Medication review by GPs reduces polypharmacy in the elderly: A quality use of medicines program

2004 ◽  
Vol 10 (1) ◽  
pp. 78 ◽  
Author(s):  
Patrick GM Bolton ◽  
Steven W Tipper ◽  
Judith L Tasker
Keyword(s):  
Medication Review ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Median Number ◽  
Quality Assurance Program ◽  
Care Needs ◽  
Quality Use Of Medicines ◽  
Assisted Gps ◽  
Medication Reviews ◽  
Complex Care Needs

This paper describes a Quality Use of Medicines program, addressing polypharmacy in the elderly through a quality assurance program that assisted GPs to improve their prescribing through medication reviews. Sixty-two GPs from four Divisions of General Practice each enrolled up to 12 of their patients aged over 65 for medication review. Data about the total number of medications, and number and dosage of selected cardiovascular and psychotropic medications taken by these patients, were collected. A statistically significant reduction in the total number of medications (p < 0.00005), and the dose (p = 0.028) and number (p = 0.0077) of benzodiazepines, and an increase in the number of Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants (p = 0.0075) were observed. We conclude that these results suggest that medication review by GPs on patients who have complex care needs can be associated with a reduction in the median number of medications that these patients take.

scholarly journals Type 1 medication review based on a pharmacy’s electronic medication records: first steps towards an algorithm to stratify patients for tailored pharmacy services

2021 ◽  
Vol 18 (1) ◽  
pp. 1-15
Author(s):  
Ligia Reis ◽  
Miguel Monteiro ◽  
Luis Lourenço ◽  
João Gregório
Keyword(s):  
Medication Review ◽  
Median Number ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Convenience Sample ◽  
Knowledge Based ◽  
Inappropriate Drugs ◽  
Medication Reviews ◽  
Definition Of

Algorithms, queries, and knowledge-based systems are among approaches to screen electronic patient records stored in databases and support pharmacist medication reviews. The aim of this study was to perform a type 1 medication review and identify clusters that enable the definition of an algorithm to tailor pharmacy professional interv A retrospective observational study was conducted on a convenience sample of pharmacy records. Records were included if patients had a medication dispensing history between June 2017 - July 2018 and used two or more chronic medications. Statistical analysis used a two-step cluster to identify common characteristics among fifty-five sets of patient records which underwent Type 1 medication review. The median number of drugs used per patient was five [IQR: 3.0 – 7.0]. 18.2% of patients had inappropriate drugs, and 30.9% had moderate or major interaction potential. Four clusters were identified based on the variables of interactions, number of drugs used, contraindications, Beers criteria and measurable biomarkers, allowing to envision possible pharmaceutical interventions, as well as the priority in providing that intervention. The identification of patient clusters via medication review of electronic records of pharmacy patients supports the design of criteria-based algorithms, likely to be automated.

ASSOCIATIONS BETWEEN FRAILTY, COMPLEX CARE NEEDS AND QUALITY OF LIFE IN MULTI-MORBID OLDER PEOPLE

2014 ◽  
pp. 1-6
Author(s):  
N. BLEIJENBERG ◽  
V.H. TEN DAM ◽  
I. DRUBBEL ◽  
M.E. NUMANS ◽  
N.J. DE WIT ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
The Elderly ◽  
Complex Care ◽  
Care Needs ◽  
Self Assessment ◽  
Primary Care Practices ◽  
Complex Care Needs ◽  
The Relationship

Background:Little is known regarding the complex care needs, level of frailty or quality of life ofmulti-morbid older patients. Objectives:The objective of this study was to determine the relationship betweenfrailty, complexity of care and quality of life in multi-morbid older people. Design:Cross-sectional study.Setting: Thirteen primary care practices in the Netherlands. Participants:1,150 multi-morbid older people livingin the community. Measurements:The level of frailty was assessed with the Groningen Frailty Indicator.Complexity of care needs was measured with the Intermed for the Elderly Self-Assessment. Quality of life (QoL)was measured with two items of the RAND-36. Results:In total, 758 out of 1,150 (65.9%) patients were frail,8.3% had complex care needs, and the mean QoL score was 7.1 (standard deviation 1.2). Correlations betweenfrailty and complexity, frailty and QoL, and complexity of care and QoL were 0.67, -0.51 and -0.52 (all p<0.001)respectively. All patients with complex care needs were frail, but, only 12.5% of the frail patients had complexcare needs. Problems at climbing up stairs was associated with higher levels of frailty and complexity of care butwith a lower QoL. Conclusions:Higher levels of frailty and complexity of care are associated with a lower QoLin multi-morbid older people. The results of this study contribute to a better understanding these concepts and arevaluable for the development of tailored interventions for older persons in the future.

scholarly journals System models for resilience in gerontology: application to the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katarzyna Klasa ◽  
Stephanie Galaitsi ◽  
Andrew Wister ◽  
Igor Linkov
Keyword(s):  
The Elderly ◽  
System Level ◽  
Improve Quality ◽  
Care Needs ◽  
Individual Level ◽  
Chronic Stressors ◽  
The World ◽  
Aging Adults ◽  
The Individual

AbstractThe care needs for aging adults are increasing burdens on health systems around the world. Efforts minimizing risk to improve quality of life and aging have proven moderately successful, but acute shocks and chronic stressors to an individual’s systemic physical and cognitive functions may accelerate their inevitable degradations. A framework for resilience to the challenges associated with aging is required to complement on-going risk reduction policies, programs and interventions. Studies measuring resilience among the elderly at the individual level have not produced a standard methodology. Moreover, resilience measurements need to incorporate external structural and system-level factors that determine the resources that adults can access while recovering from aging-related adversities. We use the National Academies of Science conceptualization of resilience for natural disasters to frame resilience for aging adults. This enables development of a generalized theory of resilience for different individual and structural contexts and populations, including a specific application to the COVID-19 pandemic.

