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[PMID]:28743244
[Au] Autor:Bazargan M; Smith J; Yazdanshenas H; Movassaghi M; Martins D; Orum G
[Ad] Endereço:Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA. mobazarg@cdrewu.edu.
[Ti] Título:Non-adherence to medication regimens among older African-American adults.
[So] Source:BMC Geriatr;17(1):163, 2017 Jul 25.
[Is] ISSN:1471-2318
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use. METHODS: Four-hundred African Americans, aged 65 years and older, were recruited from South Los Angeles. Structured, face-to-face interviews and visual inspection of participants' medications were conducted. From the medication container labels, information including strength of the drug, expiration date, instructions, and special warnings were recorded. The Medication Regimen Complexity Index (MRCI) was measured to quantify multiple features of drug regimen complexity. The Beers Criteria was used to measure the PIM use. RESULTS: Participants reported taking an average of 5.7 prescription drugs. Over 56% could not identify the purpose of at least one of their medications. Only two-thirds knew dosage regimen of their medications. Thirty-five percent of participants indicated that they purposely had skipped taking at least one of their medications within last three days. Only 8% of participants admitted that they forgot to take their medications. The results of multivariate analysis showed that co-payment for drugs, memory deficits, MRCI, and medication-related knowledge were all associated with adherence to dosage regimen of medications. Participants with a higher level of knowledge about therapeutic purpose and knowledge about dosage regimen of their medications were seven times (CI: 4.2-10.8) more likely to adhere to frequency and dose of medications. Participants with a low complexity index were two times (CI: 1.1-3.9) more likely to adhere to the dosage regimen of their medications, compared with participants with high drug regimen complexity index. CONCLUSIONS: While other studies have documented that non-adherence remains an important issue among older adults, our study shows that for underserved elderly African Americans, these issues are particularly striking. A periodic comprehensive assessment of all medications that they use remains a critical initial step to identify medication related issues. Assessment of their disease and medication related knowledge (e.g., therapeutic purposes, side-effects, special instructions, etc.) and their ability to follow complicated medication regimens and modification of their drug regimens requires inter-professional collaboration.
[Mh] Termos MeSH primário: Afroamericanos/psicologia
Conhecimentos, Atitudes e Prática em Saúde
Alfabetização em Saúde/métodos
Adesão à Medicação/psicologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Feminino
Hospitalização/tendências
Seres Humanos
Masculino
Educação de Pacientes como Assunto/métodos
Polimedicação
Lista de Medicamentos Potencialmente Inapropriados/tendências
Medicamentos sob Prescrição/efeitos adversos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Prescription Drugs)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1186/s12877-017-0558-5


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[PMID]:29258401
[Au] Autor:Schmiedl S; Rottenkolber M; Szymanski J; Drewelow B; Siegmund W; Hippius M; Farker K; Guenther IR; Hasford J; Thuermann PA; German Net of Regional Pharmacovigilance Centers (NRPC)
[Ad] Endereço:a Philipp Klee-Institute for Clinical Pharmacology , HELIOS Clinic Wuppertal , Wuppertal , Germany.
[Ti] Título:Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients.
[So] Source:Expert Opin Drug Saf;17(2):125-137, 2018 Feb.
[Is] ISSN:1744-764X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies evaluating the impact of age and potentially inappropriate medication (PIM) on avoidable adverse drug reactions (ADRs) are scarce. METHODS: In this prospective, multi-center, long-term (8.5 years) observational study, we analysed ADRs leading to hospitalization in departments of internal medicine. ADRs causality and preventability were assessed using standardised algorithms. PIM was defined based on the PRISCUS-list. Multivariate analyses and estimation of ADR incidence rates were conducted. RESULTS: Of all 6,427 ADR patients, a preventable ADR was present in 1,253 (19.5%) patients (elderly patients ≥70 years: 828). Risk factors for preventable ADRs in elderly patients were multimorbidity, two to four ADR-causative drugs, and intake of particular compounds (e.g. spironolactone) but not sex, PIM usage, or the total number of drugs. Regarding particular compounds associated with preventable ADRs, highest incidence rates for preventable ADRs were found for patients aged ≥70 years for spironolactone (3.3 per 1,000 exposed persons (95% CI: 1.4-6.6)) and intermediate-acting insulin (3.3 per 1,000 exposed persons (95% CI: 1.6-6.1)). CONCLUSION: Avoiding PIM usage seems to be of limited value in increasing safety in elderly patients whereas our results underline the importance of an individualized medication review of the most commonly implicated drugs in preventable ADRs (supported by BfArM FoNr: V-11337/68605/2008-2010).
