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2.
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
3.
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
4.
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
5.
PLoS One ; 16(5): e0251340, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33974637

RESUMO

BACKGROUND: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. METHODS: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. RESULTS: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). CONCLUSION: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful.


Assuntos
Antibacterianos/efeitos adversos , Prescrição Inadequada/efeitos adversos , Injúria Renal Aguda/etiologia , Idoso , Antibacterianos/administração & dosagem , Proteína C-Reativa/análise , /virologia , Comorbidade , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , /isolamento & purificação
6.
BMC Geriatr ; 21(1): 297, 2021 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-33964882

RESUMO

BACKGROUND: Prescribing cascades are a source of inappropriate prescribing for older adults with dementia. We aimed to study three prescribing cascades in older Nova Scotians with dementia using administrative databases. METHODS: Cohort entry for Nova Scotia Seniors' Pharmacare Program beneficiaries was the date of dementia diagnosis. Prescription drug dispensing data was extracted for inciting medication and second treatment (cholinesterase inhibitor and bladder anticholinergic, metoclopramide and Parkinson's disease medication, or calcium channel blocker (CCB) and diuretic) over the six-year period April 1, 2009 to March 31, 2015. In three separate analyses, dispensing an inciting medication signaled a look back of 365 days from the date of first dispensing to confirm that the second treatment was started after the inciting medication. The prescribing cascade was considered when the second treatment was started within 180 days of the inciting treatment. Sex differences in the prescribing cascade were tested using t-tests or chi square tests as appropriate. Both univariate (unadjusted) and multivariate (adjusted) logistic regression (adjusted for age, rurality, and sex) and Cox proportional hazards regression was used to identify risk factors for the prescribing cascade. RESULTS: From March 1, 2005 to March 31, 2015, 28,953 Nova Scotia Seniors' Pharmacare beneficiaries with dementia (NSSPBD) were identified. There were 60 cases of bladder anticholinergics following cholinesterase inhibitors, 11 cases of Parkinson's disease medication following metoclopramide, and 289 cases of a diuretic following CCB in the cohort. Regression analysis demonstrated that risk of bladder anticholinergics following cholinesterase inhibitors and diuretics following CCBs were associated with female sex. Cox regression suggested that bladder anticholinergics were less often used by those on cholinesterase inhibitors and did not identify CCB use as leading more frequently to diuretic use. CONCLUSIONS: The combination of diuretics following CCB was the most common prescribing cascade and bladder anticholinergics following cholinesterase inhibitors the second most common. However, exposure to the inciting medications did not increase risk of exposure to the second treatments. Combinations of bladder anticholinergics following cholinesterase inhibitors and diuretics following CCBs were more common for women raising concern that women may be at increased risk of these prescribing cascades.


Assuntos
Bloqueadores dos Canais de Cálcio , Demência , Idoso , Antagonistas Colinérgicos/efeitos adversos , Estudos de Coortes , Demência/tratamento farmacológico , Demência/epidemiologia , Feminino , Humanos , Prescrição Inadequada , Masculino , Estudos Retrospectivos
7.
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
8.
Pan Afr Med J ; 38: 62, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889228

RESUMO

Introduction: ciprofloxacin is a second-generation fluoroquinolone, which has been used as one of the top three antibacterial agents prescribed in Ethiopia. However, its use has deviated from the recommendation of standard treatment guidelines resulting in a gradual increase in antimicrobial resistance. Therefore, this study aimed to evaluate the annual use of ciprofloxacin in 2016 based on the standard Ethiopian treatment and World Health Organization guidelines, in governmental hospitals, in Eastern Ethiopia from 1st May to 30th June 2018. Methods: a hospital-based retrospective cross-sectional study was conducted to evaluate medical records of patients who had taken ciprofloxacin in 2016. The total sample size (n=522) was proportionally allocated to each hospital based on the respective consumption data. A simple random sampling method was employed to collect the required sample. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. Results: in this study, 522 medical records were reviewed, with a male to female ratio of 1.03: 1. Ciprofloxacin was indicated in 478 (91.6%) participants whose age was greater than eighteen years. The majority were treated in the medical and emergency outpatient departments (n=477, 91.4%). Urinary tract infections (n=224, 42.9%), acute febrile illnesses (n=68, 13.0%), and typhoid fever (n=54, 10.4%) were the top indications to which ciprofloxacin was prescribed. Non-steroidal anti-inflammatory drugs (NSAIDs) (n=241, 34.7%) and antimicrobials (n=135, 19.6%) were among the most frequently co-indicated agents. Based on the standard Ethiopian treatment guidelines, therapy was appropriate in 30% (n= 159) of patients. The major reason for inappropriate utilization (95%) was the wrong duration of antibiotic use (n=228). Evaluation based on World Health Organization criteria showed that indication, dose, and frequency were in line with the recommendation. Conclusion: ciprofloxacin was primarily indicated for urinary tract infections. The drug was appropriately used in less than one-third of patients, with the wrong duration being the main reason for overall inappropriate utilization. This trend may potentially impose a high risk to the emergence of drug-resistant microorganisms. To this end, further studies addressing the susceptibility pattern of bacterial isolates towards ciprofloxacin should be carried out.


