Inappropriate Medications with imminent risk of Cardiovascular and Cerebrovascular Adverse Events (PIM-CCVAE), in addition to the factors associated with a group of elderly individuals undergoing therapeutic care in a Brazilian public service. METHODS: A cross-sectional retrospective study conducted at a secondary level service located in Carapicuíba, SP, Brasil. Only elderly individuals (≥60 years) who were treated in one of the outpatient departments were included. The use of PIM-CCVAE was defined based on the PIM-CCVAEs list. In this research, we used descriptive statistics and logistic regression to identify and track possible predictors of MPI use. All statistical analyses were performed using Stata software version 15.1 (Stata Corporation). RESULTS: The sample included 233 elderly individuals, with a mean age of 74.9 (± 9.4) years. Of these, 74.2% used at least one PIM-CCVAE, with an average daily intake of 1.3 (± 1) PIM/elderly. The presence of comorbidities, diseases of the circulatory system, polypharmacy, and low to moderate scores in morbidity and mortality were important factors associated with an increased odds ratio for the consumption of PIM-CCVAE. It is also emphasized that the presence of neurological symptoms proved to be a protective factor for this outcome. CONCLUSION: Given the clinical severity and imminent risk of CCVAE in the researched group, preventive measures should be instituted to minimize health problems related to medication in the public network.


Assuntos
Sistema Cardiovascular , Prescrição Inadequada , Idoso , Idoso de 80 Anos ou mais , Brasil , Transtornos Cerebrovasculares , Estudos Transversais , Humanos , Polimedicação , Estudos Retrospectivos , Fatores de Risco
10.
Rev Med Suisse ; 16(706): 1690-1692, 2020 Sep 16.
Artigo em Francês | MEDLINE | ID: mdl-32936550

RESUMO

With the rise of life-expectancy, the number of comorbidities can increase and lead to polypharmacy (≥ 5 drugs/day) and excessive polypharmacy (> 9 drugs/day). In order to define suitable therapeutic targets, it is essential to take into account the heterogeneity of this population which can be classified into 3 categories : robust, vulnerable or dependent. In this context, the concept of deprescription, which englobes the process of tapering or stopping drugs, aimed at improving patient outcomes, becomes an important therapeutic tool. In the context of hypertension, this approach seems to be a safe, provided that patients can benefit from regular monitoring. It must be considered in vulnerable and dependent patients or patients institutionalized in nursing homes. Although, scientific evidence slowly accumulates, its levels remain moderate. Finally, the deprescribing process, can also be applied in specifics situations in order to prevent adverse events, such as during a heat wave.


Assuntos
Anti-Hipertensivos/administração & dosagem , Desprescrições , Humanos , Casas de Saúde , Polimedicação
11.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32850119

RESUMO

Vascular aging leads to arterial hypertension, which is the leading cause of cardiovascular mortality and morbidity in older adults. Blood pressure reduction is effective in reducing the cardiovascular risk and is safe in ambulatory older adults. It is important to note that blood pressure control in this group of patients is challenging because of comorbidities, polypharmacy, and frailty. Choice of pharmacotherapy is not simple and should be individualized.


Assuntos
Anti-Hipertensivos , Pressão Sanguínea/efeitos dos fármacos , Hipertensão , Idoso , Envelhecimento , Anti-Hipertensivos/uso terapêutico , Comorbidade , Idoso Fragilizado , Humanos , Hipertensão/tratamento farmacológico , Polimedicação
13.
PLoS One ; 15(8): e0238091, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817712

