Validating claims‐based definitions for deprescribing: Bridging the gap between clinical and administrative data

Pharmacoepidemiology and Drug Safety, Journal Year: 2024, Volume and Issue: 33(4)

Published: March 31, 2024

Abstract Background Limited research has evaluated the validity of claims‐based definitions for deprescribing. Objectives Evaluate deprescribing against electronic health records (EHRs) benzodiazepines (BZDs) after a fall‐related hospitalization. Methods We used novel data linkage between Medicare fee‐for‐service (FFS) and Part D with our system's EHR. identified patients aged ≥66 years hospitalization, continuous enrollment in FFS 6 months pre‐ post‐hospitalization, ≥2 BZD fills pre‐hospitalization. Using standardized EHR abstraction tool, we adjudicated sub‐sample hospitalization at UNC. (e.g., gaps supply, dosage reductions) versus chart review using sensitivity specificity. Results Among 257 overall sample, 44% were 66–74 years, 35% had low‐income subsidy, 79% female. prevalence ranged from 8.2% (no refills) to 36.6% (30‐day gap). When incorporating dosage, 55.3% 65.8%. validation ( n = 47), approximately one‐third BZDs deprescribed Compared EHR, supply claims good sensitivity, but poor Incorporating increased worsened Conclusions The was low; however, specificity 90‐day gap >90%. Replication other EHRs low‐value medications is needed guide future research.

Language: Английский

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Assessing the prevalence of anticholinergic and sedative medications to avoid in older adults from the French Health Data System

Journal of the American Geriatrics Society, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 3, 2025

Abstract Background In older people, medications with anticholinergic or sedative properties are associated falls, frailty, and functional cognitive impairment. These often described as a subset of potentially inappropriate (PIMs). We examined the prevalence to avoid in people France 2023. Methods This cross‐sectional study used anonymized data from large electronic healthcare database, French National Health Data System (Système des Données de Santé, SNDS). All aged 65 years January 1, 2023, December 31, were included this study. Dispensations identified according PIM criteria (2023 American Geriatrics Society Beers Criteria REMEDI[e]S tool). The was assessed for population by age (65–84 85 older) living place (home institutionalized patients) subgroups terms number percentage patients. Results 16,938,152 patients (55% women). Among all patients, 79.8% between 84 20.2% older. Most lived at home (97.0%), 3.0% institutionalized. 32.8% among 32.3% 65–84 34.8% 32.1% 54.5% most commonly dispensed oxazepam (5.27%), alprazolam zopiclone (4.85%), bromazepam (4.23%), metopimazine (2.88%), paroxetine (2.70%), nefopam (2.57%), hydroxyzine (2.17%). Conclusions highlighted that still frequently prescribed despite development regular updating criteria. Future studies needed assess whether has led worsened outcomes adults who utilized these medications, new initiatives should be developed further promote deprescribing prescribers pharmacists.

Language: Английский

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Progressive Biocatalysts for the Treatment of Aqueous Systems Containing Pharmaceutical Pollutants

Life, Journal Year: 2023, Volume and Issue: 13(3), P. 841 - 841

Published: March 20, 2023

The review focuses on the appearance of various pharmaceutical pollutants in water sources, which dictates need to use methods for effective purification and biodegradation compounds. biological catalysts (enzymes cells) is discussed as one progressive approaches solving problems this area. Antibiotics, hormones, pharmaceuticals containing halogen, nonsteroidal anti-inflammatory drugs, analgesics antiepileptic drugs are among substrates biocatalysts processes that can be carried out. enzymes soluble immobilized forms compounds (PCPs) has been analyzed. Various living cells (bacteria, fungi, microalgae) taken separate cultures or components natural artificial consortia involved biocatalytic under aerobic anaerobic conditions. Cells introduced into treatment systems suspended form used deep PCPs. potential combinations with physical–chemical wastewater evaluated relation removing analyzes recent results main current trends development PCPs, pros cons used.

Language: Английский

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Anticholinergic and sedative medication use in older patients with cognitive concerns

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(9), P. 2792 - 2799

Published: April 29, 2024

Anticholinergic (AC) and sedative medications are a risk factor for cognitive impairment. This study sought to characterize AC use in older patients seen outpatient neuropsychological evaluation evaluate their associations with different domains. We hypothesized that would be associated worse attention/processing speed (AP), executive functioning (EF), memory. conducted cross-sectional chart review of 392 (mean [M] age = 72 ± 7.7 years, range 54-91). Medications were characterized by number (≥1 on the Cognitive Burden Scale [ACB]), medications, polypharmacy (≥5 daily medications). Demographically adjusted composites calculated AP, EF, Bivariate Pearson correlations assessed relationships between medication cognition. Multivariate linear regressions evaluated significant medication-cognition associations, controlling total medical comorbidities, estimated premorbid functioning. Polypharmacy was common (80%; n 314). Most (70%; 275) used ≥1 (range 0-9). Over half (63%; 248) drugs 0-7), yet ACB scores ≤2 74% patients. Sedative negatively correlated AP (r -0.134, p 0.008) EF -0.105, 0.04). -0.106, 0.037). Sedatives priori covariates significantly predicted performance (R2 0.127, < 0.001); using more uniquely (β -0.426, 0.049). No found prevalent this sample Though both drug classes had negative sedatives particularly association AP. Contrary our hypotheses, memory not use; however, anticholinergic burden low within sample, deficits may masquerade as problems.