Assuntos
Antibacterianos/administração & dosagem , Ciprofloxacina/administração & dosagem , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Criança , Estudos Transversais , Farmacorresistência Bacteriana , Etiópia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adulto Jovem
9.
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
10.
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
12.
Sao Paulo Med J ; 139(2): 107-116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33825769

RESUMO

BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.


Assuntos
Prescrição Inadequada , Médicos , Idoso , Brasil , Estudos Transversais , Humanos , Polimedicação , Atenção Primária à Saúde
13.
Artigo em Inglês | MEDLINE | ID: mdl-33924094

RESUMO

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, "missing patient documentation" was the most common, followed by "adverse effect" and "drug not indicated." The most frequent intervention was "therapy stopped". In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.


Assuntos
Polimedicação , Insuficiência Renal Crônica , Idoso , Idoso de 80 Anos ou mais , Humanos , Prescrição Inadequada , Conduta do Tratamento Medicamentoso , Farmacêuticos , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos
16.
J Prim Care Community Health ; 12: 21501327211003687, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33733905

RESUMO

BACKGROUND: The COVID-19 pandemic has changed the delivery of primary care in the NHS. Consultations have largely moved from face-to-face to remote, forcing practitioners to modify the ways in which they deliver care to patients. AIM: In this study, we aim to investigate the appropriateness of antibiotic prescribing in tonsillitis during the COVID-19 pandemic. DESIGN AND SETTING: An observational quantitative analysis in the North Wales primary care setting. METHOD: Retrospective review of computer records across 5 GP centers from March 2020 until the end of October 2020. Data was extracted and analyzed using chi-square or fisher exact rank and Mann-Whitney test. RESULTS: Our results have shown no significant difference in antibiotic prescribing behavior comparing face-to-face and remote consultations. CONCLUSION: Remote consultation is as effective as face-to-face consultation with regards to the assessment of tonsillitis and the appropriateness of antibiotic prescription in primary care.


Assuntos
Antibacterianos/uso terapêutico , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Telemedicina , Tonsilite/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Atenção à Saúde , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Retrospectivos , País de Gales , Adulto Jovem
17.
Medicine (Baltimore) ; 100(12): e25015, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761656

RESUMO

ABSTRACT: Older adults are the leading users of medications, where this can be associated with a high number of potentially inappropriate medications (PIMs) and of potentially inappropriate prescribing (PIP) and consequent harm to health. No Brazilian study evaluating potentially inappropriate prescribing in older patients with Alzheimer's disease (AD) was found. This study determined and analyzed the prevalence of PIP and PIM prescribed for older people with AD.A cross-sectional study was carried out at the Specialty Drugs Pharmacy in the city of Sorocaba, São Paulo State, Brazil. The MEDEX system provided the register in older people with AD and data were collected during interviews with patients and/or caregivers between June and September 2017. The PIMs were identified according to the 2019 Beers Criteria. The association between PIMs and independent variables was analyzed by Poisson regression.This study included 234 older patients with AD. The prevalence of PIP prescribed was 66.7% (n = 156). Of the 1073 medications prescribed, 30.5% (n = 327) were inappropriate with most affecting the central nervous system or cardiovascular, particularly quetiapine (12.8%) and acetylsalicylic acid (11.6%), respectively. Around 45.2% of the PIMs should be avoided in older people, especially sertraline (14.2%) and clonazepam (7.4%). After adjusted analysis, the PIMs were associated with the diagnosis of depression (P = 0.010) and the number of comorbidities (P = 0.005).There was a high number of PIMs among older people, a substantial number of which should have been avoided in this population. Health care professionals can apply these findings to improve safety in the use of medications for treating patients with AD.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Prescrição Inadequada/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Brasil , Fármacos Cardiovasculares/efeitos adversos , Fármacos Cardiovasculares/uso terapêutico , Fármacos do Sistema Nervoso Central/efeitos adversos , Fármacos do Sistema Nervoso Central/uso terapêutico , Clonazepam/efeitos adversos , Clonazepam/uso terapêutico , Estudos Transversais , Interações Medicamentosas , Feminino , Humanos , Masculino , Polimedicação , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Sertralina/efeitos adversos , Sertralina/uso terapêutico
18.
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
19.
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
20.
Sr Care Pharm ; 36(4): 187-190, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33766191

RESUMO

Older people are particularly susceptible to acute kidney injury (AKI) for a variety of reasons. Because of this, medication changes during admission and transitions of care follow-up are often necessary to ensure the safety of these patients. The American Geriatrics Society's Beers Criteria provide guidance for select medications that are potentially inappropriate in the older adult population. However, other medications, particularly those for cardiovascular disease and diabetes that are not included in the kidney function-specific section of the Beers Criteria (Table 6), can sometimes be overlooked. This manuscript will provide insight to both pharmacists and student pharmacists on the importance of being vigilant for medications that may need dosage adjustment during episodes of AKI. As interns in the outpatient setting, pharmacy students can provide education to patients and their families in order to ensure these medications are being taken correctly and are properly restarted if their discontinuation was intended for only a short time.


Assuntos
Injúria Renal Aguda/prevenção & controle , Guias como Assunto , Prescrição Inadequada , Transferência de Pacientes , Estudantes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Cálculos da Dosagem de Medicamento , Seguimentos , Hospitais , Humanos , Estados Unidos
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