[Mh] Termos MeSH primário: Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia
Hospitalização/estatística & dados numéricos
Prescrição Inadequada/estatística & dados numéricos
Lista de Medicamentos Potencialmente Inapropriados
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Algoritmos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Feminino
Seres Humanos
Incidência
Estudos Longitudinais
Masculino
Meia-Idade
Análise Multivariada
Estudos Prospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1080/14740338.2018.1415322


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[PMID]:29194557
[Au] Autor:Leahy LG
[Ti] Título:Caution is Key When Prescribing for Older Adults.
[So] Source:J Psychosoc Nurs Ment Health Serv;55(12):7-10, 2017 Dec 01.
[Is] ISSN:0279-3695
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The end of the year can trigger the recognition that aging adults are no longer as independent as they once were. Psychiatric nurses and other mental health professionals may see an increase in older adults being referred for treatment. As the most appropriate psychosocial/psychotherapeutic and psychopharmacological treatments are identified for older adults, there are some unique challenges inherent in coordinating the care of this population. It is especially important for prescribing psychiatric advanced practice nurses to update, review, and cross-reference older patients' lists of medications at every appointment. Although the obstacles to treating older adults may appear daunting, prudent, responsible, cautious practice should be exercised to ensure they achieve improved functionality, maintain safety, reduce risks, and enhance their quality of life. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 7-10.].
[Mh] Termos MeSH primário: Prescrições de Medicamentos/enfermagem
Transtornos Mentais/tratamento farmacológico
Enfermagem Psiquiátrica
Psicotrópicos/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Envelhecimento
Seres Humanos
Lista de Medicamentos Potencialmente Inapropriados/utilização
Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Psychotropic Drugs)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.3928/02793695-20171113-01


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[PMID]:28448783
[Au] Autor:Caffiero N; Delate T; Ehizuelen MD; Vogel K
[Ad] Endereço:1 Pharmacy Department, Kaiser Permanente Colorado, Aurora.
[Ti] Título:Effectiveness of a Clinical Pharmacist Medication Therapy Management Program in Discontinuation of Drugs to Avoid in the Elderly.
