Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil

Abstract Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs.

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Perspectives of Healthcare Professionals Regarding Factors Associated with Antimicrobial Resistance (AMR) and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia

Antibiotics ◽

10.3390/antibiotics10070878 ◽

2021 ◽

Vol 10 (7) ◽

pp. 878

Author(s):

Mohamed A. Baraka ◽

Amany Alboghdadly ◽

Samar Alshawwa ◽

Asim Ahmed Elnour ◽

Hassan Alsultan ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Inappropriate Prescribing ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Sectional Study ◽

Key Factors ◽

Eastern Province ◽

Cross Sectional ◽

Factors Associated ◽

Factors Influencing

Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing antimicrobials would minimize the risk of resistance and, consequently, improve patients’ clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. A cross-sectional study was conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed, validated, and piloted survey specific with closed-ended questions. A value of p < 0.05 was considered to be statistically significant. All data analysis was performed using the Statistical Package for Social Sciences (IBM SPSS version 23.0). 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All of the respondents acknowledged effectiveness, previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) as being key factors influencing physicians’ choice during antimicrobial prescribing. The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials were reported to be common practices. Furthermore, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials, and the use of antimicrobials without a physician’s prescription (i.e., self-medication) represent key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.

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Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031483 ◽

2019 ◽

Vol 9 (9) ◽

pp. e031483 ◽

Cited By ~ 2

Author(s):

Socheat Cheng ◽

Tahreem Ghazal Siddiqui ◽

Michael Gossop ◽

Espen Saxhaug Kristoffersen ◽

Christofer Lundqvist

Keyword(s):

Pain Intensity ◽

Older Patients ◽

Adverse Drug Events ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Medication Misuse ◽

Factors Associated ◽

Concurrent Use

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.

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Factors associated with patients’ and GPs’ assessment of the burden of treatment in multimorbid patients: a cross-sectional study in primary care

BMC Family Practice ◽

10.1186/s12875-019-0974-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Lilli Herzig ◽

Andreas Zeller ◽

Jérôme Pasquier ◽

Sven Streit ◽

Stefan Neuner-Jehle ◽

...

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Burden Of Treatment ◽

Multimorbid Patients

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Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-Sectional Study

Pharmacy ◽

10.3390/pharmacy8040219 ◽

2020 ◽

Vol 8 (4) ◽

pp. 219

Author(s):

Rishabh Sharma ◽

Manik Chhabra ◽

Kota Vidyasagar ◽

Muhammed Rashid ◽

Daniela Fialova ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Patients ◽

Tertiary Care ◽

Cross Sectional Study ◽

Beers Criteria ◽

Sectional Study ◽

Older Population ◽

Cross Sectional ◽

Factors Associated

Background: Older patients with type 2 diabetes mellitus (T2DM) are at greater risk of receiving potentially inappropriate medications (PIM) during hospitalization which may result in adverse outcomes. Aim: To evaluate the extent of PIM use in the older population with T2DM during hospitalization in a tertiary care hospital in India. Methods: A cross-sectional study was carried out from August 2019 to January 2020 in a tertiary care teaching hospital among the older population (aged ≥ 65 years) hospitalized with T2DM. Medications prescribed during hospitalization were reviewed following Beers Criteria 2019 to identify the extent of polypharmacy and PIM use. Binary logistic regression was applied to determine the factors associated with PIM use. Results: The mean age of the 150 patients hospitalized with T2DM was 68.85 ± 5.51 years, most of whom were men (54.7%). The participants had at least four comorbidities and were receiving an average of nine medications per day; the median length of hospital stay was 8 days (interquartile range (IQR): 4–19 days). Overall, three quarters (74%) of the participants had at least one PIM prescribed during their hospitalization as per Beers Criteria. Significant factors associated with the use of PIM during hospitalization are patients taking a higher number of medications (odds ratio (OR): 7.85, 95% CI 1.49–41.10), lower creatinine clearance values (OR: 12.90, 95% CI 2.81–59.28) and female patients (OR: 2.29; 95% CI: 1.05–4.97). Conclusions: PIM use is frequently observed in older T2DM patients during hospitalization. Polypharmacy, reduced renal function and female gender are associated with higher PIM use. Engaging clinical pharmacists in evaluating medication appropriateness can improve the outcomes of older patients.

