Age and Sex Patterns of Drug Prescribing in a Defined American Population

Zhong, Wenjun; Kremers, Hilal Maradit; Sauver, Jennifer L. St.; Yawn, Barbara P.; Ebbert, Jon O.; Roger, Véronique L.; Jacobson, Debra J.; McGree, Michaela E.; Brue, Scott M.; Rocca, Walter A.

doi:10.1016/j.mayocp.2013.04.021

Cited by 102 publications

(101 citation statements)

References 33 publications

(48 reference statements)

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“…About two-thirds of the elderly are estimated to have two or more chronic conditions (9,183). Up to three out of four elderly are regularly prescribed one or more medication (6)(7)(8)(9), and up to two thirds have polypharmacy (five or more medications) (9,184,185). Moreover, people over 65 years account for three times as many healthcare expenditures than those individuals younger than 65 years (186), and experience more DRMs, often considered as preventable (43,(50)(51)(52).…”

Section: Rational Of the Thesismentioning

confidence: 99%

“…Antipsychotics>3 months without review 7 Neuroleptics>3 months without review 8 Systemic corticoids>1 year without review 9 2 Excluded in STOPP criteria with diagnosis of glaucoma, cardiac conductive abnormalities, constipation, prostatism or history of urinary retention 3 Excluded in STOPP criteria with diagnosis dementia, chronic glaucoma, chronic constipation, and chronic prostatism 4 Non-indicated in in osteoarthritis in STOPP. Both criteria highlight the inappropriateness of NSAIDs in case of heart failure, hypertension, renal failure 5 Inappropriate indication as hypnotics 6 For ankle edema or as first line therapy in hypertension 7 One month in STOPP criteria 8 One month in STOPP criteria 9 Maintenance therapy for moderate-severe chronic obstructive pulmonary disease in STOPP…”

Section: Appendixmentioning

confidence: 99%

“…Both criteria highlight the inappropriateness of NSAIDs in case of heart failure, hypertension, renal failure 5 Inappropriate indication as hypnotics 6 For ankle edema or as first line therapy in hypertension 7 One month in STOPP criteria 8 One month in STOPP criteria 9 Maintenance therapy for moderate-severe chronic obstructive pulmonary disease in STOPP…”

Section: Appendixmentioning

confidence: 99%

“…More than half of the adult population, and three out of four individuals aged 65 years and older, use at least one prescribed medication, mainly to treat chronic conditions (6)(7)(8)(9)(10). Advances in medication therapies have resulted in major improvements in the prevention and treatment of many diseases (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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Aim:The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods:A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period;PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete vi non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions:A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention.Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs.Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice.In summary, this thesis shows a significant potential for improvements of medication use and outcomes.Key words: Drug-related morbidity, medica...

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Section: Rational Of the Thesismentioning

confidence: 99%

Section: Appendixmentioning

confidence: 99%

Section: Appendixmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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“…A 2009 survey done by the Mayo Clinic illustrated that almost 70% of residents in Olmstead County, Minnesota, took at least one prescription medication during that year with 50% taking a prescription medication in the previous month [5]. In the same study, roughly half of those surveyed took medications from 2 or more drug groups and 20% took medications from 5 or more drug groups.…”

Section: Introductionmentioning

confidence: 99%

Medication Use by Runners in Self-Care Situations

Taylor¹,

Santanello²

2017

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The benefits of running for cardiovascular health have long been established, but no relationship between runners/non-runners and their usage of prescription and over-the-counter (OTC) medications has been established. A comprehensive survey was sent out via Facebook, Inc., to self-identified runners to assess runners' first response to 5 common self-care situations. The results were compared to the national average of the U.S. population who take prescription and OTC medications. What was also assessed was the relationship between average weekly miles run and the likelihood to choose OTC medications. 714 runners, residing predominately in the St. Louis, Missouri metropolitan area, completed the survey and their results were drastically different than the national average use for prescription and OTC medication in the general (non-runners) population. Approximately 30% of the runners in this study are on daily prescription medications versus a national average of 70% of the U.S. population. In each of the 5 common self-care situations, less than 50% of runners chose an OTC medication as their first option for self-care vs. the national average of 80%. Results of the study also showed that runners with a weekly mile average of 30 miles or more were less likely to choose an OTC option for self-care than runners with a weekly average of 15 miles or less. Overall, results of this survey suggest that runners are less likely to take medications and may be healthier than the average U.S. citizen overall.

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