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Abstract:The ageing process is associated with an increased probability of accumulating health deficits, chronic conditions and geriatric syndromes, leading to a growing prevalence of multimorbidity, defined as the co-occurrence of two or more chronic conditions (of which, at least one physical condition). One of the most frequent and direct consequences of multimorbidity, especially amongst older adults, is polypharmacy, a condition characterized by the concomitant use of five or more drugs per day. Polypharmacy is on… Show more
“…These interventions require key steps to be implemented: 1. sharing among the whole care team (clinicians, general practitioners, nurses, pharmacists) criteria to be used in the identification of the inappropriate use of a drug, 2. medication reviewing supported by digital tools, and 3. therapeutic changes, including the definition of patient’s follow-up, shared with patient and caregiver. The use of educational interventions and computerized prescription of drugs, which informatic tools may support, could stimulate this type of action and not only be applied at the nursing home level but also exported to other care settings ( Lunghi et al, 2022 ; Crisafulli et al, 2022 ). A multicenter, prospective pilot study confirms that the combination of educational programs and informatic media can reduce the use of potentially inappropriate drugs in care homes ( Pasina et al, 2016 ).…”
Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies.Objectives: This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs).Methods: Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used.Results: In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses—DDDs/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs/100 days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs/100 days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs/100 days of NH stay.Conclusion: The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness.
“…These interventions require key steps to be implemented: 1. sharing among the whole care team (clinicians, general practitioners, nurses, pharmacists) criteria to be used in the identification of the inappropriate use of a drug, 2. medication reviewing supported by digital tools, and 3. therapeutic changes, including the definition of patient’s follow-up, shared with patient and caregiver. The use of educational interventions and computerized prescription of drugs, which informatic tools may support, could stimulate this type of action and not only be applied at the nursing home level but also exported to other care settings ( Lunghi et al, 2022 ; Crisafulli et al, 2022 ). A multicenter, prospective pilot study confirms that the combination of educational programs and informatic media can reduce the use of potentially inappropriate drugs in care homes ( Pasina et al, 2016 ).…”
Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies.Objectives: This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs).Methods: Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used.Results: In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses—DDDs/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs/100 days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs/100 days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs/100 days of NH stay.Conclusion: The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness.
“…In general, the process should rely on validated tools and algorithms, and be structured in four sequential phases (Fig. 1 ): 1. pharmacotherapeutic history; 2. pharmacotherapeutic analysis; 3. multidisciplinary pharmacotherapeutic plan; and 4. follow-up [ 1 , 6 , 8 , 10 ]. Fig.…”
Section: Methodology Of Medication Review and Deprescribingmentioning
confidence: 99%
“…Due to higher susceptibility to adverse health outcomes, these adults often struggle with diminished physical resilience, functional limitations, and multiple comorbidities. Addressing the unique needs of frail patients is a crucial aspect of modern healthcare, aiming to optimize their health and ensure quality of life [ 6 ].…”
Section: Target Populationmentioning
confidence: 99%
“…Therefore, it is crucial to implement preventive strategies to reduce PIPs and to simplify patients’ daily therapeutic regimens. Medication review and deprescribing is a two-step patient-centred approach aiming at optimising the use of medicines through a systematic and periodic evaluation of pharmacological therapies (medication review) received by a patient and the judicious withdrawal or dose reduction of medications that are either inappropriate or unnecessary (deprescribing) [ 6 ]. Medication review can be categorized into different levels: unstructured and/or opportunistic (ad hoc, level 0), technical review of list of patient’s medicines (prescription review, level 1), review of medicines with patient’s full notes (treatment review, level 2), face-to-face review of medicines and condition (clinical medication review, level 3) [ 7 ].…”
Section: Introductionmentioning
confidence: 99%
“…To optimize polypharmacy, it is necessary to assess the patient’s medication list, identifying both unnecessary drug prescriptions (overtreatment) as well as potential undertreatment. This evaluation should consider individual patients’ care goals, clinical conditions, life expectancy, and preferences [ 6 ].…”
Recent medical advancements have increased life expectancy, leading to a surge in patients affected by multiple chronic diseases and consequent polypharmacy, especially among older adults. This scenario increases the risk of drug interactions and adverse drug reactions, highlighting the need for medication review and deprescribing to reduce inappropriate medications and optimize therapeutic regimens, with the ultimate goal to improving patients’ health and quality of life. This position statement from the Italian Scientific Consortium on medication review and deprescribing aims to describe key elements, strategies, tools, timing, and healthcare professionals to be involved, for the implementation of medication review and deprescribing in different healthcare settings (i.e., primary care, hospital, long-term care facilities, and palliative care). Challenges and potential solutions for the implementation of medication review and deprescribing are also discussed.
ImportanceProton pump inhibitors (PPIs) are a widely prescribed class of drugs, potentially interacting with a large number of medicines, especially among older patients with multimorbidity and polypharmacy. Beyond summary of product characteristics (SPCs), interaction checkers (ICs) are routinely used tools to help clinicians in medication review interventions.ObjectiveTo assess the consistency of information on drugs potentially interacting with PPIs as reported in their SPCs and different ICs.Design, Setting, and ParticipantsThis cross-sectional study was conducted using data from SPCs for 5 PPIs (omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole) and 5 ICs (ie, INTERCheck WEB, Micromedex, Lexicomp, Epocrates, and drugs.com). Information from the SPCs and the ICs were extracted between July 15 and 30, 2023.Main Outcomes and MeasuresThe main outcome was the level of agreement among SPCs and the 5 ICs in identifying drugs potentially interacting with PPIs and attributing drug-drug interaction (DDI) severity categories. The level of agreement was computed using Gwet AC1 statistic on the 5 ICs and by comparing 4-sets and 2-sets of ICs. As a sensitivity analysis, the level of agreement in listing PPI-related DDIs was evaluated using Cohen κ and Fleiss κ coefficients.ResultsConsidering SPCs and the 5 ICs, a total of 518 potentially interacting drugs with omeprazole were reported, 455 for esomeprazole, 433 for lansoprazole, 421 for pantoprazole, and 405 for rabeprazole. As compared with the ICs, the SPCs reported a much smaller number of drugs potentially interacting with PPIs, with proportions ranging from 2.7% (11 potentially interacting drugs) for rabeprazole to 7.6% (33 potentially interacting drugs) for lansoprazole of the total identified drugs at risk of interaction with a PPI. The overall level of agreement among the 5 ICs for identifying potential interactions was poor (from 0.23 [95% CI, 0.21-0.25] for omeprazole to 0.27 [95% CI, 0.24-0.29] for pantoprazole and 0.27 [95% CI, 0.25-0.29] for rabeprazole). Similarly, the level of agreement was low in 4-set and 2-set analyses as well as when restricting the analysis to the potential DDIs identified as severe (range, 0.30-0.32).Conclusions and RelevanceThis cross-sectional study found significant disagreement among different ICs and SPCs, highlighting the need to focus on standardizing DDI databases. Therefore, to ensure evaluation and prevention of clinically relevant DDIs, it is recommended to revise multiple ICs and consult with specialists, such as clinical pharmacologists, particularly for patients with complex medical conditions.
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