Review of Clinical Questions Submitted to Norwegian Drug Information Centres Concerning Administration and Dosage to Older Patients of Relevance to Patient-Centric Care

Abstract

Patient-centric care entails optimising healthcare provision to patients based on their perspective and opinion. It involves appropriate treatment at a reasonable cost and a focus on patient characteristics in the decision-making process to make it more personally useful. The optimisation of medicines in the older population is a challenge due to physiological changes, comorbidity, and polypharmacy. Furthermore, patient-centric care is difficult to achieve due to the high proportion of patients with dementia and frailty. Decision support concerning the appropriateness of indication, formulation, dose, administration, co-prescribing, and length of treatment to older patients is frequently in demand. In the current study, we aimed to review clinical questions concerning administration and dosage to older patients of relevance to patient-centric care. We analysed questions concerning medicines to patients 65 years or older in the database of the network of Norwegian drug information centres from 2010 to 2020. The analysis included the distribution of drugs, diseases, and recurring topics among the questions. Through a Boolean search that combined the indexed categories of “older” and “administration and dosage”, we retrieved 84 question-answer pairs. Questions about psychotropic and cardiovascular drugs in relation to therapy, adverse drug reactions, and pharmacokinetics dominated, and more than 60% of the questions came from physicians. Topics relevant to patient-centric pharmacotherapy were drug withdrawal (10 questions), drug formulation (8 questions), drug initiation (8 questions), and switching drugs (5 questions). One question concerned drug withdrawal and switching, and one question drug formulation and switching. Answers provided decision support regarding appropriate formulations of drugs to patients with dementia who chew capsules or tablets, the use of parenteral administration in patients who refuse to take oral formulations, and the pharmacokinetics of transdermal or rectal drug administration. The results highlight the importance of including pharmacological factors in the assessment of the acceptability and appropriateness of oral and parenteral medicine to older patients.

Assessment on the Pattern of Drug Information Queries in a Tertiary Care Hospital, Chennai

“…Physicians were the primary users of this service followed by the Pharmacists and other health-care professionals. This finding is correlated with similar studies conducted by SK S et al (2018)., 7 Andreassen LM et al (2021)., 12 and George B et al (2005)., 13 at drug information centres and is quite different from the multi-centred study conducted in Ethiopia 14 where Pharmacists were the primary drug information users. Most of the queries were received and responded through in-person as DIC is more accessible to everyone.…”

Features of pharmacotherapy at elderly and senile patients

“…в сша от 5 и более лс в неделю принимает свыше 40% пожилых пациентов, при этом около 50% пациентов получает хотя бы одно лишнее лс. Однако проблема полипрагмазии заключается не только в высокой частоте встречаемости этого явления, но и в корректной интерпретации данной дефиниции [2,3,22,23].…”

“…Основными причинами полипрагмазии у пожилых являются одновременно ведение одного пациента врачами разных специальностей, многокомпонентные схемы фармакотерапии в виду низкой эффективности монорежимов, некорректные руководства по лечению различных заболеваний, а также ряд социальноэкономических факторов (самолечение, «агрессивный» маркетинг лс в средствах массовой информации) [22][23][24].…”

“…в частности, нлр у коморбидного пожилого или старческого возраста пациента с полипрагмазией может быть ошибочно принята врачом за новое заболевание, требующее дополнительной фармакологической коррекции (рис. 3) [3,5,6,8,[22][23][24][25][26].…”

“…это усугубляет сложившуюся «картину» лекарственного взаимодействия и приводит к развитию «фармакологических каскадов» (например: амлодипин → отеки → фуросемид → гипокалиемия → препараты калия) [2,3,[22][23][24]26].…”