Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(2), P. 589 - 603

Published: Nov. 25, 2023

Abstract Background The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed investigate the association of DBI with clinical prescribing outcomes in observational pharmaco‐epidemiological studies, effect on functional pre‐clinical models. Methods A search nine electronic databases, citation indexes gray literature was performed (April 1, 2007–December 31, 2022). Studies that reported primary data or conducted any setting humans aged ≥18 years animals were included. Quality assessment using Joanna Briggs Institute critical appraisal tools Systematic Review Centre for Laboratory animal Experimentation risk bias tool. Results Of 2382 studies screened, 70 met inclusion criteria (65 humans, five animals). In included function ( n = 56), cognition 20), falls 14), frailty 7), mortality 9), quality life 8), hospitalization length stay 5), readmission 1), other 15) 2). higher significantly associated increased (11/14, 71%), poorer (31/56, 55%), (11/20, 55%) related outcomes. Narrative synthesis used due significant heterogeneity study population, setting, type, definition DBI, outcome measures. could not be pooled heterogeneity. animals, 18), 2), 1). a caused frailty. Conclusions may decreased cognition. Higher inconsistently mortality, stay, frailty, reduced life. Human findings respect are supported by preclinical interventional studies. as tool identify older adults at harm.

Language: Английский

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Dynamic changes in medication burden leading to fall and hospital readmissions in older adults: Toward a strategy for improving risk and managing costs

Journal of Managed Care & Specialty Pharmacy, Journal Year: 2025, Volume and Issue: 31(1), P. 96 - 100

Published: Jan. 1, 2025

The majority of a health plan's performance and designated Star Rating is related to medication-related behavior, eg, medication adherence, review, reconciliation, that are intricately adverse drug events (ADEs). Altered pharmacodynamics pharmacokinetics owing aging make older adults more vulnerable ADEs like falls, fractures, hospitalizations, mortality. Prevention avoidable risk factors such as burden can help maintain quality life. Studies multiple populations have established index (DBI), dose-dependent measure anticholinergic sedative burden, be strongly associated with worsening vertigo, dizziness, balance, which all predicate falls. mean difference in DBI greater than 0.1 provides predictive power for events, falls 30-day readmission rates. Inclusion delta metric especially on an electronic medical record has the potential reduce fall incidence outcomes hospitalizations death; this presents opportunity improve Centers Medicare & Medicaid Services Ratings by using meaningful tools foster engagement among informed active beneficiaries. We believe information extremely relevant real-world decision-making care professionals, specifically when changes dynamic happen very quickly. Moreover, managed organizations now dedicated eliciting deeper understanding mitigation social inequalities use consequences. Among proposed solutions includes tailoring prescription utilization management decrease incidences complications unintended costs. Understanding relationship between exposures causing costs third-party payments remains vital because United States, approximately one-third hospital admissions occur ADEs. This achieved emphasizing equitable therapy initiatives minimize racial disparities affect financial these patients. Importantly, approach becomes even critical systems increasingly emphasize star ratings, reflect delivered By prioritizing metrics we ensure not only clinically effective but also focused improving patients' overall well-being. Lastly, future directions, timely application advanced technologies artificial intelligence machine learning analyzing could enhance our ability predict value adjustments their correlation other These process vast amounts data quickly accurately, identifying patterns risks might otherwise go unnoticed.

Language: Английский

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Preadmission medications and recent falls in older inpatients: an observational study

International Journal of Clinical Pharmacy, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 7, 2025

Falls in older adults might increase due to polypharmacy. This study aimed explore the association between preadmission medications and history of falls inpatients. observational inpatients aged ≥ 65 years was conducted over 4 at Ballina Hospital, Australia. The Medication Regimen Complexity Index (MRCI), Drug Burden (DBI), Anticholinergic Effect on Cognition (AEC) scores were calculated for medications. Polypharmacy questionnaires administered identify past 6 months aptitude toward medication use. Overall, 194 participants with a mean age 80.2 (SD 8.0) included. daily number regular 7.8 3.9) MRCI score 22 12.6). Among participants, 107 (55%) reported 47 (24%) 2 falls. Age hearing impairment positively associated (p = 0.007 p 0.003, respectively). History 20 0.018), an AEC 0.010) DBI 1 after adjustment 0.041). Forgetting 0.043). Antihypertensive use did not risk. Implementing decisive approach simplify complex regimens, along patient-focused management strategies, may help reduce risk adults. Sedatives anticholinergic should be avoided whenever possible.

Language: Английский

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A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial

Trials, Journal Year: 2022, Volume and Issue: 23(1)

Published: April 4, 2022

Opioids and benzodiazepines (BZDs) are some of the most commonly prescribed medications that contribute to falls in older adults. These challenging appropriately prescribe monitor, with little guidance on safe prescribing these for patients. Only a handful small studies have evaluated whether reducing opioid BZD use through deprescribing has positive impact outcomes. Leveraging strengths large health system, we targeted consultant pharmacist intervention deprescribe opioids BZDs adults seen primary care practices North Carolina.We developed toolkit process based literature review from an interprofessional team pharmacists, geriatricians, investigators. A total fifteen been randomized receive service (n = 8) or usual 7). The consists several components: (1) weekly automated reports identify chronic users BZDs, (2) clinical medication review, (3) recommendations and/or alternate therapies routed prescribers electronic record. We will collect data all patients presenting one clinics who meet criteria their prescription order history. year prior evaluate baseline exposures using morphine milligram equivalents (MMEs) diazepam (DMEs). In following intervention, changes discontinuations between control clinics. Incident be as secondary outcome. To date, study enrolled 914 1048 users. anticipate 80% power detect 30% reduction MMEs DMEs.This clinic pragmatic trial valuable evidence regarding interventions reduce settings.Clinicaltrials.gov NCT04272671 . Registered February 17, 2020.

