Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients

Regueiro, Rebeca Fernández; Menendez, Carlos E.; Tassa, J. Morís de la

doi:10.1016/j.rceng.2018.12.013

Cited by 8 publications

(10 citation statements)

References 31 publications

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“…More importantly, Najjar et al involved -in addition to the educational intervention-a clinical pharmacist's intervention where the clinical pharmacist reviewed the medications and gave recommendations to the physicians who accepted 61.83% of the proposed recommendations. Similarly, the review of medications by a medical interest was effective in reducing PIMs of discharged older patients in Spain [44].…”

Section: Musculoskeletal Systemmentioning

confidence: 98%

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Akkawi

Mohamed

Aris

2020

J of Pharm Policy and Pract

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Background: Potentially inappropriate prescribing (PIP) is associated with the incidence of adverse drug reactions, drug-related hospitalization and other negative outcomes in older adults. After hospitalization, older adults might be discharged with several types of PIPs. Studies have found that the lack of healthcare professionals' (HCPs) knowledge regarding PIP is one of the major contributing factors in this issue. The purpose of this study is to investigate the impact of a multifaceted intervention on physicians' and clinical pharmacists' behavior regarding potentially inappropriate medication (PIM) and potential prescribing omission (PPO) among hospitalized older adults. Methods: This is a before-and-after study that took place in a tertiary Malaysian hospital. Discharge medications of patients ≥65 years old were reviewed to identify PIMs/PPOs using version 2 of the STOPP/START criteria. The prevalence and pattern of PIM/PPO before and after the intervention were compared. The intervention targeted the physicians and clinical pharmacists and it consisted of academic detailing and a newly developed smartphone application (app). Results: The study involved 240 patients before (control group) and 240 patients after the intervention. The prevalence of PIM was 22% and 27% before and after the intervention, respectively (P = 0.213). The prevalence of PPO in the intervention group was significantly lower than that in the control group (42% Vs. 53.3%); P = 0.014. This difference remained statistically significant after controlling for other variables (P = 0.015). The intervention was effective in reducing the two most common PPOs; the omission of vitamin D supplements in patients with a history of falls (P = 0.001) and the omission of angiotensin converting enzyme inhibitor in patients with coronary artery disease (P = 0.03). Conclusions: The smartphone app coupled with academic detailing was effective in reducing the prevalence of PPO at discharge. However, it did not significantly affect the prevalence or pattern of PIM.

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Section: Musculoskeletal Systemmentioning

confidence: 98%

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Akkawi

Mohamed

Aris

2020

J of Pharm Policy and Pract

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“…All 40 studies had been published in the period 2011-19, and the majority (n = 31) had been published in the 5 years immediately prior to the conduct of the synthesis (Table 5). The studies had been conducted in Europe [mainly Spain (n = 13), 51,53,56,58,60,61,73,79,[84][85][86][87][88] Belgium (n = 5) 49,55,57,74,78 and Ireland (n = 3)],…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

“…The majority of studies had been conducted in hospitals, most frequently across multiple departments (n = 25). 49,52,[54][55][56][57][58]60,64,[66][67][68][69][70][71][72][73][74]77,78,80,82,83,85,87 Other studies were conducted in nursing homes (n = 9), 59,61,62,65,75,79,81,84,88 primary care (n = 5) 50,51,53,63,86 or a community pharmacy (n = 1) 76 . The majority of studies (n = 29) 49, 51-53,56-59,62,65,68-71,73-77,79,81-88 used both STOPP and START tools.…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

“…The quality appraisal of the studies has been presented in separate tables. For nonrandomised studies, out of 28 studies, 18 studies 49,[56][57][58][59][60][61][62][63][64][65]68,69,74,75,77,79,85 were scored as being of high quality and 10 studies 52,66,67,72,76,80,81,[86][87][88] scored as being of medium quality (see Appendix 9, Table 21). For RCTs, out of 12 studies, 11 studies 50,51,[53][54][55]70,71,73,[82][83][84] scored as being of high importance and only one study 78 was scored as being of medium importance (see Appendix 10, Table 22).…”

Section: Critical Appraisalmentioning

confidence: 99%

“…Methodological limitations were found in all the studies, including uncontrolled groups, short follow-ups, small sample sizes, potential selection bias and insufficient information on confounding factors. Furthermore, generalisability was limited, as 25 49,[52][53][54][55]57,58,[60][61][62][64][65][66][67][68][69][70][71][72]74,77,78,80,82,83,85,87 of the 40 studies were conducted in a single institution or hospital or nursing home or clinical units.…”

Section: Critical Appraisalmentioning

confidence: 99%

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STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Gangannagaripalli

Porter

Davey

et al. 2021

Health Serv Deliv Res

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Background Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults. Objectives To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts. Design A realist synthesis. Setting Primary care, hospital care and nursing homes. Patients Patients aged ≥ 65 years. Interventions Any intervention based on the use of the STOPP/START tools. Review methods Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies. Results We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs. Limitations None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse. Conclusions No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings. Study registration This study is registered as PROSPERO CRD42018110795. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.

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Reducción del número de prescripciones inadecuadas: comunicación farmacia-prescriptor

Ena

2019

Revista Clínica Española

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Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients

Cited by 8 publications

References 31 publications

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Reducción del número de prescripciones inadecuadas: comunicación farmacia-prescriptor

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