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Polypharmacy and deprescribing

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https://www.readbyqxmd.com/read/30112863/rate-and-appropriateness-of-polypharmacy-in-older-patients-with-hemophilia-compared-with-age-matched-controls
#1
Pier Mannuccio Mannucci, Alessandro Nobili, Emanuela Marchesini, Emily Oliovecchio, Laura Cortesi, Antonio Coppola, Elena Santagostino, Paolo Radossi, Giancarlo Castaman, Lelia Valdrè, Cristina Santoro, Annarita Tagliaferri, Cosimo Ettorre, Ezio Zanon, Giovanni Barillari, Isabella Cantori, Teresa Maria Caimi, Gianluca Sottilotta, Flora Peyvandi, Alfonso Iorio
BACKGROUND: In older people, multiple chronic ailments lead to the intake of multiple medications (polypharmacy) that carry a number of negative consequences (adverse events, prescription and intake errors, poor adherence, higher mortality). Because ageing patients with haemophilia (PWHs) may be particularly at risk due to their pre-existing multiple comorbidities (arthropathy, liver disease), we chose to analyse the pattern of chronic drug intake in a cohort of PWHs aged 60 years or more...
August 16, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/30046021/polypharmacy-and-medication-related-problems-in-hemodialysis-patients-a-call-for-deprescribing
#2
Majed Alshamrani, Abdullah Almalki, Mohamed Qureshi, Oyindamola Yusuf, Sherine Ismail
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period...
July 25, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/30018092/deprescribing-in-primary-care-in-portugal-depil17-20-a-three-phase-observational-and-experimental-study-protocol
#3
Pedro Augusto Simões, Luiz Miguel Santiago, José Augusto Simões
INTRODUCTION: Polypharmacy is commonly defined as the simultaneous taking of five or more drugs. Deprescribing is the process of tapering or stopping medications with the aim of improving patient outcomes and optimising current therapy, and there are several tools aiming at identifying potentially inappropriate medications, especially in the elderly. The direct involvement of patients and their caregivers in the choice and administration of drugs has long been known to be very important, but it is not usually applied...
July 17, 2018: BMJ Open
https://www.readbyqxmd.com/read/30002869/supporting-prescribing-in-irish-primary-care-protocol-for-a-non-randomised-pilot-study-of-a-general-practice-pharmacist-gpp-intervention-to-optimise-prescribing-in-primary-care
#4
Karen Cardwell, B Clyne, F Moriarty, E Wallace, T Fahey, F Boland, L McCullagh, S Clarke, K Finnigan, M Daly, M Barry, S M Smith
Background: Prescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. The aim of this study is to develop and test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system. Methods: This non-randomised pilot study will use a mixed-methods approach...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29986668/reduction-of-inappropriate-medication-in-older-populations-by-electronic-decision-support-the-prima-eds-study-a-qualitative-study-of-practical-implementation-in-primary-care
#5
Anja Rieckert, Christina Sommerauer, Anja Krumeich, Andreas Sönnichsen
BACKGROUND: Within the EU-funded project PRIMA-eDS (Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support) an electronic decision support tool (the "PRIMA-eDS-tool") was developed for general practitioners (GPs) to reduce inappropriate medication in their older polypharmacy patients. After entering patient data relevant to prescribing in an electronic case report form the physician received a comprehensive medication review (CMR) on his/her screen displaying recommendations regarding missing indications, necessary laboratory tests, evidence-base of current medication, dose adjustments for renal malfunction, potentially harmful drug-drug interactions, contra-indications, and possible adverse drug events...
July 9, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29880094/polypharmacy-in-assisted-living-and-impact-on-clinical-outcomes
#6
MULTICENTER STUDY
Barbara Resnick, Elizabeth Galik, Marie Boltz, Sarah Holmes, Steven Fix, Erin Vigne, Shijun Zhu, Regina Lewis
OBJECTIVE: The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. DESIGN: This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT)...
