Abstract:Through this structured review of the published literature, we aimed to provide an up-to-date description of strategies (human-related) and tools (mainly from the digital field) facilitating the appropriateness of drug use in older adults. The evidence of each strategy and tool’s effectiveness and sustainability largely derives from local and heterogeneous experiences, with contrasting results. As a general framework, three main steps should be considered in implementing measures to improve appropriateness: pr… 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.
“…The healthcare professionals who should be involved in the service include physicians in charge of the patient’s care, e.g., general practitioners (GPs), ward physicians, and specialists, then clinical pharmacologists (both pharmacists and physicians), hospital pharmacists with training and experience in clinical pharmacology, and other supporting healthcare professionals, such as nurses and psychologists [ 10 ].…”
Section: Methodology Of Medication Review and Deprescribingmentioning
confidence: 99%
“…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
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.
“…Given the impact of inappropriate prescription in elderly patients, different tools have been proposed to help optimize the use of medications in older patients, such as the Beers criteria, STOPP/START, PRISCUS, Medication Appropriateness Index, Drug Burden Index, and anticholinergic risk scale, to assess the anticholinergic load, among others ( Hilmer et al, 2007 ; Rudolph et al, 2008 ; Lunghi et al, 2022 ; By the 2023 American Geriatrics Society Beers Criteria ® Update Expert Panel, 2023 ; Mann et al, 2023 ; O’Mahony et al, 2023 ). According to the Catalan Health Service instruction 04/2012, all patients on chronic treatment should undergo a pharmacological review at least every year ( Department of Health.…”
Section: Introductionmentioning
confidence: 99%
“…A multidisciplinary approach, with an interprofessional collaboration, allows the sharing of clinical knowledge and different perspectives about institutionalized patients to improve their pharmacological treatments ( Disalvo et al, 2020 ; Lunghi et al, 2022 ; Song et al, 2023 ). Data from patients with the highest multi-morbidity are essential for the provision of adequate healthcare to patients with multiple chronic conditions.…”
Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs.Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug–drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs.Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%.Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.
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