Polypharmacotherapy is a major concern in the elderly and especially in older women after the age of 80. It results from the intake of prescription and non-prescription drugs, being often a problem of evidence-based therapy. Besides the fact that women live longer than men and outnumber them, reasons for polypharmacy in women are diverse and include a different attitude towards intake of drugs between men and women, the propensity of women to rather see a physician and talk about their problems, the load of family responsibility as women are the main caregivers within a family, the influence of physician sex on patient care, the level of education, social deprivation and self-rated health. Women are more often prescribed potentially inappropriate medication and more often become victims of adverse drug reactions. This is not only due to the number and quality of drugs prescribed but also to differences in pharmacokinetics and - dynamics which make them more vulnerable to drug exposure. Thus, inappropriate prescribing contributes to hospitalization, poor quality of life, costs, compliance issues and poor outcomes. More preclinical and clinical studies with elderly patients and especially elderly women are needed to study the underlying mechanisms of the pharmacologic differences and obtain more insight into the difference in risk between men and women. Attention to prescribing of medications, consistent review of medication lists, and reevaluation of indications and outcomes of prescribing are essential to ensure that drugs are used appropriately in elderly women, polypharmacy is minimized and safety for patients is maximized.
Background In a study evaluating polypharmacy in a cohort of older internal-medicine patients in Austria, inappropriate prescribing and adverse drug events (ADEs) were highly prevalent. According to the literature, computerised physician order entry systems (CPOESs) improve medication safety. Purpose To implement a CPOES and to evaluate its benefit and acceptance. Materials and methods A study group of 3 clinical pharmacists, 2 cardiologists and a study nurse implemented and evaluated the Rp-Doc CPOES on two surgical, two internal and one neurological ward from November 2009 to April 2010. Depending on the ward, the support given by the study group in entering data into the system was organised differently. The acceptance of Rp-Doc by its users was evaluated by a questionnaire. Results During the study period, 1259 patients were admitted. The medication of 560 patients (44%) was documented and analysed by Rp-Doc. Depending on the support that was given, Rp-Doc was used more or less (28-65%). Rp-Doc identified potential drug-drug interactions, wrong doses, duplicated medicines, contraindications and inappropriate medicines. In a questionnaire returned by 18 users, the time that was needed to document the data was considered too long, the alert overkill concerning potential drug-drug interactions and the lack of recommendation of alternatives in case a drug was considered inappropriate were criticised. The information regarding dosing, contraindications and drug adjustment in renal failure was appreciated. The majority felt that the system increased their vigilance regarding drug-drug interactions (69%), ADEs (58%), prescribing in the older (50%) and awareness of cost (27%). There was a lack of personal computers, staff and time to really use the advantages of the CPOES. Conclusions To implement a CPOES successfully, sufficient professional support and adequate infrastructure are necessary. Once implemented, it would improve medication safety and help to identify those patients who are in greatest need of pharmaceutical care.
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