Review: Polypharmacy and precision medicine — R0/PR2 DOI Creative Commons

Published: Nov. 23, 2022

Precision medicine is an approach to maximise the effectiveness of disease treatment and prevention minimise harm from medications by considering relevant demographic, clinical, genomic environmental factors in making decisions. complex, even for decisions about single drugs diseases, as it requires expert consideration multiple measurable that affect pharmacokinetics pharmacodynamics, many patient-specific variables. Given increasing number patients with conditions medications, there a need apply lessons learned precision monotherapy management optimise polypharmacy. However, optimisation polypharmacy particularly challenging because vast interacting influence drug use response. In this narrative review, we aim provide latest research findings achieve context Specifically, review aims (1) summarise challenges achieving specific polypharmacy; (2) synthesise current approaches (3) summary literature field prediction unknown drug–drug interactions (DDI) (4) propose novel For our proposed model be implemented routine clinical practice, comprehensive intervention bundle needs integrated into electronic medical record using bioinformatic on wide range data predict effects regimens individual. addition, clinicians trained interpret results sources including pharmacogenomic testing, DDI physiological-pharmacokinetic-pharmacodynamic modelling inform their medication reviews. Future studies are needed evaluate efficacy test generalisability so can at scale, aiming improve outcomes people

Language: Английский

The anticholinergic burden: from research to practice DOI Creative Commons
Sarah N. Hilmer, Danijela Gnjidic

Australian Prescriber, Journal Year: 2022, Volume and Issue: 45(4), P. 118 - 120

Published: July 29, 2022

The anticholinergic burden: from research to practice

Language: Английский

Citations

30
Polypharmacy and precision medicine DOI Creative Commons
Kenji Fujita, Nashwa Masnoon, John Mach

et al.

Cambridge Prisms Precision Medicine, Journal Year: 2023, Volume and Issue: 1

Published: Jan. 1, 2023

Precision medicine is an approach to maximise the effectiveness of disease treatment and prevention minimise harm from medications by considering relevant demographic, clinical, genomic environmental factors in making decisions. complex, even for decisions about single drugs diseases, as it requires expert consideration multiple measurable that affect pharmacokinetics pharmacodynamics, many patient-specific variables. Given increasing number patients with conditions medications, there a need apply lessons learned precision monotherapy management optimise polypharmacy. However, optimisation polypharmacy particularly challenging because vast interacting influence drug use response. In this narrative review, we aim provide latest research findings achieve context Specifically, review aims (1) summarise challenges achieving specific polypharmacy; (2) synthesise current approaches (3) summary literature field prediction unknown drug-drug interactions (DDI) (4) propose novel For our proposed model be implemented routine clinical practice, comprehensive intervention bundle needs integrated into electronic medical record using bioinformatic on wide range data predict effects regimens individual. addition, clinicians trained interpret results sources including pharmacogenomic testing, DDI physiological-pharmacokinetic-pharmacodynamic modelling inform their medication reviews. Future studies are needed evaluate efficacy test generalisability so can at scale, aiming improve outcomes people

Language: Английский

Citations

17
Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review DOI Creative Commons

Bonnie M. Liu,

Lisa Kouladjian O’Donnell, Mitchell R. Redston

et al.

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

Citations

17
A stewardship program to facilitate anticholinergic and sedative medication deprescribing using the drug burden index in electronic medical records DOI Creative Commons
Nashwa Masnoon, Sarita Lo, Sarah N. Hilmer

et al.

British Journal of Clinical Pharmacology, Journal Year: 2022, Volume and Issue: 89(2), P. 687 - 698

Published: Aug. 30, 2022

The drug burden index (DBI) measures a person's total exposure to anticholinergic and sedative medications, which are commonly associated with harm. Through incorporating the DBI in electronic medical records (eMR) implementing stewardship program, we aimed determine (i) uptake of steward's recommendations deprescribe and/or drugs by team (ii) whether accepted were actioned hospital or recommended for follow-up General Practitioner post-discharge.

Language: Английский

Citations

20
Impact of a Comprehensive Intervention Bundle Including the Drug Burden Index on Deprescribing Anticholinergic and Sedative Drugs in Older Acute Inpatients: A Non-randomised Controlled Before-and-After Pilot Study DOI Creative Commons
Kenji Fujita, Patrick K. Hooper, Nashwa Masnoon

et al.

Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(7), P. 633 - 642

Published: May 9, 2023

Implementation of the Drug Burden Index (DBI) as a risk assessment tool in clinical practice may facilitate deprescribing. The purpose this study is to evaluate how comprehensive intervention bundle using DBI impacts (i) proportion older inpatients with at least one DBI-contributing medication stopped or dose reduced on discharge, compared admission; and (ii) changes deprescribing different classes during hospitalisation. This before-and-after was conducted an Australian metropolitan tertiary referral hospital. Patients aged ≥ 75 years admitted acute care service for 48 h from December 2020 October 2021 prescribed were included. During control period, usual provided. intervention, access added, including clinician interface displaying score electronic medical record. In subsequent 'stewardship' stewardship pharmacist used provide clinicians patient-specific recommendations medications. Overall, 457 hospitalisations patients stopped/reduced discharge increased 29.9% (control period) 37.5% [intervention; adjusted difference (aRD) 6.5%, 95% confidence intervals (CI) −3.2 17.5%] 43.1% (stewardship; aRD 12.1%, CI 1.0–24.0%). opioid prescriptions rose 17.9% 45.7% (p = 0.04). Integrating accompanying program promising strategy sedative anticholinergic medications inpatients.

