Potentially Inappropriate Prescribing and Vulnerability and Hospitalization in Older Community-Dwelling Patients

2014 ◽  
Vol 48 (12) ◽  
pp. 1546-1554 ◽  
Author(s):  
Caitriona Cahir ◽  
Frank Moriarty ◽  
Conor Teljeur ◽  
Tom Fahey ◽  
Kathleen Bennett
Keyword(s):  
Inappropriate Prescribing ◽  
Community Dwelling ◽  
Potentially Inappropriate Prescribing

scholarly journals Prescribing cascades in community-dwelling adults: protocol for a systematic review

2021 ◽  
Vol 4 ◽  
pp. 72
Author(s):  
Ann Doherty ◽  
Frank Moriarty ◽  
Fiona Boland ◽  
Barbara Clyne ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Case Series ◽  
Evidence Base ◽  
Community Dwelling ◽  
Cochrane Library ◽  
Ageing Population ◽  
Potentially Inappropriate Prescribing ◽  
Inclusion Criteria

Introduction: Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults. Methods: The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years); risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to ‘treat’ or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers.  A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist. Discussion: This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades. Registration: PROSPERO [CRD42021243163, 31/03/2021].

scholarly journals Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019003 ◽  
Author(s):  
David O Riordan ◽  
Carole Elodie Aubert ◽  
Kieran A Walsh ◽  
Anette Van Dorland ◽  
Nicolas Rodondi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Screening Tool ◽  
Inappropriate Prescribing ◽  
Community Dwelling ◽  
System Level ◽  
Potentially Inappropriate Prescribing ◽  
Duration Of Action ◽  
Significant Difference ◽  
The Impact ◽  
Trial Participants

ObjectivesTo estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries.DesignA secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset.ParticipantsA subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands.ResultsThe overall prevalence of PIP was lower in the Irish participants (8.7%) compared with the Swiss (16.7%) and Dutch (12.5%) participants (P=0.15) and was not statistically significant. The overall prevalence of PPOs was approximately one-quarter in the Swiss (25.3%) and Dutch (24%) participants and lower in the Irish (14%) participants (P=0.04) and the difference was statistically significant. The hypnotic Z-drugs were the most frequent PIP in Irish participants, (3.5%, n=4), while it was non-steroidal anti-inflammatory drug and oral anticoagulant combination, sulfonylureas with a long duration of action, and benzodiazepines (all 4.3%, n=7) in Swiss, and benzodiazepines (7.1%, n=18) in Dutch participants. The most frequent PPOs in Irish participants were vitamin D and calcium in osteoporosis (3.5%, n=4). In the Swiss and Dutch participants, they were bone antiresorptive/anabolic therapy in osteoporosis (9.9%, n=16, 8.6%, n=22) respectively. The odds of any PIP after adjusting for age, sex, multimorbidity and polypharmacy were (adjusted OR (aOR)) 3.04 (95% CI 1.33 to 6.95, P<0.01) for Swiss participants and aOR 1.74 (95% CI 0.79 to 3.85, P=0.17) for Dutch participants compared with Irish participants. The odds of any PPOs were aOR 2.48 (95% CI 1.27 to 4.85, P<0.01) for Swiss participants and aOR 2.10 (95% CI 1.11 to 3.96, P=0.02) for Dutch participants compared with Irish participants.ConclusionsThis study has estimated and compared the prevalence and type of PIP and PPOs among this cohort of community-dwelling older people. It demonstrated a significant difference in the prevalence of PPOs between the three populations. Further research is urgently needed into the impact of system level factors as this has important implications for patient safety, healthcare provision and economic costs.

scholarly journals Prescribing cascades in community-dwelling adults: protocol for a systematic review

2021 ◽  
Vol 4 ◽  
pp. 72
Author(s):  
Ann Doherty ◽  
Frank Moriarty ◽  
Fiona Boland ◽  
Barbara Clyne ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Case Series ◽  
Evidence Base ◽  
Community Dwelling ◽  
Cochrane Library ◽  
Ageing Population ◽  
Potentially Inappropriate Prescribing ◽  
Inclusion Criteria

Introduction: Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults. Methods: The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years), including those in residential or nursing homes; risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to ‘treat’ or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers.  A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist. Discussion: This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades. Registration: PROSPERO [CRD42021243163, 31/03/2021].

scholarly journals The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

2016 ◽  
Vol 4 ◽  
pp. 205031211665256 ◽  
Author(s):  
David O Riordan ◽  
Kieran A Walsh ◽  
Rose Galvin ◽  
Carol Sinnott ◽  
Patricia M Kearney ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Inappropriate Prescribing ◽  
Community Dwelling ◽  
Controlled Trials ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Randomised Controlled ◽  
Community Dwelling Older Adults

Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov , metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients.

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