June 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29869294/pharmacist-led-medication-assessment-and-deprescribing-intervention-for-older-adults-with-cancer-and-polypharmacy-a-pilot-study
#7
Andrew Whitman, Kathlene DeGregory, Amy Morris, Supriya Mohile, Erika Ramsdale
PURPOSE: The aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic. METHODS: Adult patients with cancer aged 65 and older underwent a comprehensive geriatric assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies...
June 4, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29861195/isn-t-it-time-we-stop-counting-the-number-of-drugs-to-define-polypharmacy-in-this-new-era-of-deprescribing-and-what-related-outcomes-should-be-measured
#8
EDITORIAL
Joseph T Hanlon, Emily R Hajjar
No abstract text is available yet for this article.
August 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29682764/how-confident-are-physicians-in-deprescribing-for-the-elderly-and-what-barriers-prevent-deprescribing
#9
L Djatche, S Lee, D Singer, S E Hegarty, M Lombardi, V Maio
WHAT IS KNOWN AND OBJECTIVE: Deprescribing is the process of discontinuing or reducing the dosage of medications that are no longer appropriate or aligned with goals of care, which is paramount in elderly patients with multiple comorbidities and polypharmacy. The objective of this study was to assess the perceptions of primary care physicians on deprescribing for elderly patients and potential barriers to deprescribing that physicians experience in the Local Health Authority (LHA) of Parma, Emilia-Romagna, Italy...
August 2018: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/29678983/older-patients-perception-of-deprescribing-in-resource-limited-settings-a-cross-sectional-study-in-an-ethiopia-university-hospital
#10
Henok Getachew Tegegn, Yonas Getaye Tefera, Daniel Asfaw Erku, Kaleab Taye Haile, Tamrat Befekadu Abebe, Fasil Chekol, Yonas Azanaw, Asnakew Achaw Ayele
OBJECTIVE: To assess older patients' attitude towards deprescribing of inappropriate medications. DESIGN: This was an institutional-based, quantitative, cross-sectional survey. SETTING: Outpatient clinics of the University of Gondar Referral and Teaching Hospital in Ethiopia. PARTICIPANTS: Patients aged 65 or older with at least one medication were enrolled in the study from 1 March to 30 June 2017. Excluded patients were those who had severe physical or psychological problems and who refused to participate...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29665778/characteristics-of-elderly-patients-with-polypharmacy-who-refuse-to-participate-in-an-in-hospital-deprescribing-intervention-a-retrospective-cross-sectional-study
#11
Junpei Komagamine, Kenichi Sugawara, Kazuhiko Hagane
BACKGROUND: Few studies have evaluated the characteristics of elderly patients with polypharmacy refusing deprescribing. The aim of this study was to evaluate the prevalence of potentially inappropriate medication (PIM) use in elderly patients accepting and refusing a deprescribing intervention and to investigate factors associated with deprescribing refusal. METHODS: We conducted a retrospective cross-sectional study by analyzing the electronic medical records from a single hospital...
April 17, 2018: BMC Geriatrics
https://www.readbyqxmd.com/read/29659552/improving-pharmacists-targeting-of-patients-for-medication-review-and-deprescription
#12
Vanessa Marvin, Emily Ward, Barry Jubraj, Mark Bower, Iñaki Bovill
Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the greatest impact on patient care. Aim: To use a consensus building process to produce guidance for pharmacists to support the identification of patients at risk from their medicines, and to articulate expected actions and escalation processes...
April 16, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29568537/a-province-wide-cross-sectional-study-of-demographics-and-medication-use-of-patients-in-hemodialysis-units-across-ontario
#13
Marisa Battistella, Racquel Jandoc, Jeremy Y Ng, Eric McArthur, Amit X Garg
Background: Hemodialysis patients are at an increased risk of polypharmacy as they have the highest pill burden of all chronically ill patient populations, with an estimated average of 12 medications per day. Objectives: The aim of this study was to evaluate prescribing patterns of outpatient medications in patients receiving in-center hemodialysis. This was done to identify potential candidate medications for future quality improvement initiations to optimize prescribing...
