Interventions to reduce the prescription of inappropriate medicines in older patients

Santos, Nathalia Serafim dos; Marengo, Lívia Luize; Barberato‐Filho, Silvio

doi:10.11606/s1518-8787.2019053000781

Cited by 28 publications

(39 citation statements)

References 56 publications

(99 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…and should involve different components (i.e. medication review, education/training, and use different tools/instruments) [ 57 , 58 ]. Such interventions must not only solve medication-related problems (e.g.…”

Section: Discussionmentioning

confidence: 99%

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications

2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications

2021

View full text Add to dashboard Cite

show abstract

“…This high consumption of PIMs needs to be controlled by multi‐pronged approaches to limit its long‐term effects on the patient. A recent systematic review [ 21 ] reported that a combination of interventions is needed to increase the safety of medication use in elderly such as effective medication review by a pharmacist working as part of a multidisciplinary team, training on the use of validated tools for the detection of PIMs and computerized systems with risk alerts to support drug prescription in elderly.…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study

Zahwe

Skouri

Rachidi

et al. 2020

International Journal of Pharmacy Practice

View full text Add to dashboard Cite

Objectives Primary objectives were to evaluate the use of potentially inappropriate medication (PIM) use in elderly heart failure (HF) patients and the factors associated with the number of PIMs. Secondary objectives were to test for the correlation between PIMs and quality of life (QOL) and depression. Methods A cross‐sectional study was conducted among 125 elderly Lebanese HF patients with left ventricular ejection fraction <50%. Data on socio‐demographics, clinical data and medications were collected. Patients were interviewed with Minnesota living with Heart Failure Questionnaire (MLHFQ) and Patient Health Questionnaire‐9 (PHQ‐9). Medication profile per patient was evaluated for PIMs using Beers Criteria. The correlations between the number of PIMs and the MLHFQ, PHQ‐9 and the number of medications were tested using Pearson’s correlation. Linear regression was done to predict the factors associated with the number of PIMs. Key findings Patients were taking a total of 1035 medications with a mean of 8.28 ± 3.14 medications. In total, 80.0% of patients were taking at least one PIM. Diuretics (55.2%) and proton pump inhibitors (41.6%) were most commonly prescribed PIMs. The number of PIMs was moderately correlated with the number of medications and the MLHFQ score. Linear regression showed that the number of medications, age ≥85 years, chronic kidney disease and HF with New York Heart Association III were associated with more PIMs. Conclusions A high percentage of PIMs was found among a sample of elderly Lebanese HF patients. HF multidisciplinary team is needed to control the prescription of PIMs in this vulnerable population.

show abstract

“…Our study showed that while polypharmacy increased for people with diabetes between 2012 and 2016, the prevalence of PIM in older patients with polypharmacy decreased in this period. This suggests that the continuing attention and many initiatives to decrease inappropriate polypharmacy in older patients have had an effect in this population [21]. Studies in the general population using Beers criteria also showed decreasing trends in the annual PIM prevalence between 1995 and 2004 in France [22], and between 2007 and 2014 in US [23].…”

Section: Principal Findings and Their Relationship With The Literaturementioning

confidence: 95%

Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes

Oktora

Alfian

Bos

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective Polypharmacy is common in people with diabetes and associated with the use of potentially inappropriate medication (PIM). This study aimed to assess trends in prevalence of polypharmacy and PIM in older and middle-aged people with diabetes. Methods A repeated cross-sectional study using the University Groningen IADB.nl prescription database was conducted. All people [?]45 years treated for diabetes registered in the period 2012-2016 were included. PIMs were assessed using Beers criteria for people [?]65 years old, and PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria for 45-64 years old. Chi-square tests and regression analysis were applied. Results The prevalence of polypharmacy increased from 56.5% to 58.2% during the study period. In 2016, the prevalence of polypharmacy was 36.9% in the group of 45-54 years old, 50.3% in 55-64 years old, and 66.2% in [?]65 years old. All age-groups showed significant increases. The prevalence of older people with at least one PIM decreased around 3%, while in the middle-aged group this prevalence increased around 1% with a highest level in 2015. The most common PIMs in both age groups were the use of long-term high-dose proton-pump-inhibitors, benzodiazepines, and strong opioids without laxatives. Of those, only benzodiazepines showed a decreasing trend. Conclusions Polypharmacy increased in older and middle-aged people with diabetes. While the prevalence of PIM decreased over time in older age, this trend was not observed in middle-aged people with diabetes. Efforts are needed to decrease the use of PIMs in populations already burdened with many drugs, notably at middle age

show abstract

Interventions to reduce the prescription of inappropriate medicines in older patients

Cited by 28 publications

References 56 publications

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications

Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study

Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes

Contact Info

Product

Resources

About