Effects of medication reviews on use of potentially inappropriate medications in elderly patients; a cross-sectional study in Swedish primary care

Lenander, Cecilia; Bondesson, Åsa Åb; Viberg, Nina; Beckman, Anders; Midlöv, Patrik

doi:10.1186/s12913-018-3425-y

Cited by 58 publications

(74 citation statements)

References 32 publications

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“…We found an average of 7.5 recommendations per patient; all patients had at least one recommendation. This is higher than the average of 1.1-5.9 drug-related problems found in medication reviews performed jointly by a pharmacist and a GP, described in a literature review by Geurts et al [3,[22][23][24][25][26][27][28][29]. Other medication review studies reported between 84% and 98% of patients to have at least one drug-related problem compared with 100% in this study [22,25,29,30].…”

Section: Recommended Changes To Medicationcontrasting

confidence: 64%

Systematic Medication Review in General Practice by an Interdisciplinary Team: A thorough but Laborious Method to Address Polypharmacy among Elderly Patients

et al. 2020

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Polypharmacy increases the risk of hospitalization but may be reduced by medication review. The study objective is to describe and evaluate a method for conducting medication review in general practice by an interdisciplinary medication team of pharmacists and physicians—in this case conducted by a team from the Department of Clinical Pharmacology—based on information concerning medication, diagnosis, relevant laboratory data and medical history supplied by the general practitioner. We discussed the medication review with the patients’ general practitioners and received feedback from them regarding acceptance rates of the recommended changes. Ninety-four patients with a total of 1471 prescriptions were included. A medication change was recommended for nearly half of the prescriptions (48%); at least one change of medication was recommended for all patients. The acceptance rate for recommended medication changes was 55%, corresponding to a mean of 4.2 accepted recommendations per patient. For 18% of all 1471 prescriptions, the general practitioner agreed either to discontinue (stop the medication completely) or reduce the dose of the medication. This method is thorough, but since it requires several healthcare professionals, it is rather time-consuming. There is a need to support medication review in general practice, but although this method may be too time consuming in most cases, it may nevertheless prove to be a useful tool managing the most complicated patients.

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Section: Recommended Changes To Medicationcontrasting

confidence: 64%

Systematic Medication Review in General Practice by an Interdisciplinary Team: A thorough but Laborious Method to Address Polypharmacy among Elderly Patients

et al. 2020

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“…Medication reconciliation at admission and discharge increased signi cantly in the intervention site in phase two in this study. Medication review has been reported to signi cantly improve the appropriateness of prescribing in aged care facilities [14,15] and primary health care [13].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported the effect of interventions on medication safety for older people in the community or primary care settings [12][13][14][15], however this study evaluated the effectiveness of a pharmacist intervention for PWD inpatients and the effect on polypharmacy and PIMS. Medication safety for PWD is particularly important because of the risks associated with medications for PWD.…”

Section: Discussionmentioning

confidence: 99%

“…Where it is possible to reduce medications, the risk for PWD is also reduced. Some previous intervention studies have been conducted to reduce PIMs in community/primary care settings [12][13][14] and nursing homes, for older people [15]; however no studies have been conducted in hospital settings or on PWD for this purpose. Previous studies of older people in non-hospital settings used interventions such as education interventions, medication reviews and collaborative care approaches.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Effect of an Intervention on Potentially Inappropriate Medications (PIMS), Polypharmacy and Anticholinergic Burden Scores for People with Dementia; Results from the SMS Dementia Study†: A Quasi-Experimental Study

