Overuse of medications in low- and middle-income countries: a scoping review

Bulletin of the World Health Organization, Journal Year: 2023, Volume and Issue: 101(1), P. 36 - 61D

Published: Jan. 1, 2023

To identify and summarize the evidence about extent of overuse medications in low- middle-income countries, its drivers, consequences potential solutions.We conducted a scoping review by searching databases PubMed®, Embase®, APA PsycINFO® Global Index Medicus using combination MeSH terms free text words around overtreatment. We included studies any language published before 25 October 2021 that reported on overuse, screened 3489 unique records 367 reporting over 5.1 million prescriptions across 80 countries - with from 58.6% (17/29) all low-, 62.0% (31/50) lower-middle- 60.0% (33/55) upper-middle-income countries. Of studies, 307 (83.7%) medications, estimates ranging 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes antimicrobials, psychotropic drugs, proton pump inhibitors antihypertensive drugs. Drivers limited knowledge harms polypharmacy, poor regulation financial influences. Consequences were patient harm cost. Only 11.4% (42/367) evaluated solutions, which regulatory reforms, educational, deprescribing audit-feedback initiatives.Growing suggests is widespread within multiple drug classes, few data solutions randomized trials. Opportunities exist build collaborations rigorously develop evaluate reduce medications.Identifier et résumer les données démontrant l'ampleur de la surconsommation médicaments dans pays à revenu faible intermédiaire, mais aussi causes cette surconsommation, ses conséquences pistes solution.Nous avons mené une analyse exploratoire en effectuant recherche bases l'Index mondial l'aide d'une combinaison termes mots texte libre liés aux surtraitements. Nous inclus des études rédigées toutes langues publiées avant le octobre 2021, qui mentionnaient causes, passé revue documents uniques conservé faisant état plus 5,1 millions d'ordonnances intermédiaire – ces concernaient 58,6% faible, 62,0 % ceux tranche inférieure 60,0% supérieure. Sur l'ensemble reprises, (83,7%) signalaient médicaments, avec estimations comprises entre 7,3% 98,2% (écart interquartile: 30,2-64,5). Cette s'observait principalement catégories telles que antimicrobiens, substances psychotropes, inhibiteurs pompe protons antihypertenseurs. Plusieurs étaient évoquées: méconnaissance dégâts polypharmacie, mauvaise réglementation influences économiques. Les surtout néfastes pour santé patients coûts engendrés. À peine 11,4% examinaient parmi lesquelles réformes réglementaires, ainsi initiatives sensibilisation, déprescription d'audit–feedback.Un faisceau croissant preuves indique est largement répandue nombreuses substances, peu d'informations circulent quant issues essais randomisés. Il existe néanmoins opportunités collaboration permettraient développer d'évaluer rigoureusement solution lutter contre médicaments.Identificar y resumir evidencia sobre el grado del uso excesivo medicamentos los países ingresos bajos medios, sus causas, consecuencias posibles soluciones.Se realizó una revisión exploratoria mediante búsquedas las datos partir combinación términos palabras texto sobretratamiento. Se incluyeron estudios cualquier idioma publicados antes octubre informaran excesivo, examinaron registros únicos se informaron más millones recetas con 58,6 todos bajos, medios 60,0 altos. De incluidos, (83,7 %) medicamentos, estimaciones oscilaban 7,3 98,2 (rango intercuartil: Las clases usadas exceso incluían antimicrobianos, psicofármacos, inhibidores bomba protones antihipertensores. Los factores causantes conocimiento limitado daños polifarmacia, falta regulación influencias financieras. daño pacientes coste. Solo 11,4 evaluaron soluciones, encontraban reformas normativas, iniciativas educación, desprescripción retroalimentación auditorías.Cada vez hay evidencias está muy extendido múltiples dispone insuficientes soluciones procedentes ensayos aleatorizados. Hay oportunidades crear colaboraciones para desarrollar evaluar rigor reducir medicamentos.