Language: Английский

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Impact of a clinical decision support system on identifying drug‐related problems and making recommendations to providers during community pharmacist‐led medication reviews in Ontario, Canada: A pilot study

Journal of Evaluation in Clinical Practice, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 13, 2024

Abstract Objective To evaluate the impact of a clinical decision support system (CDSS) to identify drug‐related problems (DRPs) during community pharmacist medication reviews. Design Pilot 3‐phase (group), open‐label study. Setting and Participants Two pharmacies in Sarnia, Ontario, with pharmacists providing reviews patients. Study Procedures Five participated three phases (groups). During Phase 1, conducted 25 adult patients using usual approaches. In 2, were trained use CDSS DRPs, then tool different group 3, without aid additional Main Outcome Measures The primary outcome was recommendation care physician alter pharmacotherapy based on review, assessed mean number frequency (yes/no) recommendations by patient. Secondary outcomes included potential actual review duration time, pharmacist's perceptions patient satisfaction review. Results physicians per Phases 2 3 did not differ: 1.0 (SD = I.2) versus 1.5 (1.0) (1.0), respectively; p 0.223. percentage pharmacy sent across phases, however, differed: 52% 80% 88%, 0.010, more compared 1. There DRPs other groups. no differences time. Pharmacists had positive attitudes about CDSS. Patients generally satisfied their Conclusions This small pilot study provides some preliminary evidence for performance feasibility that will act on. Future research is recommended validate these findings larger sample.

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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Enhancing deprescribing: A qualitative understanding of the complexities of pharmacist‐led deprescribing in care homes

Health & Social Care in the Community, Journal Year: 2022, Volume and Issue: 30(6)

Published: Nov. 1, 2022

The English National Overprescribing Review identified that older people often take eight or more medicines a day. report recommended pharmacists in primary care should responsibility for addressing polypharmacy. is safety concern homes as approximately half of home residents are prescribed at least one medicine unnecessary now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing the planned activity stopping reducing may no longer be appropriate. Deprescribing, when performed by pharmacist, multidisciplinary requiring close communication with general practitioners (GPs) staff. A recently completed trial integrated prescribing rights into peoples' found significant variation proactive deprescribing activity. aim current study was specifically explore beliefs practices homes. qualitative approach adopted examine individual, social contextual factors acted enablers barriers pharmacist Semi-structured interviews were conducted participants previous (16 pharmacists, 6 GPs 7 staff from Northern Ireland, Scotland England). Using thematic analysis, we two themes: (a) Structures systems affecting deprescribing, context which happened, team involvement routine GP surgeries homes; (b) Balancing risks perception individual risk mitigated understanding medical background residents. supported clinical overprescribing greater than deprescribing. While can involve all health professionals team, these results suggest well placed lead process; having both competence professional willingness drive this forward.

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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Safer medicines To reduce falls and refractures for OsteoPorosis (#STOP): a study protocol for a randomised controlled trial of medical specialist-initiated pharmacist-led medication management reviews in primary care

BMJ Open, Journal Year: 2023, Volume and Issue: 13(8), P. e072050 - e072050

Published: Aug. 1, 2023

Minimal trauma fractures (MTFs) often occur in older patients with osteoporosis and may be precipitated by falls risk-increasing drugs. One category of drugs concern are those sedative/anticholinergic properties. Collaborative medication management services such as Australia's Home Medicine Review (HMR) can reduce patients' intake sedative/anticholinergics improve continuity care. This paper describes a protocol for an randomised controlled trial to determine the efficacy HMR service who have sustained MTF. Eligible participants follows: ≥65 years age, using ≥5 medicines including at least one drug, MTF under treatment eight Osteoporosis Refracture Prevention clinics Australia. Consenting will control (standard care) or intervention groups. For group, medical specialists refer pharmacist focused on reducing risk predominately through making recommendations medicines, adherence antiosteoporosis medicines. Twelve months from allocation, comparisons between groups made. The main outcome measure is participants' cumulative exposure sedative anticholinergics, Drug Burden Index. Secondary outcomes include adherence, emergency department visits, hospitalisations, mortality. Economic evaluation compare strategy standard Approval was obtained via New South Wales Research Ethics Governance Information System (approval number: 2021/ETH12003) site-specific approvals granted Human Committees each research site. Study published peer-reviewed journals. It provide robust insight into effectiveness pharmacist-based medicine-related osteoporosis. We anticipate that this study take 2 fully accrue follow-up. ACTRN12622000261718.

Language: Английский

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Drug burden index in people living with HIV over 50 years of age in a real clinical practice cohort

Enfermedades Infecciosas y Microbiología Clínica, Journal Year: 2024, Volume and Issue: 42(7), P. 347 - 353

Published: Aug. 1, 2024

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