Refine Search

New Search

Results: 18

(searched for: doi:10.1111/jgs.16413)
Save to Scifeed
Page of 1
Articles per Page
by
Show export options
  Select all
, Xiaomeng Ma, Lisa McCarthy, Terence Tang, Lauren Lapointe-Shaw, Walter P. Wodchis, Olavo Fernandes, Emily G. McDonald
Published: 30 August 2022
Abstract:
Background: Certain combinations of medications can be harmful and may lead to serious drug-drug interactions. Identifying potentially problematic medication clusters could help guide prescribing decisions in hospital. Objectives: To characterize medication prescribing patterns at hospital discharge and determine which medication clusters are associated with an increased risk of adverse drug events (ADEs) in the 30-days post hospital discharge. Methods: All residents of the province of Ontario in Canada aged 66 years or older admitted to hospital between March 2016-February 2017 were included. Identification of medication prescribing clusters at hospital discharge was conducted using latent class analysis. Cluster identification was based on medications dispensed 30-days post-hospitalization. Multivariable logistic regression was used to assess the potential association between membership to a particular medication cluster and ADEs post-discharge, while also evaluating other patient characteristics. Results: 188,354 patients were included in the study cohort. Median age (IQR) was 77 (71-84) and patients had a median (IQR) of 9 (6-13) medications dispensed in the year prior to admission. The study population consisted of 6 separate clusters of dispensing patterns post discharge: Cardiovascular (14%), respiratory (26%), complex care needs (12%), cardiovascular and metabolic (15%), infection (10%) and surgical (24%). Overall, 12,680 (7%) patients had an ADE in the 30-days following discharge. After considering other patient characteristics, those in the respiratory cluster had the highest risk of ADEs (aOR: 1.12, 95% CI: 1.08-1.17) compared to all the other clusters, while those in the neurocognitive & complex care needs cluster had the lowest risk (aOR:0.82, 95% CI: 0.77-0.87). Conclusion: This study suggests that ADEs post hospital discharge are linked to identifiable clusters of medications, in addition to non-modifiable patient characteristics, such as age and certain comorbidities. This information may help clinicians and researchers better understand what patient populations and which types of interventions may benefit patients, to reduce their risk of experiencing an ADE. KEY POINTS This study suggests that ADEs post hospital discharge are linked to identifiable clusters of medications, in addition to non-modifiable patient characteristics, such as age and certain comorbidities. This information may help clinicians and researchers better understand what patient populations and which types of interventions may benefit patients, to reduce their risk of experiencing an ADE. PLAIN LANGUAGE SUMMARY Certain combinations of medications prescribed to patients when they are being discharged from hospital can increase the risk of adverse events after hospital discharge.
Frances Y. Hu, Lynne O'Mara, Samir Tulebaev, Ariela R. Orkaby, Zara Cooper, Rachelle E. Bernacki
Journal of the American Geriatrics Society, Volume 70, pp 2404-2414; https://doi.org/10.1111/jgs.17916

João Delgado, Philip H Evans, Denis Pereira Gray, Kate Sidaway-Lee, Louise Allan, Linda Clare, Clive Ballard, Jane Masoli, Jose M Valderas, David Melzer
British Journal of General Practice, Volume 72; https://doi.org/10.3399/bjgp.2021.0413

Abstract:
Background: Higher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality of care; however, its effects on patients with dementia are mostly unknown.Aim: To estimate the associations between CGPC and potentially inappropriate prescribing (PIP), and with the incidence of adverse health outcomes (AHOs) in patients with dementia.Design and setting: A retrospective cohort study with 1 year of follow-up anonymised medical records from 9324 patients with dementia, aged ≥65 years living in England in 2016.Method: CGPC measures include the Usual Provider of Care (UPC), Bice–Boxerman Continuity of Care (BB), and Sequential Continuity (SECON) indices. Regression models estimated associations with PIPs and survival analysis with incidence of AHOs during the follow-up adjusted for age, sex, deprivation level, 14 comorbidities, and frailty.Results: The highest quartile (HQ) of UPC (highest continuity) had 34.8% less risk of delirium (odds ratio [OR] 0.65, 95% confidence interval [CI] = 0.51 to 0.84), 57.9% less risk of incontinence (OR 0.42, 95% CI = 0.31 to 0.58), and 9.7% less risk of emergency admissions to hospital (OR 0.90, 95% CI = 0.82 to 0.99) compared with the lowest quartile. Polypharmacy and PIP were identified in 81.6% (n = 7612) and 75.4% (n = 7027) of patients, respectively. The HQ had fewer prescribed medications (HQ: mean 8.5, lowest quartile (LQ): mean 9.7, P<0.01) and had fewer PIPs (HQ: mean 2.1, LQ: mean 2.5, P<0.01), including fewer loop diuretics in patients with incontinence, drugs that can cause constipation, and benzodiazepines with high fall risk. The BB and SECON measures produced similar findings.Conclusion: Higher CGPC for patients with dementia was associated with safer prescribing and lower rates of major adverse events. Increasing continuity of care for patients with dementia may help improve treatment and outcomes.
, Parag Goyal, Lan Jiang, Sebhat Erqou, James L. Rudolph, John E. McGeary, Nicole M. Rogus-Pulia, Caroline Madrigal, Lien Quach, Wen-Chih Wu, et al.
Published: 3 January 2022
Journal of General Internal Medicine pp 1-12; https://doi.org/10.1007/s11606-021-07233-2