الغرض تحديد وتلخيص الأدلة على مدى الاستخدام المفرط للأدوية في الدول ذات الدخل المنخفض والمتوسط، ودوافع هذا الاستخدام، وعواقبه، والحلول الممكنة له. الطريقة لقد أجرينا مراجعة عن كثب طريق البحث قواعد البيانات PubMed®‎، وEmbase®‎، وAPA PsycINFO®‎، وGlobal باستخدام مجموعة من مصطلحات MeSH، وكلمات نصية حرة بخصوص والمعالجة المفرطة. وقمنا بتضمين دراسات ‎‎‎نُشرت بأية لغة قبل أكتوبر/تشرين أول 2021، وكنا نُبلغ ودوافعه، وحلوله. النتائج قمنا بفحص سجلاً فريداً، وتضمين دراسة كشفت أكثر مليون وصفة طبية دولة دخل منخفض إلى متوسط مع %58.6 كل المنخفض، و%62.0 المتوسط الأدنى، و%60.0 الأعلى. بين الدراسات المشمولة، (%83.7) للأدوية، تقديرات تتراوح %7.3 %98.2 (المدى الشرائح الربعية: 30.2 64.5). وشملت الفئات الأكثر استخدامًا بشكل شائع مضادات الميكروبات، والعقاقير المؤثرة العقل، ومثبطات مضخة البروتون، والأدوية الخافضة للضغط. تضمنت الدوافع معرفة محدودة بأضرار المفرط، وتعدد الأدوية، وسوء التنظيم، والتأثيرات المالية. كانت العواقب هي حدوث الضرر للمرضى، فضلًا التكلفة. قامت %11.4 فقط بتقييم الحلول، والتي الإصلاحات التنظيمية، والمبادرات التعليمية، ومبادرات الحد الوصفات الطبية، التدقيق والمراجعة. الاستنتاج تشير الدلائل المتزايدة أن هو ظاهرة منتشرة والدخل المتوسط، عبر فئات عديدة بيانات قليلة الحلول التجارب العشوائية. توجد فرص لبناء علاقات تعاون لتطوير، وتقييم فعال للحد للأدوية.旨在确定和概述关于中低收入国家药物滥用的程度、其驱动因素、后果和潜在解决方案的证据。.我们通过搜索 PubMed®、Embase®、APA 和 数据库,结合使用 主题词和自由词,对药物滥用和过度治疗情况进行了一项范围审查。我们纳入了 年 10 月 日之前以任何语言发表的研究,并报告了药物滥用的程度、其驱动因素、结果和解决方案。.我们筛选了 项独特记录,纳入了 份研究,报告涉及 个中低收入国家的 510 多万份处方,其中所有低收入国家的研究占 (17/29)、所有中下收入国家的研究占 以及中上收入国家的研究占 (33/55)。纳入的研究中,307 份研究报告了药物滥用的程度,估计范围为 至 98.2%(四分位距:30.2–64.5)。常见的滥用药物包括抗菌药物、精神治疗药物、质子泵抑制剂和抗高血压药。驱动因素包括对药物滥用危害的认识有限、多重用药、监管不力以及财务影响。后果是患者受到伤害并承担费用。只有 研究评估了解决方案,其中包括监管改革、教育、取消处方和审查反馈方案。.越来越多的证据表明中低收入国家普遍存在药物滥用情况,涉及多种药物类别,但有关随机试验中得出的解决方案的数据却很少。应创建机会建立合作,严格开发和评估潜在解决方案,以减少药物滥用情况。.Определить и обобщить данные о масштабах чрезмерного использования лекарственных средств в странах с низким средним уровнем дохода, его движущих факторах, последствиях возможных способах решения проблемы.Авторы провели предварительный обзор путем поиска данных базах Medicus, используя комбинацию терминов слов произвольного текста, касающихся употребления передозировки ими. Были включены исследования на всех языках, опубликованные до октября г., которых сообщалось употребления, причинах, проанализировали уникальных записей включили исследований, более чем млн рецептов дохода. Среди них были из стран 62,0% дохода ниже среднего выше среднего. Из включенных исследований степени средств, при этом оценки колебались от (межквартильный диапазон: 30,2–64,5). Как правило, к числу классов чрезмерно используемых относятся: противомикробные препараты, психотропные средства, ингибиторы протонной помпы антигипертензивные препараты. К движущим факторам ограниченные знания вреде использования, полипрагмазия, слабое регулирование финансовое влияние. Последствия для пациентов заключаются во вреде, причиненном их здоровью, дополнительных затратах. Только оценивались способы проблемы, которые включали программу по реформированию нормативно-правовой базы, инициативы области образования, а также направлении постепенного прекращения определенных внедрения аудита обратной связью.Все больше свидетельствуют том, что чрезмерное использование широко распространено отношении нескольких лекарств, полученных ходе рандомизированных немного. Существуют возможности налаживания сотрудничества целью тщательной разработки потенциальных способов сокращения средств.