Language: Английский

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Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(8), P. 2347 - 2358

Published: June 3, 2024

Abstract Background The use of potentially inappropriate medications (PIMs) is associated with increased risk hospitalizations and emergency room visits varies by racial ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive review (CMR) to all beneficiaries who qualify, provides a platform reduce PIM use. objective this study was assess the impact CMR on discontinuation in Medicare whether differed race or ethnicity. Methods Retrospective cohort community‐dwelling ≥66 years age were eligible for MTM from 2013 2019 based 5% fee‐for‐service claims data linked 100% file. Among those using PIM, MTM‐eligible recipients matched non‐recipients via sequential stratification. probability estimated regression models pooled yearly subcohorts accounting within‐beneficiary correlations. most common PIMs discontinued after reported. Results We 24,368 during observation period. Median 74–75, 35% males, White (86%–87%), median number 1. In adjusted analyses, receipt positively (adjusted relative [aRR]: 1.26, 95% CI: 1.20–1.32). There no evidence differential commonly glimepiride, zolpidem, digoxin, amitriptyline, nitrofurantoin. Conclusions are discontinuation, suggesting greater could facilitate reduction groups.

Language: Английский

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Effects of anticholinergic and sedative medication use on fractures: A self‐controlled design study

Journal of the American Geriatrics Society, Journal Year: 2021, Volume and Issue: 69(11), P. 3212 - 3224

Published: July 22, 2021

Abstract Background/Objectives Unintentional falls are a leading cause of injury for older adults, and evidence is needed to understand modifiable risk factors. We evaluated 1‐year fall‐related fracture whether dispensing medications with anticholinergic/sedating properties temporally associated an increased odds these fractures. Design A retrospective cohort study nested self‐controlled analyses conducted between January 1, 2014, December 31, 2016. Setting Twenty percent nationwide, random sample US Medicare beneficiaries. Participants New users who were 66+ years old had Parts A, B, D coverage but no claims in the year before initiation eligible. Measurements followed new until first non‐vertebral, (primary outcome), disenrollment, death, or end data. estimated corresponding 95% confidence intervals (CIs) after use. applied case‐crossover case‐time‐control designs estimate ratios (ORs) CIs by comparing anticholinergic and/or sedating medication exposure (any vs. none) during 14‐day hazard period preceding earlier control period. Results total 1,097,989 beneficiaries initiated The cumulative incidence fracture, accounting death as competing risk, was 5.0% (95% CI: 5.0%–5.0%). Using design (n = 41,889), adjusted OR association fractures 1.03 0.99, 1.08). Accounting noted temporal trend using 209,395), 1.60 1.52, 1.69). Conclusion Use Patients their healthcare providers should consider pharmacologic non‐pharmacologic treatments target condition that safer.

Language: Английский

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Utilization of Drug Decision Support Strategies Including Drug Characteristics to Reduce the Risk of Iatrogenesis in Advanced Age

Current Pharmacology Reports, Journal Year: 2023, Volume and Issue: 9(1), P. 32 - 42

Published: Jan. 9, 2023

Language: Английский

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Is anticholinergic and sedative drug burden associated with postdischarge institutionalization in community‐dwelling older patients acutely admitted to hospital? A Norwegian registry‐based study

Pharmacoepidemiology and Drug Safety, Journal Year: 2022, Volume and Issue: 32(6), P. 607 - 616

Published: Dec. 31, 2022

Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization postdischarge institutionalization (PDI) in community-dwelling older patients acutely admitted to hospital.A cross-sectional study using data from Norwegian Patient Registry Prescription Database. We studied hospitalized ≥70 years during 2013 (N = 86 509). Patients geriatric wards underwent subgroup analyses (n 1715). calculated by Drug Burden Index (DBI), use of AC/SED drugs, number drugs. Piecewise linearity DBI versus PDI a knot point (DBI 2.45) was identified. Statistical included an adjusted multivariable logistic regression model.In total population, 45.4% were exposed at least one drug, compared 52.5% subgroup. drugs significantly associated with PDI. The odds ratios (ORs) 1.11 (95% CI 1.07-1.15) for < 2.45 1.08 1.04-1.13) ≥ 2.45. OR 1.07 1.05-1.09). AC component 1.23 1.13. In subgroup, ORs closer 1 drugs.The highly prevalent acute hospital admissions, number, or just gave similar associations applying DBI. Using showed higher sensitivity, indicating that reduce risk PDI, clinical approach could be

Language: Английский

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