Kable¹,

Fraser

Fullerton

et al. 2020

Preprint

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Background People with dementia (PWD) are at risk for medication related harm due to their impaired cognition and frequently being prescribed many medications. Few previous studies of PWD inpatients have been focused on medication safety interventions.This study aimed to evaluate an intervention designed to improve medication safety for people with dementia (PWD) and their carers during an unplanned admission to hospital. This article reports the effect of the intervention on potentially inappropriate medications (PIMs), polypharmacy and anticholinergic burden scores for PWD in the study. Methods A quasi-experimental pre-post design using an intervention site and a control site was conducted in 2017-2019, in a regional area in New South Wales, Australia. PIMs, polypharmacy and anticholinergic burden were measured at admission, discharge and three months after discharge. In addition, medication reconciliation at admission and scoring of pharmacists recommendations using severity and relevance scores were measured. Results There were 628 participants including 350 in the post-intervention phase. Polypharmacy for these admissions was high, and there was approximately 30% reduction in the number of medications at discharge. PIMs at admission were also high, and decreased significantly at discharge however there was no treatment effect associated with the intervention. The mean anticholinergic burden score also decreased significantly between admission and discharge, however, no treatment effect was seen. Conclusions High rates of polypharmacy and PIMs in this study indicate this study population was admitted with multiple comorbidities. Reduced PIMs at discharge were correlated with reduced anticholinergic burden. Medication reconciliation resulted in many recommendations that contributed to the reductions in medications. Although the study did not report a treatment effect, reductions in the number of medications and PIMs reduced medication related risk for PWD. Reduced risks associated with inappropriate or unnecessary medications can reduce hospital admissions and adverse events for PWD. This intervention was feasible to implement, and future multisite studies should be designed to recruit larger study samples to evaluate interventions for improving medication safety for PWD. They should also adopt routine screening for cognitive impairment to identify PWD at admission.

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“…Low prevalence in our study may be attributed to the tertiary care centre, good knowledge and practice among the treating physicians. Good knowledge of drugs and review of medications by the primary physician may improve the use of inappropriate medications in elderly 22 .…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication use in the Elderly in a Tertiary Care Centre in South India

Christopher¹,

Pranita²,

Mathews³

et al. 2018

JIAG

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Introduction-Elderly patients have multiple comorbidities requiring treatment. Drug prescription plays an important role in the care of the elderly. Inappropriate prescribing is considered a major public health issue, given its direct association with substantial morbidity, mortality and health service costs that result from adverse drug reaction. The aim of the present study was to estimate the prevalence of inappropriate medication use in hospitalised elderly, as defined by Beers Criteria 2012. The risk factors associated with the use of potentially inappropriate medications were also evaluated. Materials and Methods-This study was done from April 2013 to August 2014 in the department of Geriatrics of a tertiary care centre in South India. Demographic parameters, comorbidities, pharmacokinetic parameters, cognitive and functional status and details of drugs (over 2 weeks) were collated. Results-Total of 280 hospitalised patients were included. The prevalence of potentially inappropriate medication use in our study was 33.2% as per Beers criteria version 2012. Use of drug with anticholinergic activity was found in 13.4% and among sedatives major contributior were benzodiazepines in 6.5% subjects. Age, depression and polypharmacy were found to be independent risk factors for potentially inappropriate medication use. Conclusion-Present study showed high prevalence of inappropriate drug use in the elderly. Effective intervention to optimise drug prescribing in elderly is therefore needed to prevent adverse drug reactions, drug interactions, cognitive impairment, falls and mortality.

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Effects of medication reviews on use of potentially inappropriate medications in elderly patients; a cross-sectional study in Swedish primary care

Cited by 58 publications

References 32 publications

Systematic Medication Review in General Practice by an Interdisciplinary Team: A thorough but Laborious Method to Address Polypharmacy among Elderly Patients

Systematic Medication Review in General Practice by an Interdisciplinary Team: A thorough but Laborious Method to Address Polypharmacy among Elderly Patients

Evaluation of the Effect of an Intervention on Potentially Inappropriate Medications (PIMS), Polypharmacy and Anticholinergic Burden Scores for People with Dementia; Results from the SMS Dementia Study†: A Quasi-Experimental Study

Potentially Inappropriate Medication use in the Elderly in a Tertiary Care Centre in South India

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