Language: Английский

Citations

7
Development, validation and evaluation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© DOI
Lisa Kouladjian O’Donnell, Emily Reeve, Sarah N. Hilmer

et al.

Research in Social and Administrative Pharmacy, Journal Year: 2021, Volume and Issue: 18(7), P. 3174 - 3183

Published: Sept. 14, 2021

Language: Английский

Citations

15
Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: A systematic review DOI Creative Commons
Selvana Awad, Krestina L. Amon, Andrew Baillie

et al.

International Journal of Medical Informatics, Journal Year: 2023, Volume and Issue: 172, P. 105017 - 105017

Published: Feb. 9, 2023

Poorly designed electronic medication management systems (EMMS) or computerized physician order entry (CPOE) in hospital settings can result usability issues and turn, patient safety risks. As a science, human factors analysis methods have potential to support the safe usable design of EMMS.To identify describe that been used redesign EMMS settings.A systematic review, following PRISMA guidelines, was conducted by searching online databases relevant journals from January 2011 May 2022. Studies were included if they described practical application clinician-facing EMMS, its components. Methods extracted mapped centered (HCD) activities: understanding context use; specifying user requirements; producing solutions; evaluating design.Twenty-one papers met inclusion criteria. Overall, 21 with prototyping, testing, participant surveys/questionnaires interviews most frequent. Human frequently evaluate system (n = 67; 56.3%). Nineteen (90%) aimed and/or iterative design; only one paper utilized safety-oriented method one, mental workload assessment method.While review identified methods, primarily subset available rarely focused on safety. Given high-risk nature complex environments, for harm due poorly there is significant apply more design.

Language: Английский

Citations

6
Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study DOI Creative Commons
Andrea Torres-Robles, Karen Allison, Simon Poon

et al.

Journal of Medical Internet Research, Journal Year: 2023, Volume and Issue: 25, P. e44540 - e44540

Published: July 31, 2023

As a response to the COVID-19 pandemic, Sydney Local Health District in New South Wales, Australia, launched rpavirtual program, first full-scale virtual hospital remotely monitor and follow up stable patients with COVID-19. part of intervention, pulse oximeter wearable device was delivered their oxygen saturation levels, critical indicator patient deterioration. Understanding users' perceptions toward is fundamental assessing its usability acceptability contributing effectiveness but no research date has explored user experience for remote monitoring this setting.This study aimed explore use, performance, by clinicians during COVID-19.Semistructured interviews testing were conducted. Stable adult (aged ≥18 years) who used monitored rpavirtual, these interviewed. Clinicians could be nurses, doctors, or staff team that assisted use oximeter. Usability conducted had when they contacted. Interviews coded using Theoretical Framework Acceptability. think-aloud protocol. Data collected until reached.Twenty-one (average age 51, SD 13 15 41, 11 completed interview. Eight testing. All participants liked thought it easy use. They also good understanding how device's purpose. Patients' use-related characteristics (eg, warmth hands hand steadiness) identified users as factors negatively impacting accurate oximeter.Patients very positive monitoring, indicating high device. However, may impact accuracy should considered delivering interventions monitoring. Targeted instructions about necessary specific populations older people unfamiliar technology). Further focus on integration data into electronic medical records real-time secure

Language: Английский

Citations

5
The Unseen Hand: AI-Based Prescribing Decision Support Tools and the Evaluation of Drug Safety and Effectiveness DOI
Harriet Dickinson,

Dana Y. Teltsch,

Jan Feifel

et al.

Drug Safety, Journal Year: 2023, Volume and Issue: 47(2), P. 117 - 123

Published: Nov. 29, 2023

Language: Английский

Citations

5
Geriatric medicine and health care for older people in Australia DOI Open Access
David G. Le Couteur, Leon Flicker, Sarah N. Hilmer

et al.

Age and Ageing, Journal Year: 2022, Volume and Issue: 51(3)

Published: Jan. 6, 2022

Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged open it up market forces. A recent inquiry into (Royal Commission Care Quality Safety) documented the outcome of this policy-substandard at most levels. The provision services older Aboriginal Torres Strait Islander peoples, who have high prevalence frailty cognitive impairment, was also identified as inadequate. effects yet be implemented changes funding response report remain seen. Despite backdrop, geriatricians contributed a steady growth medical interventions focussed on specific geriatric issues such dementia, falls, polypharmacy orthogeriatrics. These are often driven by, or collaboration with researchers, aim generate research data well provide patient care. numbers academic other health professionals increasing, training specialist now includes significant component.

Language: Английский

Citations

8