[So] Source:J Manag Care Spec Pharm;23(5):525-531, 2017 May.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite evidence of fall risk associated with some drugs to avoid in the elderly (DAEs), many aged patients continue to receive them. OBJECTIVE: To assess the effectiveness of a clinical pharmacist medication therapy management program (MTM) on discontinuation of prescribed DAEs. METHODS: This was a retrospective cohort study conducted at an integrated health care delivery system. Kaiser Permanente Colorado beneficiaries aged ≥65 years who were MTM-eligible and targeted for a DAE dispensing between 01/01/2015 and 09/30/2015 were included in the observation group. Medicare beneficiaries who were not eligible for MTM but had a targeted DAE dispensing during the same time period were included in the control group. The percentage of patients with another DAE dispensing of the same specified medication (no matter the strength) during the 100 days following index DAE dispensing was assessed. Univariate and multivariable logistic regression analyses were conducted. RESULTS: A total of 9,059 Medicare beneficiaries were included, with 226 beneficiaries in the MTM group and 8,833 beneficiaries in the non-MTM group. Beneficiaries were primarily female and white and had a high burden of chronic disease. The percentages of patients with another dispensing of the specified DAE were 7.1% (95% CI = 3.7%-10.4%) for the MTM beneficiaries and 35.3% (95% CI 34.2%-36.2%) for the non-MTM beneficiaries (P < 0.001). The OR for the MTM group to have received another dispensing of the specified DAE was 0.12 (95% CI = 0.08-0.22) with adjustment for potential confounders. CONCLUSIONS: A clinical pharmacist-provided MTM intervention was associated with decreased DAE dispensing in Medicare beneficiaries. Future studies should evaluate means to further decrease DAE use in the aged. DISCLOSURES: This study was funded by the Kaiser Permanente Colorado Pharmacy Department. The funder had no role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the manuscript for publication. Delate has received grant funding from Janssen Pharmaceutical Companies of Johnson & Johnson outside of this study. The authors report no other disclosures. Delate supervised the study and had complete access to the data and takes responsibility for the data integrity. Study concept and design were contributed by Caffiero, Delate, Ehizuelen, and Vogel. Delate collected the data, assisted by the other authors, and analysis and interpretation of the data were provided by Ehizuelen and Vogel, along with Caffiero and Delate. The manuscript was written by Caffiero and Delate, with assistance from Ehizuelen and Vogel, and revised by all the authors. Preliminary findings from this study were presented at the Mountain States Conference for Pharmacy Residents, Fellows, and Preceptors on May 13, 2016, in Salt Lake City, Utah.
[Mh] Termos MeSH primário: Prescrição Inadequada/prevenção & controle
Conduta do Tratamento Medicamentoso
Assistência Farmacêutica/organização & administração
Farmacêuticos/organização & administração
[Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle
Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Colorado
Prestação Integrada de Cuidados de Saúde/organização & administração
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Medicare
Lista de Medicamentos Potencialmente Inapropriados
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.5.525


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[PMID]:28458417
[Au] Autor:Rakesh KB; Chowta MN; Shenoy AK; Shastry R; Pai SB
[Ad] Endereço:Department of Pharmacology, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India.
[Ti] Título:Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital.
[So] Source:Indian J Pharmacol;49(1):16-20, 2017 Jan-Feb.
[Is] ISSN:1998-3751
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess the polypharmacy and appropriateness of prescriptions in geriatric patients in a tertiary care hospital. METHODS: An observational study was done in geriatric patients (>60 years) of either gender. The data collected from patients included: Socio-demographic data such as age, gender, marital status, educational status, socioeconomic status, occupation, nutritional status, history of alcohol/smoking, exercise history, details of comorbid diseases, medication history, findings of clinical examination etc. In this study, polypharmacy was considered as having 5 or more medications per prescription. Medication appropriateness for each patient was analysed separately based on their medical history and clinical findings by applying medication appropriateness index, screening tool to alert to right treatment (START) and Beers criteria and STOPP criteria. RESULTS: A total of 426 patients, 216 (50.7%) were males and 210 (49.3%) were females. Polypharmacy was present in 282 prescriptions (66.2%). Highest prevalence of polypharmacy was seen in 70-79 years age group compared to the other two groups and it was statistically significant. Out of 426 patients, 36 patients were receiving drugs which were to be avoided as per Beers criteria. Among the total patients, 39 patients were overprescribed as per MAI, 56 patients were under prescribed as per START criteria and 85 out of 426 prescriptions were inappropriate in accordance with beers criteria, stop criteria, start criteria and MAI index. CONCLUSION: Around 66.19% patients were receiving polypharmacy. Significant number of patients were receiving drugs which are to be avoided as well as overprescribed and under prescribed. Inappropriate prescription was seen in a good number of patients.
[Mh] Termos MeSH primário: Prescrição Inadequada/estatística & dados numéricos
Polimedicação
Padrões de Prática Médica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Lista de Medicamentos Potencialmente Inapropriados
Padrões de Prática Médica/normas
Prevalência
Centros de Atenção Terciária
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.4103/0253-7613.201036


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[PMID]:28804870
[Au] Autor:Fried TR; Niehoff KM; Street RL; Charpentier PA; Rajeevan N; Miller PL; Goldstein MK; O'Leary JR; Fenton BT
[Ad] Endereço:Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
[Ti] Título:Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.