RESUMO

BACKGROUND: It is now well recognised that the risk of severe COVID-19 increases with some long-term conditions (LTCs). However, prior research primarily focuses on individual LTCs and there is a lack of data on the influence of multimorbidity (≥2 LTCs) on the risk of COVID-19. Given the high prevalence of multimorbidity, more detailed understanding of the associations with multimorbidity and COVID-19 would improve risk stratification and help protect those most vulnerable to severe COVID-19. Here we examine the relationships between multimorbidity, polypharmacy (a proxy of multimorbidity), and COVID-19; and how these differ by sociodemographic, lifestyle, and physiological prognostic factors. METHODS AND FINDINGS: We studied data from UK Biobank (428,199 participants; aged 37-73; recruited 2006-2010) on self-reported LTCs, medications, sociodemographic, lifestyle, and physiological measures which were linked to COVID-19 test data. Poisson regression models examined risk of COVID-19 by multimorbidity/polypharmacy and effect modification by COVID-19 prognostic factors (age/sex/ethnicity/socioeconomic status/smoking/physical activity/BMI/systolic blood pressure/renal function). 4,498 (1.05%) participants were tested; 1,324 (0.31%) tested positive for COVID-19. Compared with no LTCs, relative risk (RR) of COVID-19 in those with 1 LTC was no higher (RR 1.12 (CI 0.96-1.30)), whereas those with ≥2 LTCs had 48% higher risk; RR 1.48 (1.28-1.71). Compared with no cardiometabolic LTCs, having 1 and ≥2 cardiometabolic LTCs had a higher risk of COVID-19; RR 1.28 (1.12-1.46) and 1.77 (1.46-2.15), respectively. Polypharmacy was associated with a dose response higher risk of COVID-19. All prognostic factors were associated with a higher risk of COVID-19 infection in multimorbidity; being non-white, most socioeconomically deprived, BMI ≥40 kg/m2, and reduced renal function were associated with the highest risk of COVID-19 infection: RR 2.81 (2.09-3.78); 2.79 (2.00-3.90); 2.66 (1.88-3.76); 2.13 (1.46-3.12), respectively. No multiplicative interaction between multimorbidity and prognostic factors was identified. Important limitations include the low proportion of UK Biobank participants with COVID-19 test data (1.05%) and UK Biobank participants being more affluent, healthier and less ethnically diverse than the general population. CONCLUSIONS: Increasing multimorbidity, especially cardiometabolic multimorbidity, and polypharmacy are associated with a higher risk of developing COVID-19. Those with multimorbidity and additional factors, such as non-white ethnicity, are at heightened risk of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Multimorbidade , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Polimedicação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bancos de Espécimes Biológicos , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/virologia , Grupos Étnicos , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etnologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Autorrelato , Reino Unido/epidemiologia
14.
MMWR Morb Mortal Wkly Rep ; 69(34): 1149-1155, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32853194

RESUMO

The U.S. drug overdose epidemic continues to cause substantial morbidity and mortality. In 2017, 967,615 nonfatal drug overdoses were treated in emergency departments (EDs), a 4.3% increase from 2016 in all overdoses and a 3.1% increase in opioid-involved overdoses (1). During 2017 and 2018, syndromic surveillance revealed that 37.2% of overdoses treated in EDs in 18 states involved multiple drugs (2). To describe changes in rates and proportions of suspected nonfatal drug and polydrug overdoses treated in EDs, CDC analyzed syndromic surveillance data from 2018 to 2019 in 29 states. Rates of overdoses involving opioids, cocaine, and amphetamines increased 9.7%, 11.0%, and 18.3%, respectively, and the rate of benzodiazepine-involved overdoses decreased 3.0%. Overdoses co-involving opioids and amphetamines increased from 2018 to 2019, overall, in both sexes, and in most age groups. In 2019, 23.6%, 17.1%, and 18.7% of overdoses involving cocaine, amphetamine, and benzodiazepines, respectively, also involved opioids. Expanding overdose prevention, treatment, and response efforts is needed to reduce the number of drug and polydrug overdoses. This includes linkage into treatment, harm reduction services, and community-based programs for persons who use drugs; expanding overdose prevention efforts, including increased naloxone provision, to persons who use stimulants; addressing the illicit drug supply; and identifying specific risk factors for populations using these drugs. Continued surveillance with expanded coverage of additional jurisdictions of the evolving drug overdose epidemic is important to the success of these efforts.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Polimedicação , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
15.
Med Clin North Am ; 104(5): 777-789, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773045

RESUMO

Geriatric assessment is a comprehensive, multifaceted, and interdisciplinary evaluation of medical, socioeconomic, environmental, and functional concerns unique to older adults; it can be focused or broadened according to the needs of the patient and the concerns of clinical providers. Herein, the authors present a high-yield framework that can be used to assess older adult patients across a variety of settings.


Assuntos
Função Executiva , Avaliação Geriátrica/métodos , Desempenho Físico Funcional , Polimedicação , Idoso , Meio Ambiente , Humanos , Múltiplas Afecções Crônicas/tratamento farmacológico , Fatores Socioeconômicos
16.
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
17.
Lancet Gastroenterol Hepatol ; 5(9): 862-874, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32818465

RESUMO

Drug-induced liver injury (DILI) is a rare, unpredictable, and potentially serious adverse reaction. It is induced by many drugs, herbs, and dietary supplements and represents a diagnostic challenge to clinicians. Older people (aged 65 years and older) are often polymedicated, and their declining physiological function affects drug pharmacokinetics. There is no consistent evidence that age is a general risk factor for DILI; however, age might be a risk factor with specific medications, with antimicrobials and cardiovascular drugs being the most likely medications to cause DILI in older people. Ageing influences DILI phenotypes, making cholestatic damage and chronic DILI more likely. In older people with DILI, comorbidities act as confounding causes and account for higher mortality unrelated to the liver. There are no specific therapies for DILI and supportive measures are still the mainstay of management. This Review highlights current advances and gaps in DILI epidemiology, mechanisms, and diagnosis that are pertinent to older individuals.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Colestase/induzido quimicamente , Suplementos Nutricionais/efeitos adversos , Plantas Medicinais/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/mortalidade , Doença Hepática Induzida por Substâncias e Drogas/terapia , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Farmacocinética , Fenótipo , Polimedicação , Fatores de Risco
18.
Geriatr Gerontol Int ; 20(10): 961-966, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32812703

