Multimorbidity patterns in chronic older patients, potentially inappropriate prescribing and adverse drug reactions: protocol of the multicentre prospective cohort study MoPIM

IntroductionMultimorbidity is a major challenge for current healthcare systems and professionals. From the different approaches that have been proposed to analyse this issue, the hypothesis of the existence of association patterns of different chronic conditions is gaining visibility. In addition, multimorbidity can be associated to polypharmacy, which can lead to a higher risk of potentially inappropriate prescribing (PIP) and consequently to adverse drug reactions (ADRs). The general objective of this novel study is to identify the association between PIP, multimorbidity patterns, polypharmacy and the presence of ADRs in older patients admitted for exacerbation of chronic diseases.Methods and analysisThe MoPIM (morbidity, potentially inappropriate medication) study is a multicentre prospective cohort study of an estimated sample of 800 older (≥65 years) patients admitted to five general hospitals in Spain due to an exacerbation of a chronic disease. Patients referred to home hospitalisation, admitted due to an acute process or with a fatal outcome expected at the time of admission are excluded. Sociodemographic data, chronic morbidities and geriatric syndromes, number of chronic prescribed medications, PIP at admission to hospital and on discharge, according to the newest screening tool of older screening tool of older person's potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria, and ADRs during hospitalisation are being collected. Multimorbidity patterns will be identified using cluster analyses techniques, and the frequency of polypharmacy, PIP and ADRs will be calculated. Finally, the possible relationship between those indicators will be identified through bivariate and multivariate analyses.Ethics and disseminationThe project has been approved by the clinical research ethics committees of each centre: Comité Ético de investigación Clínica del Parc Taulí, Comitè Ètic d'Investigació Clínica Osona per a la Recerca i Educació Sanitàries (FORES), Comité de Ètica de la Investigación con Medicamentos (CEIm)-Parc de Salut MAR, Comité Ético de Investigación Clínica de Euskadi, Comité de Ética de Investigación del Hospital Universitario de Canarias. The results will be actively and mainly disseminated through publication in peer-reviewed journals and communications in scientific conferences.Trial registration numberNCT02830425.

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Adverse Drug reactions in an Ageing PopulaTion (ADAPT) study protocol: a cross-sectional and prospective cohort study of hospital admissions related to adverse drug reactions in older patients

BMJ Open ◽

10.1136/bmjopen-2017-017322 ◽

2017 ◽

Vol 7 (6) ◽

pp. e017322 ◽

Cited By ~ 2

Author(s):

Caitriona Cahir ◽

Carmel Curran ◽

Catherine Byrne ◽

Caroline Walsh ◽

Anne Hickey ◽

...

Keyword(s):

Cohort Study ◽

Adverse Drug Reactions ◽

Prospective Cohort Study ◽

Study Protocol ◽

Prospective Cohort ◽

Older Patients ◽

Hospital Admissions ◽

Ageing Population ◽

Drug Reactions ◽

Cross Sectional

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Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community‐dwelling older people: a prospective cohort study

British Journal of Clinical Pharmacology ◽

10.1111/bcp.12995 ◽

2016 ◽

Vol 82 (3) ◽

pp. 849-857 ◽

Cited By ~ 28

Author(s):

Frank Moriarty ◽

Kathleen Bennett ◽

Caitriona Cahir ◽

Rose Anne Kenny ◽

Tom Fahey

Keyword(s):

Cohort Study ◽

Older People ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Inappropriate Prescribing ◽

Adverse Outcomes ◽

Community Dwelling ◽

Potentially Inappropriate Prescribing ◽

Community Dwelling Older People

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Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

International Journal of Epidemiology ◽

10.1093/ije/dyv096.212 ◽

2015 ◽

Vol 44 (suppl_1) ◽

pp. i162-i162

Author(s):

B. Ahmed ◽

K. Nanji ◽

J. Patel

Keyword(s):

Cohort Study ◽

Adverse Drug Reactions ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Drug Reactions

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Adverse Drug Reactions and Clinical Outcomes in Patients Initiated on Antiretroviral Therapy: A Prospective Cohort Study From Ethiopia

Drug Safety ◽

10.1007/s40264-015-0295-7 ◽

2015 ◽

Vol 38 (7) ◽

pp. 629-639 ◽

Cited By ~ 9

Author(s):

Woldesellassie M. Bezabhe ◽

Luke R. Bereznicki ◽

Leanne Chalmers ◽

Peter Gee ◽

Desalew M. Kassie ◽

...

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Clinical Outcomes ◽

Adverse Drug Reactions ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Drug Reactions

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Incidence and Predictors of Adverse Drug Reactions Caused by Drug-Drug Interactions in Elderly Outpatients: A Prospective Cohort Study

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3cc86 ◽

2012 ◽

Vol 15 (2) ◽

pp. 332 ◽

Cited By ~ 23

Author(s):

Paulo Roque Obreli-Neto ◽

Alessandro Nobili ◽

Divaldo Pereira De Lyra Júnior ◽

Diogo Pilger ◽

Camilo Molino Guidoni ◽

...

Keyword(s):

Cohort Study ◽

Drug Interactions ◽

Adverse Drug Reactions ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Primary Objective ◽

Public Healthcare ◽

Drug Reactions ◽

Elderly Outpatients ◽

Significant Difference

Purpose. The primary objective of this study was to investigate the incidence of drug-drug interactions (DDIs) related to adverse drug reactions (ADRs) in elderly outpatients who attended public primary healthcare units in a southeastern region of Brazil. The secondary objective was to investigate the possible predictors of DDI-related ADRs. Methods. A prospective cohort study was conducted between November 1, 2010, and November 31, 2011, in the primary public healthcare system in the Ourinhos micro-region in Brazil. Patients who were at least 60 years old, with at least one potential DDI, were eligible for inclusion in the study. Eligible patients were assessed by clinical pharmacists for DDI-related ADRs for 4 months. The causality of DDI-related ADRs was assessed independently by four clinicians using three decisional algorithms. The incidence of DDI-related ADRs during the study period was calculated. Logistic regression analysis was used to study DDI-related ADR predictors. Results. A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6.5%. A multivariate analysis indicated that the adjusted odds ratios (ORs) rose from 0.91 (95% confidence interval [CI] = 0.75-1.12, p = 0.06) in patients aged 65-69 years to 4.40 (95% CI = 3.00-6.12, p < 0.01) in patients aged 80 years or older. Patients who presented two to three diagnosed diseases presented lower adjusted ORs (OR = 0.93 [95% CI = 0.68-1.18, p = 0.08]) than patients who presented six or more diseases (OR = 1.12 [95% CI = 1.02-2.01, p < 0.01]). Elderly patients who took five or more drugs had a significantly higher risk of DDI-related ADRs (OR = 2.72 [95% CI = 1.92-3.12, p < 0.01]) than patients who took three to four drugs (OR = 0.93 [95% CI = 0.74-1.11, p = 0.06]). No significant difference was found with regard to sex (OR = 1.08 [95% CI 0.48-2.02, p = 0.44]). Conclusion. The incidence of DDI-related ADRs in elderly outpatients was significant, and most of the events presented important clinical consequences. Because clinicians still have difficulty managing this problem, highlighting the factors that increase the risk of DDI-related ADRs is essential. Polypharmacy was found to be a significant predictor of DDI-related ADRs in our sample. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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