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Potentially inappropriate medication including drug-drug interaction and the risk of frequent falling, hospital admission, and death in older adults - results of a large cohort study (getABI)

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: Feb. 15, 2023

Introduction: With growing age, multiple chronic diseases may result in polypharmacy. Drugs that should be avoided older adults are called potentially inappropriate medications (PIM). Beyond PIM, drug-drug interactions (DDI) known to related adverse drug events. This analysis examines the risk of frequent falling, hospital admission, and death associated with PIM and/or DDI (PIM/DDI) prescription. Materials methods: post hoc used data a subgroup getABI study participants, large cohort community-dwelling adults. The comprised 2120 participants who provided detailed medication report by telephone interview at 5-year follow-up. risks course following 2 years were analysed logistic regression uni- multivariable models adjustment for established factors. Results: Data all 2,120 was available endpoint death, 1,799 1,349 falling. showed an association PIM/DDI prescription falling (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.06–2.60, p = 0.027) as well admission (OR 1.29, CI 1.04–1.58, 0.018), but not 1.00, 0.58–1.72, 0.999). Conclusion: No found years. alert physicians provide closer look prescriptions.

Language: Английский

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Nutritional Status and Potentially Inappropriate Medications in Elderly

Journal of Clinical Medicine, Journal Year: 2022, Volume and Issue: 11(12), P. 3465 - 3465

Published: June 16, 2022

(1) Background: The association between polypharmacy and malnutrition has been investigated in several studies; however, few of these specifically deepened the relationship potentially inappropriate medication malnutrition. With a descriptive approach, primary aim our study was to evaluate impact nutritional status, assessed with Mini Nutritional Assessment (MNA), on medications (PIM), estimated 10-year survival, risk adverse drug reactions elderly patients; secondary how Screening Tool Older People’s Prescriptions (STOPP), Alert Right Treatment (START), BEERS 2019 criteria identify PIM compared status. (2) Methods: In this study, 3091 subjects were enrolled, whom 2748 (71.7%) women; median age 80 years, an interquartile range 75 85 years age. at outpatient service for frail older people University Hospital Cagliari. population evaluated their: MNA, Charlson Comorbidity Index, survival estimation, 2019, STOPP START criteria, ADR Risk scores. (3) Results: We divided into three groups: MNA1 (MNA score ≥ 24), MNA2 (23.5−17), MNA3 (<17): severity comorbidities, alerts, significantly worse both MNA1—with exception “non-anti-infective that should be avoided or have their dosage reduced varying levels kidney function adults”. Moreover, higher than MNA3, also MNA3. Finally, scores lower (4) Conclusions: Our demonstrated status checked and, first time, criteria.

Language: Английский

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Polypharmacy and malnutrition in older people: A narrative review

Nutrition, Journal Year: 2023, Volume and Issue: 115, P. 112134 - 112134

Published: June 20, 2023

Language: Английский

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Evaluation of medication safety assessment tools for pharmacist-led medication reviews: the Eastern European pilot project

Frontiers in Pharmacology, Journal Year: 2024, Volume and Issue: 15

Published: Feb. 16, 2024

Background: Pharmacist-led medication reviews (MR) are one of the key methods to support safety in polypharmacy patients. The aims this study were pilot MRs Eastern European community pharmacies, describe use patients, and evaluate usability assessment tools. Methods: MR was undertaken Estonia, Latvia, Poland, Hungary, Romania, Bulgaria. Patients who used at least five medicines directed service by their GPs. Data on drug-related problems (DRPs) adherence collected pharmacists through structured patient interviews. Databases for identification potential drug-drug interactions (pDDIs) adverse drug reactions (ADRs) named Inxbase/Riskbase, as well an integrated tool comprising potentially inappropriate (PIMs) lists EU(7)-PIM EURO-FORTA, applied retroactively data investigate possibilities risks population. Results: A total 318 patients included study, 250 them elderly (≥65 years). One hundred eighty (56.6%) participants had a 504 pDDIs based Inxbase analysis. On average, there 1.6 per participant. Twenty-five (5.0%) high-risk category. 279 (87.7%) ADR 10 Riskbase categories. fifty-four (20.8%) ADRs Twenty-seven 68 documented DRPs during not databases. Using EU(7)-PIM/EURO-FORTA PIM list, 816 PIMs found 240 (96%) (on average 3.4 participant). Seventy-one (29.6%) using PIMs. Twenty-one percent 13.8% medium-risk pilot. Conclusion: Medication tools can be useful guiding decision-making MRs; however, these cannot replace interviews monitoring. Tools that include thorough explanation easy more beneficial MRs.