scholarly journals Registered nurses’ role experiences of caring for older stroke patients: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei Cheng ◽  
Jiong Tu ◽  
Xiaoyan Shen
Keyword(s):  
Nursing Education ◽  
Older People ◽  
Registered Nurses ◽  
Elderly Care ◽  
The Elderly ◽  
Working Environment ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Care Needs ◽  
Nursing Clinical Practice

Abstract Background With China’s population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses’ experiences of caring for older stroke patients. Methods A qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data. Results Two main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people’s needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment. Conclusions Sustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses’ lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

scholarly journals An Interdisciplinary Response to a Tobacco Cessation Case Vignette

2016 ◽  
Vol 12 (3) ◽  
pp. 153-164
Author(s):  
Chad D. Morris ◽  
Donna L. Richardson ◽  
Jill M. Loewen ◽  
Laura C. Vanheest ◽  
Angela Brumley-Shelton ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Tobacco Cessation ◽  
Interdisciplinary Approach ◽  
Chronic Illnesses ◽  
Mental Illnesses ◽  
Case Vignette ◽  
Care Needs ◽  
Healthcare Settings ◽  
Tobacco Treatment ◽  
Complex Care Needs

Introduction:Tobacco use is a chronic, relapsing condition. While there are proven cessation medications and counselling treatments, uptake of available aids is poor and smokers often do not have access to evidence-based services.Aims:The Association for the Treatment of Tobacco Use and Dependence (ATTUD) is an organisation of tobacco treatment specialists (TTSs) representing a wide array of disciplines and healthcare settings. This case vignette was intended to provide a clinical example of an interdisciplinary approach to tobacco use treatment.Methods:ATTUD Interdisciplinary Committee members representing tobacco-cessation experts from five professions were asked to respond to the same composite case vignette detailing key areas of clinical consideration and treatment.Results/Findings:While there were common treatment themes across professions, each provider also offered a unique treatment perspective addressing different facets of the patient's complex care needs, including attention to other chronic illnesses, mental illnesses, and preventive services. Expert responses highlighted that different treatment approaches across a continuum of healthcare settings are complementary.Conclusions:Responses to this vignette support the need to address tobacco use from an interdisciplinary approach. Existing chronic care and patient-centred models should be utilised to ensure that tobacco users receive a sufficient range of cessation services.

scholarly journals Nurses and care delivery to elderly women: a social phenomenological approach

2012 ◽  
Vol 20 (5) ◽  
pp. 888-895 ◽  
Author(s):  
Sebastião Caldeira ◽  
Miriam Aparecida Barbosa Merighi ◽  
Luz Angelica Muñoz ◽  
Maria Cristina Pinto de Jesus ◽  
Selisvane Ribeiro da Fonseca Domingos ◽  
...  
Keyword(s):  
Professional Training ◽  
Phenomenological Study ◽  
Elderly Women ◽  
Care Delivery ◽  
Methodological Approach ◽  
The Elderly ◽  
Phenomenological Approach ◽  
Care Needs ◽  
Social Actors ◽  
Action Strategies

OBJECTIVE: To understand how nurses see care delivery to elderly women. METHODS: In this phenomenological study, ten nurses working at Primary Health Care Units were interviewed between September 2010 and January 2011. RESULTS: In care delivery, nurses consider the elderly women's knowledge background and biographical situation, and also value the family's participation as a care mediator. These professionals have the acuity to capture these women's specific demands, but face difficulties to deliver care to these clients. Nurses expect to deliver qualified care to these women. CONCLUSION: The theoretical and methodological approach of social phenomenology permitted revealing that the nurse designs qualified care to elderly women, considering the possibilities in the context. This includes the participation of different social actors and health sectors, assuming collective efforts in action strategies and professional training, in line with the particularities and care needs of elderly women nurses identify.

scholarly journals Choosing the Best and Scrambling for the Rest: Hospital–Nursing Home Relationships and Admissions to Post-Acute Care

2018 ◽  
Vol 38 (4) ◽  
pp. 479-498 ◽  
Author(s):  
Renée Shield ◽  
Ulrika Winblad ◽  
John McHugh ◽  
Emily Gadbois ◽  
Denise Tyler
Keyword(s):  
Skilled Nursing Facility ◽  
Care Needs ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Referral Rates ◽  
Hospital Nursing ◽  
Complex Patients ◽  
Hospital Referral ◽  
Complex Care Needs

Objective: We explored post–Affordable Care Act hospital and skilled nursing facility (SNF) perspectives in discharge and admission practices. Method: Interviews were conducted with 138 administrative personnel in 16 hospitals and 25 SNFs in eight U.S. markets and qualitatively analyzed. Results: Hospitals may use prior referral rates and patients’ geographic proximity to SNFs to guide discharges. SNFs with higher hospital referral rates often use licensed nurses to screen patients to admit more preferred patients. While SNFs with lower hospital referral rates use marketing strategies to increase admissions, these patients are often less preferred due to lower reimbursement or complex care needs. Conclusion: An unintended consequence of increased hospital-SNF integration may be greater disparity. SNFs with high hospital referral rates may admit well-reimbursed or less medically complex patients than SNFs with lower referral rates. Without policy remediation, SNFs with lower referral rates may thus care for more medically complex long-term care patients.

Health Status Transitions in Community-Living Elderly with Complex Care Needs

2011 ◽  
pp. 223-247
Author(s):  
Louise Lafortune ◽  
François Béland ◽  
Howard Bergman ◽  
Joël Ankri
Keyword(s):  
Health Status ◽  
Community Living ◽  
Complex Care ◽  
Care Needs ◽  
Complex Care Needs
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