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Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database

Journal of Alzheimer s Disease ◽

10.3233/jad-151177 ◽

2016 ◽

Vol 52 (4) ◽

pp. 1503-1513 ◽

Cited By ~ 20

Author(s):

Heather E. Barry ◽

Janine A. Cooper ◽

Cristín Ryan ◽

A. Peter Passmore ◽

A. Louise Robinson ◽

...

Keyword(s):

Primary Care ◽

Inappropriate Prescribing ◽

Cross Sectional Study ◽

Potentially Inappropriate Prescribing ◽

Sectional Study ◽

Cross Sectional ◽

People With Dementia

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Age differences in demographic, social and health-related factors associated with loneliness across the adult life span (19–65 years): a cross-sectional study in the Netherlands

BMC Public Health ◽

10.1186/s12889-020-09208-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Thanée Franssen ◽

Mandy Stijnen ◽

Femke Hamers ◽

Francine Schneider

Keyword(s):

The Netherlands ◽

Age Differences ◽

Adult Life ◽

Cross Sectional Study ◽

Sectional Study ◽

Related Factors ◽

Adult Life Span ◽

Cross Sectional ◽

Factors Associated ◽

Health Related

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Primary care and population factors associated with NHS Health Check coverage: a national cross-sectional study

Journal of Public Health ◽

10.1093/pubmed/fdt069 ◽

2013 ◽

Vol 35 (3) ◽

pp. 431-439 ◽

Cited By ~ 29

Author(s):

M. Artac ◽

A. R. H. Dalton ◽

H. Babu ◽

S. Bates ◽

C. Millett ◽

...

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Health Check ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Nhs Health Check

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Factors associated with inappropriate attitude towards antibiotic usage among outpatients of a large public primary care center in Malaysia: A cross sectional study.

10.21203/rs.3.rs-17290/v1 ◽

2020 ◽

Author(s):

Zati Sabrina Ahmad Zubaidi ◽

Khasnur Abdul Malek ◽

Zaliha Ismail

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Antibiotic Usage ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Care Specialist ◽

Low Education ◽

Knowledge And Attitude ◽

The Relationship

Abstract Background: Antibiotic resistance is one of the biggest global threat in modern medicine. The situation is even more consequential in lower-and middle-income countries (LMIC) as financial limitations and political instability may become barriers to an impactful health policy. Therefore, The World Health organization has urge all nations to increase public awareness on antibiotic through effective educational interventions. In order for interventions to be successful, it is important to acknowledge that each country is unique in its problems as the demographic in LMIC are diverse. This study aims to identify the community’s attitude appropriateness towards antibiotic usage and their knowledge gaps, the relationship between antibiotic knowledge and their attitude as well as factors associated with inappropriate attitude towards antibiotic among outpatients attending an established primary care specialist center in Malaysia.Methodology : This cross-sectional study was conducted among 256 respondents attending a public primary care specialist clinic center. Those who fulfilled the inclusion and exclusion criteria from June to August 2017 were given a self-administered, validated and translated questionnaire. Pearson correlation was used to deduce the relationship between knowledge and attitude. Chi square test, independent t-test and multiple logistic regression were used to determine factors associated with inappropriate attitude towards antibiotic.Results: It was found that the respondents’ mean attitude and knowledge score were 29.5 ± 4.19 and 5.94 ± 2.4 respectively. The highest inappropriate attitude response was expecting antibiotic from the doctor for common colds and the most frequent incorrect knowledge response was on the domain of role of antibiotics. There is a weak positive relationship between antibiotic knowledge and attitude (r=0.315, n=256, p=0.0001). Respondents with low education level and poor antibiotic knowledge were at least 2.5 times more likely to have inappropriate attitude when handling antibiotics.Conclusion: Our study demonstrated the common inappropriate attitude towards antibiotic and areas of knowledge gap among the population. Antibiotic education should be incorporated in non-pharmacological measures of viral illnesses that is targeted among those with low education and poor antibiotic knowledge. The weak relationship between antibiotic knowledge and attitude suggest that health campaign should focus on behavioral change rather than a theoretical approach.

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