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Inappropriate prescribing

Molly Howard, Andrew Lipshutz, Breanne Roess, Emily Hawes, Zachariah Deyo, Jena Ivey Burkhart, Stephan Moll, Betsy Bryant Shilliday
Direct Oral Anticoagulants (DOACs) require specific dosing and monitoring to ensure safe and appropriate use. The purpose of this evaluation was to identify patient- and process-related factors that correlate with increased risk of inappropriate prescribing of DOACs. A retrospective chart review was conducted in three outpatient clinics within an academic medical center to identify patients started on DOAC therapy and evaluate the appropriateness of DOAC initiation. Data collected included patient demographics, DOAC medication initiated, dose, indication, baseline laboratory values, concomitant medications, type and specialty of prescriber, and initiation setting...
October 18, 2016: Journal of Thrombosis and Thrombolysis
Beate Wickop, Steffen Härterich, Christian Sommer, Anne Daubmann, Michael Baehr, Claudia Langebrake
BACKGROUND: Several classifications to identify and avoid use of potentially inappropriate medications (PIMs) in the elderly have been published. To what extent these classifications match each other and whether there are differences in the prevalence of PIM use at admission, during the inpatient stay and at discharge are largely unreported. OBJECTIVES: To determine the PIM prevalence in elderly patients at a university hospital, with a special focus on different classification systems and the chronological sequence, and to examine a possible association between PIM use and the reason for admission, as well as severe side effects and consequences of PIM use during hospitalization...
September 2016: Drugs—Real World Outcomes
Dirk Moßhammer, Hannah Haumann, Klaus Mörike, Stefanie Joos
BACKGROUND: Guideline-oriented treatments can lead to polypharmacy, i.e., the simultaneous long-term use of multiple drugs. Polypharmacy mainly affects elderly patients. The goal of this review is to survey the current scientific evidence about polypharmacy, focusing on clinical endpoints, and to point out implications for medical practice and research. METHODS: This selective literature review is based on pertinent publications that were retrieved by a selective search in PubMed employing the terms "polypharmacy AND general practice...
September 23, 2016: Deutsches Ärzteblatt International
Charmaine Tang, Mythily Subramaniam, Boon Tat Ng, Edimansyah Abdin, Lye Yin Poon, Swapna K Verma
OBJECTIVE: Early symptomatic response is pertinent in improving outcomes in first-episode psychosis. One of the ways in which this may be achieved is by reducing inappropriate delays in clozapine initiation. This study aimed to examine clozapine prescribing practices among clinicians by establishing the prevalence of clozapine use, identifying baseline clinical and demographic factors that were associated with clozapine use, examining outcomes in clozapine users versus nonusers, and identifying inappropriate antipsychotic prescription patterns prior to clozapine initiation...
October 11, 2016: Journal of Clinical Psychiatry
Ira L Leeds, Anne Fabrizio, Sara E Cosgrove, Elizabeth C Wick
Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices...
October 4, 2016: Annals of Surgery
Eva Sönnerstam, Maria Sjölander, Maria Gustafsson
BACKGROUND: Older people are more sensitive to drugs and adverse drug reactions than younger people because of age-related physiological changes such as impaired renal function. As people with dementia are particularly vulnerable to the effects of drugs, it is especially important to evaluate the dosages of renally cleared medications in this group. OBJECTIVE: The aim of this study was to estimate the prevalence of impaired renal function and inappropriate prescriptions on the basis of renal function among older patients with dementia or cognitive impairment...
October 12, 2016: Drugs & Aging
Martin Dawes, Martin N Aloise, J Sidney Ang, Pieter Cullis, Diana Dawes, Robert Fraser, Gideon Liknaitzky, Andrea Paterson, Paul Stanley, Adriana Suarez-Gonzalez, Hagit Katzov-Eckert
BACKGROUND: Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics. METHODS: We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases...
July 2016: CMAJ Open
J A Van Heerden, J R Burger, J J Gerber
BACKGROUND: Prescribing for older patients is a well-recognised problem, and inappropriate items are prescribed frequently. Several tools and criteria are available to promote rational prescribing in older patients. OBJECTIVE: To determine the prevalence of potentially inappropriate prescriptions (PIPs) in older South African patients. METHODS: A retrospective drug utilisation review was conducted using medicine claims data over a 1-year period...
September 9, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Kevin M Fain, Carlos Castillo-Salgado, David D Dore, Jodi B Segal, Andrew R Zullo, G Caleb Alexander
OBJECTIVE: We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naïve prescribing. DESIGN: Cross-sectional study. SETTING: Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims. PARTICIPANTS: From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (≥65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care...