[So] Source:J Am Geriatr Soc;65(10):2265-2271, 2017 Oct.
[Is] ISSN:1532-5415
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. DESIGN: Randomized clinical trial. SETTING: Primary care clinics at a Veterans Affairs Medical Center. PARTICIPANTS: Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). INTERVENTION: TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. MEASUREMENTS: Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. RESULTS: 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. CONCLUSION: TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes.
[Mh] Termos MeSH primário: Doença Crônica/tratamento farmacológico
Sistemas de Apoio a Decisões Clínicas
Desprescrições
Reconciliação de Medicamentos/métodos
Lista de Medicamentos Potencialmente Inapropriados
Software
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Comunicação
Registros Eletrônicos de Saúde
Feminino
Seres Humanos
Masculino
Polimedicação
Estados Unidos
United States Department of Veterans Affairs
Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.1111/jgs.15042


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[PMID]:28752589
[Au] Autor:Maclagan LC; Maxwell CJ; Gandhi S; Guan J; Bell CM; Hogan DB; Daneman N; Gill SS; Morris AM; Jeffs L; Campitelli MA; Seitz DP; Bronskill SE
[Ad] Endereço:Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
[Ti] Título:Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition.
[So] Source:J Am Geriatr Soc;65(10):2205-2212, 2017 Oct.
[Is] ISSN:1532-5415
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/OBJECTIVES: To estimate the prevalence of potentially inappropriate medication (PIM) use among older adults with cognitive impairment or dementia prior to and following admission to nursing homes and in relation to frailty. DESIGN: Retrospective cohort study using health administrative databases. SETTING: Ontario, Canada. PARTICIPANTS: 41,351 individuals with cognitive impairment or dementia, aged 66+ years newly admitted to nursing home between 2011 and 2014. MEASUREMENTS: PIMs were defined with 2015 Beers Criteria and included antipsychotics, H -receptor antagonists, benzodiazepines, and drugs with strong anticholinergic properties. Medication information was obtained at nursing home admission and in the subsequent 180 days. Multivariable Cox proportional-hazards models were used to assess the impact of frailty status (determined by a 72-item frailty index) on the hazard of starting and discontinuing PIMs. RESULTS: At admission, 44% of residents with cognitive impairment or dementia were on a PIM and prevalence varied by frailty (38.7% non-frail, 42.8% pre-frail, and 48.1% frail, P < .001). Following admission, many residents discontinued PIMs (23.5% for antipsychotics, 49.3% benzodiazepines, 32.2% anticholinergics, and 30.9% H -receptor antagonists). However, PIMs were also introduced with 10.9% newly started on antipsychotics, benzodiazepines (10.1%), anticholinergics (6.6%), and H -receptor antagonists (1.2%). After adjustment for other characteristics, frail residents had a similar risk of PIM discontinuation as non-frail residents except for anticholinergics (HR = 1.21, 95% CI 1.06-1.39) but were more likely to be newly prescribed benzodiazepines (HR = 1.32, 95% CI 1.20-1.44), antipsychotics (HR = 1.36, 1.23-1.49), and anticholinergics (HR = 1.34, 95% CI 1.20-1.50). CONCLUSION: Many residents with cognitive impairment or dementia enter nursing homes on PIMs. PIMs are more likely to be started in frail individuals following admission. Interventions to support deprescribing of PIMs should be implemented targeting frail individuals during the transition to nursing home.