The publisher has not yet granted permission to display this abstract.
International Journal of Environmental Research and Public Health, Volume 18; https://doi.org/10.3390/ijerph18189606

Abstract:
Identifying determinants of medication non-adherence in patients with multimorbidity would provide a step forward in developing patient-centered strategies to optimize their care. Medication appropriateness has been proposed to play a major role in medication non-adherence, reinforcing the importance of interdisciplinary medication review. This study examines factors associated with medication non-adherence among older patients with multimorbidity and polypharmacy. A cross-sectional study of non-institutionalized patients aged ≥65 years with ≥2 chronic conditions and ≥5 long-term medications admitted to an intermediate care center was performed. Ninety-three patients were included (mean age 83.0 ± 6.1 years). The prevalence of non-adherence based on patients’ multiple discretized proportion of days covered was 79.6% (n = 74). According to multivariable analyses, individuals with a suboptimal self-report adherence (by using the Spanish-version Adherence to Refills and Medications Scale) were more likely to be non-adherent to medications (OR = 8.99, 95% CI 2.80–28.84, p< 0.001). Having ≥3 potentially inappropriate prescribing (OR = 3.90, 95% CI 0.95–15.99, p = 0.059) was barely below the level of significance. These two factors seem to capture most of the non-adherence determinants identified in bivariate analyses, including medication burden, medication appropriateness and patients’ experiences related to medication management. Thus, the relationship between patients’ self-reported adherence and medication appropriateness provides a basis to implement targeted strategies to improve effective prescribing in patients with multimorbidity.
, Hedva Barenholtz Levy
Published: 1 September 2021
The publisher has not yet granted permission to display this abstract.
, Bernice Redley, Barbora de Courten, Elizabeth Manias
Published: 18 May 2021
British journal of clinical pharmacology, Volume 87, pp 4150-4172; https://doi.org/10.1111/bcp.14870

Abstract:
Aims To synthesise associations of potentially inappropriate prescribing (PIP) with health-related and system-related outcomes in inpatient hospital settings. Methods Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health-related and system-related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates. Results Overall, 63 studies were included. Pooled risk estimates did not show a significant association with all-cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90–1.36; adjusted hazard ratio 1.02, 83% CI 0.90–1.16), and hospital readmission (AOR 1.11, 95% CI 0.76–1.63; adjusted hazard ratio 1.02, 95% CI 0.89–1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event-related hospital admissions (AOR 1.91, 95% CI 1.21–3.01), functional decline (AOR 1.60, 95% CI 1.28–2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11–1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health-related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods. Conclusions PIP was significantly associated with a range of health-related and system-related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.
, H. J. Heppner, C. Sieber
Published: 25 February 2021
Journal: Der Internist
Der Internist, Volume 62, pp 363-372; https://doi.org/10.1007/s00108-021-00981-7

The publisher has not yet granted permission to display this abstract.
Floriane Marseau, Joaquim Prud’Homm, Guillaume Bouzillé, Elisabeth Polard, Emmanuel Oger, Dominique Somme, Marie-Noëlle Osmont, Lucie-Marie Scailteux
Journal of patient safety, Volume 18; https://doi.org/10.1097/pts.0000000000000820

Abstract:
Objective The main objective was to assess the feasibility of the trigger tool method for the retrospective detection of adverse drug reactions (ADRs) in the Rennes University Hospital. The secondary objective was to describe the performance of the method in terms of positive predictive values (PPVs) and severity or preventability of ADRs. Methods Using the Rennes University Hospital clinical data warehouse, pharmacovigilance experts performed a retrospective review of a random sample of 30 inpatient hospital medical records per month using the triggers “fall” and “delirium” to identify related ADRs among patients 65 years and older in 2018 in the geriatrics department. Using the Z test, we compared the proportion of medical records with a positive (identified) trigger related to an ADR, which were reviewed within 20 minutes using the reference of 50% reviewed within 20 minutes. Results Among the 355 medical records reviewed, 222 had at least 1 trigger and 98 at least 1 related ADR. Among the 222 positive trigger medical records, 99.6% were reviewed in under 20 minutes (P< 0.001). The pharmacovigilance assessment took 3 months. The PPVs reached 53.9% (46.0%–61.7%) for falls and 21.0% (14.3%–27.5%) for delirium. Among the ADRs, 80% were serious and 53% were preventable. Conclusions Given the low PPV of the triggers used and the considerable need for technical and human resources, the trigger tool method cannot be used as a routine tool at the pharmacovigilance center. However, it could be implemented occasionally for specific purposes such as monitoring the impact of risk minimization measures to prevent ADRs.
Leonie Picton, Jenni Ilomäki, Claire S. Keen, Samanta Lalic, Beverly Adams, Lisa M. Clinnick, Carl M. Kirkpatrick, Taliesin Ryan-Atwood, Justin P. Turner,
Journal of the American Medical Directors Association, Volume 22, pp 117-123.e1; https://doi.org/10.1016/j.jamda.2020.04.033

The publisher has not yet granted permission to display this abstract.
Page of 1
Articles per Page
by
Show export options
  Select all
Back to Top Top