Consensus validation of the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria

Holton, Alice; Gallagher, Paul; Ryan, Cristí­n; Fahey, Tom; Cousins, Gráinne

doi:10.1136/bmjopen-2017-017453

Cited by 22 publications

(18 citation statements)

References 34 publications

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“… 34 35 A study of 844 current drinkers aged 65–74 years in Australia found that older men poured drinks that were 32% larger than a standard drink of 10 g alcohol, with older women pouring drinks that were 16% larger. 36 Furthermore, in the absence of internationally agreed age-specific drinking guidelines, we used national Irish recommendations to define heavy alcohol consumption in the development of the POSAMINO criteria 9 and in this study to classify participants as heavy drinkers. Given that older adults are more vulnerable to harm even at low levels of alcohol consumption, our estimates of POSAMINO may reflect an underestimate of the true prevalence among older adults particularly for those criteria involving heavy alcohol consumption.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

et al. 2020

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ObjectivePrevious prevalence estimates of POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared with dispensing records. This study aims to estimate the prevalence of POSAMINO among community-dwelling older adults using drug dispensing data from the community pharmacy setting.DesignCross-sectional study.SettingIrish Community Pharmacy.Participants1599 consecutive older adults presenting with a prescription to 1 of 120 community pharmacies nationwide; community-dwelling, aged ≥65 years, able to speak and understand English, with no evidence of cognitive impairment. The mean age of sample was 75.5 years (SD 6.5); 55% (n=884) female.Measures38 POSAMINO criteria were identified using participants’ pharmacy dispensing records linked to self-reported alcohol consumption (beverage-specific quantity and frequency measures) over the last 12 months.ResultsThe overall prevalence of POSAMINO in the study population was 28%, with 10% at risk of at least one POSAMINO criteria and 18% at risk of two or more. Exposure to POSAMINO most commonly involved cardiovascular agents (19%) and central nervous system agents (15%). Exposure to a higher number of POSAMINO criteria was associated with younger age (adjusted incident rate ratio (AIRR): 0.97; 95% CI: 0.95 to 0.98), male sex (AIRR: 0.55; 95% CI: 0.45 to 0.67) and a higher number of comorbidities (AIRR: 1.05; 95% CI: 1.01 to 1.13).ConclusionThis study adds to the growing body of evidence, which suggests that older adults are vulnerable to potentially serious alcohol–medication interactions, particularly those involving cardiovascular and central nervous system agents, increasing their risk of orthostatic hypotension, gastrointestinal bleeds and increased sedation. Application of the POSAMINO criteria at the point of prescribing may facilitate the risk stratification of older adults and prioritise alcohol screening and brief alcohol interventions in those at greatest risk of harm.

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Section: Discussionmentioning

confidence: 99%

Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

et al. 2020

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“…An international consensus project, using a Delphi methodology could be organised to reach consensus regarding the most clinically appropriate definition of retention. The Delphi methodology allows a consensus opinion to be reached among a panel of experts through an interactive process of questionnaires [108]. A pooled analysis of individual level data from multiple cohorts, particularly those using similar methods to ascertain outcome such as prescription refill data, could also be undertaken to inform an internationally agreed definition.…”

Section: Clinical Implications and Areas For Future Researchmentioning

confidence: 99%

Retention of patients in opioid substitution treatment: A systematic review

et al. 2020

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Background Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. Methods A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. Results 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. Conclusions Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.

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“…5 Interactions can occur across a range of common medications for long term conditions, including cardiovascular diseases, pain, depression, diabetes, musculoskeletal conditions, infections, and cancer. 6 Medications that interact with alcohol are widely prescribed to people who drink alcohol. 7 Alcohol can also have a direct and adverse effect on many conditions for which medications are prescribed, even when consumption is lower than that which is defined as low risk in drinking guidelines.…”

Section: Health Risksmentioning

confidence: 99%