Register-based indicators for potentially inappropriate medication in high-cost patients with excessive polypharmacy

Saastamoinen, Leena; Verho, Jouko

doi:10.1002/pds.3764

Cited by 22 publications

(24 citation statements)

References 30 publications

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“…At a policy level, some of the high medicine use among these patients may be mitigated by identifying low‐cost treatment options for their ongoing drug needs. At a practice level, the critical evaluation of concomitant drug use of many different drug groups and an examination of the quality of pharmaceutical therapy may identify opportunities for deprescribing to improve patient outcomes, reduce risks, and save costs, given that individuals using multiple drugs are at increased risk of medication errors and drug‐related problems (Woodward ; Øymoen, Pottegård, and Almarsdóttir ; Saastamoinen and Verho ).…”

Section: Discussionmentioning

confidence: 99%

High‐Cost Users of Prescription Drugs: A Population‐Based Analysis from British Columbia, Canada

Weymann

Smolina

Gladstone

et al. 2016

Health Services Research

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ObjectiveTo examine variation in pharmaceutical spending and patient characteristics across prescription drug user groups.Data SourcesBritish Columbia's population‐based linked administrative health and sociodemographic databases (N = 3,460,763).Study DesignWe classified individuals into empirically derived prescription drug user groups based on pharmaceutical spending patterns outside hospitals from 2007 to 2011. We examined variation in patient characteristics, mortality, and health services usage and applied hierarchical clustering to determine patterns of concurrent drug use identifying high‐cost patients.Principal FindingsApproximately 1 in 20 British Columbians had persistently high prescription costs for 5 consecutive years, accounting for 42 percent of 2011 province‐wide pharmaceutical spending. Less than 1 percent of the population experienced discrete episodes of high prescription costs; an additional 2.8 percent transitioned to or from high‐cost episodes of unknown duration. Persistent high‐cost users were more likely to concurrently use multiple chronic medications; episodic and transitory users spent more on specialized medicines, including outpatient cancer drugs. Cluster analyses revealed heterogeneity in concurrent medicine use within high‐cost groups.ConclusionsWhether low, moderate, or high, costs of prescription drugs for most individuals are persistent over time. Policies controlling high‐cost use should focus on reducing polypharmacy and encouraging price competition in drug classes used by ordinary and high‐cost users alike.

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Section: Discussionmentioning

confidence: 99%

High‐Cost Users of Prescription Drugs: A Population‐Based Analysis from British Columbia, Canada

Weymann

Smolina

Gladstone

et al. 2016

Health Services Research

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“…1 Concurrent treatment with several drugs, known as polypharmacy, is costly for society and comprises a risk for medication interactions, adverse effects, hospitalizations, and increased mortality. 2 Excessive or severe polypharmacy (ie ≥10 medicine) is strongly associated with inappropriate medication use 3,4 and might represents a large pill burden to patients. Results from prior studies indicate that it can be beneficial to decrease the number of medications among multimorbid patients to reduce the risk of medication-related harms.…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and medication deprescribing: A survey among multimorbid older adults in Denmark

Schiøtz

Frølich

Jensen

et al. 2018

Pharmacology Res & Perspec

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Polypharmacy is common among multimorbid adults and associated with increased morbidity and mortality. Excessive polypharmacy (ie, ≥10 medicine) is strongly associated with inappropriate medication use, but little is known about attitudes toward deprescribing in patients with excessive polypharmacy. We surveyed 100 Danish individuals aged 65 years and above with ≥10 prescribed medications, using the validated Patients’ Attitudes Towards Deprescribing (PATD) instrument. Most participants (81, 81%) thought they took a large number of medications, and 79 (79%) believed that their medications were necessary. Even so, 85 (85%) reported that they would be willing to stop taking one or more of their regular medications if their doctor told them they could, and 11 (11%) felt that they took at least one regular medication that they no longer needed. When presented with visual presentation of various amounts of tablets and capsules, 62 (62%) of participants reported that they would be comfortable taking fewer medications than they did. Forty‐two (42%) participants had experience with stopping a regular medication. Almost all participants (92%) wanted to receive follow‐up by various means if a medication was discontinued. Forty‐one (41%) participants were interested in a consultation at an outpatient clinic specializing in polypharmacy. Overall, the answers to the PATD questionnaire suggest that our cohort of Danish, multimorbid outpatients with extensive polypharmacy have a high confidence in their healthcare providers for medication‐related decisions, even though some feel that they are taking more medications than they would like to and feel that some medications may be unnecessary. Our results underline the need for healthcare providers to offer medication reviews in patients with multimorbidity.

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“…Furthermore, while polypharmacy is a common phenomenon in aged populations because of multimorbidity, it is associated with inappropriate drug use and drug interactions leading to an increased risk of adverse drug reactions/events and indices of morbidity and mortality, especially among the very old 6–8. Potentially inappropriate medication (PIM) is defined as:

A drug in which the risk of an adverse event outweighs its clinical benefit, particularly when there is a safer or more effective alternate therapy for the same condition 9

…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria

Zeenny¹,

Wakim²,

Kuyumjian³

2017

CIA

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BackgroundPotentially inappropriate medications (PIMs) should be avoided by the aged population. The aim of this study was to assess the prevalence of PIMs among Lebanese aged outpatients using Beers criteria of 2012. The secondary objectives were to identify the correlates of the PIMs use and to compare the PIMs prevalence rates as per Beers criteria of 2003 and 2012.MethodsThis cross-sectional observational study was conducted among aged outpatients of different accredited community pharmacies across Lebanon. Data were collected through a validated questionnaire. The Beers criteria of 2012 were used to evaluate PIMs. The association between PIMs used and independent variables were analyzed by logistic regression. The differences between PIMs use according to Beers criteria 2003 and 2012 were calculated using chi-squared and McNemar’s tests.ResultsA total of 248 outpatients were analyzed. We identified 112 (45.2%) out of 248 patients taking PIMs. The leading classes of medications identified to cause PIMs were those acting on the central nervous system (71.4%). The factors associated with PIMs use were age, osteoporosis, Alzheimer/dementia, diabetes, and alcohol consumption. PIMs use increased significantly between Beers criteria 2003 and 2012 (Chi-squared test, P<0.001; McNemar’s test, P<0.001).ConclusionOur study showed a high prevalence of PIMs use in Lebanon, which is associated with various correlates. Education of health care providers and medication review should be considered to improve medication safety of older adults.

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Register-based indicators for potentially inappropriate medication in high-cost patients with excessive polypharmacy

Abstract: Excessive polypharmacy with inappropriate medication use should be prevented using all the methods. The patients with excessive polypharmacy and high-drug costs provide a most interesting group for containing pharmaceutical costs via medication reviews.

Cited by 22 publications

References 30 publications

High‐Cost Users of Prescription Drugs: A Population‐Based Analysis from British Columbia, Canada

High‐Cost Users of Prescription Drugs: A Population‐Based Analysis from British Columbia, Canada

Polypharmacy and medication deprescribing: A survey among multimorbid older adults in Denmark

Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria

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