[Mh] Termos MeSH primário: Idoso Fragilizado/estatística & dados numéricos
Instituição de Longa Permanência para Idosos
Casas de Saúde
Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos
Cuidado Transicional/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Disfunção Cognitiva/tratamento farmacológico
Demência/tratamento farmacológico
Feminino
Seres Humanos
Masculino
Análise Multivariada
Ontário
Polimedicação
Modelos de Riscos Proporcionais
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170729
[St] Status:MEDLINE
[do] DOI:10.1111/jgs.15016


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Texto completo SciELO Saúde Pública
[PMID]:28658367
[Au] Autor:Lutz BH; Miranda VIA; Bertoldi AD
[Ad] Endereço:Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil.
[Ti] Título:Potentially inappropriate medications among older adults in Pelotas, Southern Brazil.
[So] Source:Rev Saude Publica;51:52, 2017 Jun 22.
[Is] ISSN:1518-8787
[Cp] País de publicação:Brazil
[La] Idioma:eng; por
[Ab] Resumo:OBJECTIVE: To assess the use of potentially inappropriate medications among older adults. METHODS: This is a population-based cross-sectional study with 1,451 older individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do Sul, Brazil, in 2014. We have investigated the use of medications in the last 15 days. Using the Beers criteria (2012), we have verified the use of potentially inappropriate medications and their relationship with socioeconomic and demographic variables, polypharmacy, self-medication, and burden of disease. RESULTS: Among the 5,700 medications used, 5,651 could be assessed as to being inappropriate. Of these, 937 were potentially inappropriate for the older adults according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older adults studied used at least one medication considered as potentially inappropriate. The group of medications for the nervous system accounted for 48.9% of the total of the potentially inappropriate medications. In the adjusted analysis, the variables female, advanced age, white race, low educational level, polypharmacy, self-medication, and burden of disease were associated with the use of potentially inappropriate medications. CONCLUSIONS: It is important to known the possible consequences of the use of medication among older adults. Special attention should be given to the older adults who use polypharmacy. Specific lists should be created with more appropriate medications for the older population in the National Essential Medicine List. OBJETIVO: Avaliar o uso de medicamentos potencialmente inadequados entre idosos. MÉTODOS: Estudo transversal de base populacional com 1.451 idosos com 60 anos ou mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15 dias. Utilizando os critérios de Beers (2012), verificou-se a potencial inadequação dos medicamentos e sua relação com variáveis socioeconômicas e demográficas, polifarmácia, automedicação e carga de doença. RESULTADOS: Dentre os 5.700 medicamentos utilizados, 5.651 puderam ser avaliados quanto à inadequação. Destes, 937 eram potencialmente inadequados para idosos segundo os critérios de Beers de 2012 (16,6%). Cerca de 42,4% dos idosos usaram no mínimo um medicamento considerado potencialmente inapropriado. O grupo de medicamentos para o sistema nervoso correspondeu a 48,9% do total de medicamentos potencialmente inadequados. Na análise ajustada, as variáveis sexo feminino, idade avançada, cor da pele branca, baixa escolaridade, polifarmácia, automedicação e carga de doença mostraram-se associadas ao uso de medicamentos potencialmente inadequados. CONCLUSÕES: É importante que sejam bem conhecidas as possíveis consequências do uso de medicamentos entre idosos. Atenção especial deve ser dada aos idosos que fazem uso de polifarmácia. É necessário existir listas específicas com medicamentos mais adequados para uso em idosos na Relação Nacional de Medicamentos Essenciais.
[Mh] Termos MeSH primário: Lista de Medicamentos Potencialmente Inapropriados/utilização
[Mh] Termos MeSH secundário: Distribuição por Idade
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Brasil
Estudos Transversais
Feminino
Seres Humanos
Prescrição Inadequada/estatística & dados numéricos
Masculino
Meia-Idade
Polimedicação
Fatores de Risco
Automedicação/estatística & dados numéricos
Distribuição por Sexo
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE


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[PMID]:28540648
[Au] Autor:Suehs BT; Davis C; Ng DB; Gooch K
[Ad] Endereço:Comprehensive Health Insights, Inc, 515 West Market Street, 7th Floor, Louisville, KY, 40202, USA. bsuehs6@humana.com.
[Ti] Título:Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder.