Language: Английский

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Potentially inappropriate medication use in older adults with mild-moderate Alzheimer’s disease: prevalence and associations with adverse events

Age and Ageing, Journal Year: 2020, Volume and Issue: 49(4), P. 580 - 587

Published: March 25, 2020

Potentially inappropriate medication (PIM) use is prevalent in older adults and associated with adverse events, hospitalisation mortality. We assessed the patterns associations of PIM mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group.Analysis data from NILVad, an 18-month Randomised Control Trial Nilvadapine AD. The v2 STOPP criteria were applied duplicate to identify use. Associations between events/unscheduled healthcare visits addition AD progression evaluated.448 23 centres nine European countries.Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) prescribed 30.1% being 2+ PIMs. most frequent PIMs (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% 50/448), (iii) Proton-Pump Inhibitors (PPIs) (10.7% 48/448). Increasing number was greater risk events (IRR 1.17, 1.13-1.19, P < 0.001), serious 1.27; 1.17-1.37, unscheduled hospitalisations 1.16, 1.03-1.30, 0.016) GP 1.22, 1.15-1.28, 0.001). not dementia progression.PIM highly utilisation. Further attention de-prescribing this group warranted.

Language: Английский

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Potentially inappropriate medication use among older adult patients on follow-up at the chronic care clinic of a specialized teaching hospital in Ethiopia. A cross-sectional study

BMC Geriatrics, Journal Year: 2021, Volume and Issue: 21(1)

Published: Oct. 7, 2021

Older adult patients are prone to potentially inappropriate medication use (PIMU); its has been associated with multiple adverse consequences. As a result, it is crucial determine the magnitude and factors PIMU. The present study was mainly aimed assess predictors of in older on follow-up at chronic care clinic Jimma medical center.A retrospective cross-sectional conducted involving 219 aged 65 years above treatment follow-up. Data collected using checklist. 2019 updated American Geriatric Society (AGS) Beers Criteria® Screening Tool People's Potentially Inappropriate Prescriptions criteria Alert Doctors Right Treatment (STOPP/START) (version 2) were employed SPSS IBM (v22) used for data entry analysis. Categorical variables described frequency percentage, whereas continuous mean standard deviation (SD) or median interquartile range (IQR). Logistic regression identify PIMU.The average number medications prescribed per patient 4.0 (IQR = 2.0). At least one PIMU identified 182 (83.1%) 99 (45.2%) patients, based STOPP criteria, respectively. Additionally, potential prescription omission (PPO) observed 24 (10.9%) patients. risk increased age [AOR 1.21, p < 0.001], hypertension 4.17, polypharmacy 14.10, while decrease noted diagnosis ischemic stroke 0.133, 0.01] asthma 0.03, 0.001]. Using 2.10, 0.04], diabetes mellitus 2.26, heart disease 2.84, peripheral neuropathy 10.61, 6.10, 0.001] significantly PIMU.Regardless screening tool assess, revealed large proportion participants. Multiple certain condition had probability Hence, imperative tools reviewing ensure safety therapy.

Language: Английский

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Comparison of three fall risk assessment tools in older hospitalized patients in Turkey: analysis of sensitivity and specificity

Aging Clinical and Experimental Research, Journal Year: 2023, Volume and Issue: 35(5), P. 1033 - 1041

Published: March 1, 2023

Language: Английский

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Worldwide Prevalence of Polypharmacy: A Systematic Review

Current Drug Metabolism, Journal Year: 2023, Volume and Issue: 24(8), P. 568 - 586

Published: July 27, 2023

The present study has compiled the prevalence of polypharmacy worldwide and assessed in different populations, including community-dwelling individuals, hospitalized patients, institutionalized patients.This systematic review was conducted reported according to guidelines outlined Preferred Reporting Items for Systematic Reviews Meta-Analysis (PRISMA) statement. A search electronic databases, PubMed, Web Science, Scielo, performed March 2021 without any date language restrictions. Combinations following keywords were used strategy: OR multiple medications medicines drug AND prevalence. Based on inclusion criteria, two hundred eight studies (73,076,167 individuals) selected review. It observed that there is a wide variation between studies.The found be 30.2%, 61.7%, 56.9% respectively.Based analyses, this demonstrated countries high patients.

Language: Английский

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Impact of the severity of dementia due to Alzheimer’s disease on the gustatory sensitivity of older persons

Aging Clinical and Experimental Research, Journal Year: 2020, Volume and Issue: 32(11), P. 2303 - 2309

Published: Jan. 2, 2020

Language: Английский

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