October 6, 2016: Journal of the American Medical Directors Association
Diana Wucherer, Tilly Eichler, Johnanes Hertel, Ingo Kilimann, Steffen Richter, Bernhard Michalowsky, Jochen René Thyrian, Stefan Teipel, Wolfgang Hoffmann
BACKGROUND: Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD). OBJECTIVE: Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM. METHODS: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany...
October 5, 2016: Journal of Alzheimer's Disease: JAD
Maria Clara Padovani de Souza, Andrezza Gouvêa Dos Santos, Adriano Max Moreira Reis
Background The inappropriate use of systemic antifungal agents can result in unnecessary exposure, adverse events, increased microbial resistance and increased costs. Aim This study analysed the use of systemic antifungal agents and adherence to treatment guidelines for fungal infections. Setting A Brazilian tertiary hospital. Methods This cross-sectional study investigated 183 patients who were treated with systemic antifungals. Antifungal drugs were classified according to the fourth level of the Anatomical Therapeutic Chemical classification system...
October 6, 2016: International Journal of Clinical Pharmacy
L Cortejoso, R A Dietz, G Hofmann, M Gosch, A Sattler
BACKGROUND: Inappropriate pharmacotherapy among older adults remains a critical issue in our health care systems. Besides polypharmacy and multiple comorbidities, the age-related pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug reactions and medication errors. OBJECTIVE: The main target of this study was to describe the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit) of a general teaching hospital and to evaluate the clinical significance of the detected medication errors...
2016: Clinical Interventions in Aging
Idoia Arrizabalaga Aldalur, Beatriz García Martinez, Shahrazad Benabdellah Abouhammadi, María Del Carmen García Tirado, Alfredo Pardo Cabello, Pilar Parra Rosado
No abstract text is available yet for this article.
October 1, 2016: Revista Española de Geriatría y Gerontología
Chris Terpening
Allergies to various antibiotics are reported by a substantial proportion of patients. As a result, clinical decision support programming generates frequent warnings when prescribing within electronic medical records. For a variety of reasons, the majority of these warnings may be inappropriate. Our improved understanding of the underlying physiology of allergic processes reveals that the majority of cross-reacting antibiotic allergies are implausible. Appropriate history taking and workup can invalidate many more warnings...
October 2016: Southern Medical Journal
Deborah Dowell, Kun Zhang, Rita K Noonan, Jason M Hockenberry
To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13...
October 1, 2016: Health Affairs
Nancy M Birtley
Antipsychotic medications pose a significant risk to older adult patients with dementia and are frequently prescribed as first-line treatment for behaviors associated with dementia in skilled nursing facilities (SNFs). SNFs are often cited by the Centers for Medicare & Medicaid for inappropriate antipsychotic medication use. The purpose of the current article is to communicate an evidence-based practice (EBP) clinical protocol that can guide clinicians away from prescribing antipsychotic medications in the treatment of dementia behaviors...
October 1, 2016: Journal of Psychosocial Nursing and Mental Health Services
Eline Tommelein, Els Mehuys, Inge Van Tongelen, Mirko Petrovic, Annemie Somers, Pieter Colin, Sophie Demarche, Thierry Van Hees, Thierry Christiaens, Koen Boussery
BACKGROUND: In this study, we aimed to (i) determine the prevalence of potentially inappropriate prescribing (PIP) in community-dwelling older polypharmacy patients using the Ghent Older People's Prescriptions community-Pharmacy Screening (GheOP³S) tool, (ii) identify the items that account for the highest proportion of PIP and (iii) identify the patient variables that may influence the occurrence of PIP. Additionally, pharmacist-physician contacts emerging from PIP screening with the GheOP³S tool and feasibility of the GheOP³S tool in daily practice were evaluated...
October 3, 2016: Journal of Public Health
Inés Cruz-Esteve, Josep Ramón Marsal-Mora, Gisela Galindo-Ortego, Leonardo Galván-Santiago, Marcos Serrano-Godoy, Esther Ribes-Murillo, Jordi Real-Gatius
OBJECTIVE: Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. DESIGN: Cross-sectional population study...
September 29, 2016: Atencion Primaria
Barbara P Yawn, Samy Suissa, Andrea Rossi
International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit. Given the evidence of the risks associated with ICS and the limited indications for their use, there is interest in understanding the effects of withdrawing ICS when prescribed inappropriately. In this review, we discuss the findings of large ICS withdrawal trials, with primary focus on the more recent trials using active comparators...
September 29, 2016: NPJ Primary Care Respiratory Medicine
Emily S Spivak, Sara E Cosgrove, Arjun Srinivasan
Indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice more than seventy years ago. Infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. With rising burden of antimicrobial resistant organisms and Clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. Inappropriate antimicrobial use has been quantified in various settings using numerous definitions; however, no established reference standard exists...
September 28, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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