2018: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/29541966/impact-of-deprescribing-interventions-in-older-hospitalised-patients-on-prescribing-and-clinical-outcomes-a-systematic-review-of-randomised-trials
#14
REVIEW
Janani Thillainadesan, Danijela Gnjidic, Sarah Green, Sarah N Hilmer
BACKGROUND: Polypharmacy and potentially inappropriate medications (PIMs) are prevalent in older adults in hospital, and are associated with negative outcomes including adverse drug reactions, falls, confusion, hospitalisation and death. Deprescribing may reduce inappropriate polypharmacy and use of inappropriate medications. OBJECTIVE: The aim of this systematic review was to investigate the efficacy of deprescribing interventions in older inpatients to reduce PIMs and impact on clinical outcomes...
April 2018: Drugs & Aging
https://www.readbyqxmd.com/read/29515446/is-excessive-polypharmacy-a-transient-or-persistent-phenomenon-a-nationwide-cohort-study-in-taiwan
#15
Yi-Jen Wang, Shu-Chiung Chiang, Pei-Chen Lee, Yu-Chun Chen, Li-Fang Chou, Yueh-Ching Chou, Tzeng-Ji Chen
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29473423/implementation-of-proton-pump-inhibitor-deprescription-protocol-in-geriatric-residents
#16
Ovadyah Avraham, Michael Biglow
BACKGROUND: Deprescribing is a recommended intervention to reduce morbidity and mortality caused by polypharmacy in older residents. However, a lack of definite deprescription guidelines and evidence of clinically meaningful outcomes complicates or precludes the practicality of such an approach. OBJECTIVE: The objective of the present pilot study is to establish and implement a stepwise taper protocol that can potentially minimize overuse of proton pump inhibitors in a safe, effective, and feasible manner in the nursing home...
August 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29453677/changes-in-medicine-prescription-following-a-medication-review-in-older-high-risk-patients-with-polypharmacy
#17
Marian Z M Hurmuz, Sarah I M Janus, Jeannette G van Manen
Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed...
April 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29442099/prescribing-or-deprescribing-in-older-persons-what-are-the-real%C3%A2-life-concerns-in-geriatric-practice
#18
Barbara Bień, Katarzyna Bień-Barkowska
INTRODUCTION    Multimorbidity in older adults leads to polypharmacy with all its hazardous outcomes and drug‑related problems. OBJECTIVES    We aimed to assess the difference in the number of drugs between admission to and discharge from a geriatric ward and identified the patient‑related factors associated with changes in the drug regimen. PATIENTS AND METHODS    This retrospective cross‑sectional study included 301 geriatric patients who underwent drug optimization in line with the Beers and STOPP/START criteria...
April 30, 2018: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/29361432/research-priorities-for-optimizing-geriatric-pharmacotherapy-an-international-consensus
#19
Edwin C K Tan, Janet K Sluggett, Kristina Johnell, Graziano Onder, Monique Elseviers, Lucas Morin, Davide L Vetrano, Jonas W Wastesson, Johan Fastbom, Heidi Taipale, Antti Tanskanen, J Simon Bell
Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop...
March 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29353187/medication-use-in-a-cohort-of-newly-admitted-nursing-home-residents-ageing-nh-in-relation-to-evolving-physical-and-mental-health
#20
Ivana Ivanova, Maarten Wauters, Robert Vander Stichele, Thierry Christiaens, Jonas De Wolf, Tine Dilles, Monique Elseviers
BACKGROUND: Medication use is high among nursing home (NH) residents, but there is a lack of longitudinal studies, determining medication use at admission and its evolution over time. AIM: Describing the evolution of the medication use two years after entering a NH, compared to the baseline observations and exploring the relation to the physical and mental health. METHODS: Data from the observational prospective Ageing@NH study, based on an inception cohort of newly admitted residents at NHs (65+) was used, selecting those consenting and with medication chart available...
March 2018: Archives of Gerontology and Geriatrics
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