RESUMO

AIM: Studies of medication use in patients with a percutaneous endoscopic gastrostomy (PEG) tube have not been conducted adequately. The aim of this study was to describe medication use of care-dependent older adults with PEG and evaluate whether potential prescribing omissions (PPO) would affect the cause of death or acute illness. METHODS: In a geriatric long-term care hospital, 116 inpatients aged ≥65 years with insertion of a PEG tube because of dysphagia were enrolled and followed for 2 years: 2016-2018. The patients were divided into two groups, i.e., group A (who died between 2016 and 2018) and group B (who continued to be hospitalized in 2018). Clinical data and prescribed medications were recorded. Logistic regression models were conducted to assess the associations between survival and variables: age, gender, serum albumin level, serum creatinine level, body mass index (BMI), number of drugs and PPO. RESULTS: The patients' mean age was 85.3 ± 10.2 years, 57.8% were women and the mean number of drugs was 6.8 ± 3.5. Medications for managing symptoms, such as constipation and gastrointestinal symptoms, were commonly prescribed. The most common PPO medications were antiplatelet agents and anticoagulants. On logistic regression analysis, PPO had no influence on the cause of death or acute illness. Lower age, higher serum albumin level and body mass index were associated with survival in both univariate and multivariate models. CONCLUSIONS: Polypharmacy was prevalent in patients with PEG. Given the finding that PPO had no influence on health outcome, rational deprescribing could be warranted. Geriatr Gerontol Int 2020; 20: 961-966.


Assuntos
Causas de Morte , Desprescrições , Prescrições de Medicamentos/estatística & dados numéricos , Gastrostomia , Intubação Gastrointestinal , Idoso , Idoso de 80 Anos ou mais , Nutrição Enteral , Feminino , Humanos , Japão , Assistência de Longa Duração , Masculino , Polimedicação , Estudos Retrospectivos
19.
PLoS One ; 15(7): e0236830, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735592

RESUMO

BACKGROUND: Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS: In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS: The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.


Assuntos
Demência/complicações , Prescrições de Medicamentos , Serviços de Saúde para Idosos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Interações Medicamentosas , Feminino , Humanos , Estudos Longitudinais , Masculino , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Estudos Retrospectivos , Fatores de Risco
20.
PLoS One ; 15(8): e0237868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32818951

RESUMO

BACKGROUND: Older adults with chronic kidney disease (CKD) are at heightened risk for polypharmacy. We examined potentially inappropriate prescribing in this population and whether introducing pharmacists into the ambulatory kidney care model was associated with improved prescribing practices. METHODS: Retrospective cohort study using linked administrative databases. We included patients with an eGFR ≤30 mL/min/1.73 m2 ≥66 years of age followed in multidisciplinary kidney clinics in Ontario, Canada (n = 25,016 from 28 centres). The primary outcome was the absence of a statin prescription or the receipt of a potentially inappropriate prescription defined by the American Geriatric Society Beers Criteria® and a modified Delphi panel that identified key drugs of concern in CKD. We calculated the crude cumulative incidence and incidence rate for the primary outcome and used change-point regression to determine if a change occurred following pharmacist introduction. RESULTS: There were 6,007 (24%) and 16,497 patients (66%) not prescribed a statin and with ≥1 potentially inappropriate prescription, respectively. The rate of potentially inappropriate prescribing was 125.6 per 100 person-years and was higher in more recent years. The change-point regression analysis included 2,275 patients from two centres. No immediate change was detected at pharmacist introduction, but potentially inappropriate prescribing was increasing pre-pharmacist introduction, and this rising trend was reversed post-pharmacist introduction. The incidence of potentially inappropriate prescribing still remained high post-pharmacist introduction. CONCLUSIONS: Potentially inappropriate prescribing practices were common. Incorporating pharmacists into the kidney care model may improve prescribing practices. The role of pharmacists in the ambulatory kidney care team warrants further investigation in a randomized controlled trial.


Assuntos
Prescrições de Medicamentos/normas , Prescrição Inadequada/prevenção & controle , Polimedicação , Insuficiência Renal Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Canadá/epidemiologia , Gerenciamento de Dados , Feminino , Humanos , Masculino , Farmacêuticos , Lista de Medicamentos Potencialmente Inapropriados , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/patologia , Estudos Retrospectivos
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