[So] Source:Drugs Aging;34(7):535-543, 2017 Jul.
[Is] ISSN:1179-1969
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality. OBJECTIVES: The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB). METHODS: A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined. RESULTS: Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p < 0.001). The incremental net cost associated with potentially inappropriate use of antimuscarinic medication was higher under the 2012 Beers Criteria than under the 2015 Beers Criteria. CONCLUSIONS: In this cohort of patients newly initiated on antimuscarinic OAB treatment, substantial overlap of patients identified with PIM based on the 2015 Beers Criteria compared with the 2012 Beers Criteria was observed. In addition, the findings suggest that, when applied to antimuscarinic initiators, the 2015 Beers Criteria result in a greater prevalence of PIM and the identification of patients with less overall medical morbidity than the 2012 Beers Criteria.
[Mh] Termos MeSH primário: Prescrição Inadequada
Antagonistas Muscarínicos
Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos
Bexiga Urinária Hiperativa/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Custos e Análise de Custo
Bases de Dados Factuais
Feminino
Seres Humanos
Prescrição Inadequada/economia
Prescrição Inadequada/estatística & dados numéricos
Masculino
Medicare Part C
Meia-Idade
Antagonistas Muscarínicos/administração & dosagem
Antagonistas Muscarínicos/economia
Antagonistas Muscarínicos/uso terapêutico
Lista de Medicamentos Potencialmente Inapropriados/economia
Prevalência
Estudos Retrospectivos
Estados Unidos
Bexiga Urinária Hiperativa/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Muscarinic Antagonists)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171114
[Lr] Data última revisão:
171114
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1007/s40266-017-0464-8


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[PMID]:28388818
[Au] Autor:Stevens M; Hastings SN; Markland AD; Hwang U; Hung W; Vandenberg AE; Bryan W; Cross D; Powers J; McGwin G; Fattouh N; Ho W; Clevenger C; Vaughan CP
[Ad] Endereço:Birmingham/Atlanta VA GRECC, Atlanta, Georgia.
[Ti] Título:Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUiPPED).
[So] Source:J Am Geriatr Soc;65(7):1609-1614, 2017 Jul.
[Is] ISSN:1532-5415
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:EQUiPPED is a multicomponent quality improvement initiative combining education, electronic clinical decision support, and individual provider feedback to influence prescribing and improve medication safety for older adults. The objective here was to evaluate the effectiveness and sustainability of EQUiPPED to reduce the use of potentially inappropriate medications (PIMs), as defined by the American Geriatrics Society 2012 Beers Criteria, prescribed to older Veterans at the time of emergency department (ED) discharge. This evaluation represents a pre- and post-intervention comparison of PIM prescriptions at 4 urban Veteran Affairs (VA) Medical Center EDs. Poisson regression was used to compare the number of PIMs prescribed to Veterans 65 years or older discharged from the ED for at least 6 months prior to the first EQUiPPED intervention at each site and for at least 12 months following the final EQUiPPED intervention. The implementation timeline varied by site depending on local resources. All 4 sites showed a significant and sustained reduction in use of PIMs. The proportion of PIMs at site one decreased from 11.9% (SD 1.8) pre-EQUiPPED to 5.1% (SD 1.4) post-EQUiPPED (P < .0001); site 2 from 8.2% (SD 0.8) pre to 4.5% (SD 1.0) post (P < .0001); site 3 from 8.9% (SD 1.9) pre to 6.1% (SD 1.7) post (P = .0007); and site 4 from 7.4% (SD 1.7) pre to 5.7% (SD 0.8) post (P = .04). These results suggest a multicomponent program to influence provider prescribing behavior leads to safer prescribing for older adults discharged from the ED and is sustainable across multiple VA ED sites.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Geriatria
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Idoso
Hospitais de Veteranos/organização & administração
Seres Humanos
Prescrição Inadequada/prevenção & controle
Alta do Paciente
Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos
Veteranos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE
[do] DOI:10.1111/jgs.14890



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