Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review

Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(12), P. 1085 - 1100

Published: Oct. 20, 2023

To reduce prescribing cascades occurring in clinical practice, healthcare providers require information on the they can recognize and prevent. This systematic review aims to provide an overview of cascades, including dose-dependency recommendations that use prevent or reverse them. The Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) was followed. Relevant literature identified through searches OVID MEDLINE, Embase, CINAHL, Cochrane. Additionally, Web Science Scopus were consulted analyze reference lists citations. Publications English included if analyzed occurrence cascades. Prescribing at least one study demonstrated a significant association excluded when adverse drug reaction could not be confirmed Summary Product Characteristics. Two reviewers independently extracted grouped similar Descriptive summaries provided regarding analyses these A total 95 publications included, resulting 115 with reactions which found. For 52 dose dependency Dose 12 example, antipsychotics may cause extrapyramidal syndrome followed by anti-parkinson drugs. Recommendations focused dosage lowering, discontinuing medication, medication switching. Explicit alternative options given three One example switching ondansetron granisetron is experienced using metoclopramide. In total, them generated provided. Nonetheless, managing scarce.

Language: Английский

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Prescription Sequence Symmetry Analysis (PSSA) to assess prescribing cascades: a step-by-step guide

BMC Medical Research Methodology, Journal Year: 2024, Volume and Issue: 24(1)

Published: Jan. 11, 2024

Abstract Prescribing cascades occur when patients are prescribed medication to treat the adverse drug reaction of previously medication. Prescription sequence symmetry analysis (PSSA) can be used assess association between two medications in prescription or dispensing databases and thus potential occurrence prescribing cascades. In this article, a step-by-step guide is presented for conducting PSSA We describe considerations data collection setting time periods relevant parameters, including washout window, exposure continued interval blackout period. With examples, we illustrate impact changes these parameters on strengths associations observed. Given seen, recommend that researchers clearly specify explain all regarding included windows set studying with PSSA, conduct subgroup sensitivity analyses.

Language: Английский

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Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(6)

Published: June 1, 2024

Abstract Introduction Problematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional cascades represent an under-researched aspect problematic and occur when adverse drug reaction (ADR) misinterpreted as a new symptom resulting in initiation medication. The aim this study was to elicit key stakeholders’ perceptions attitudes towards polypharmacy, with focus on cascades. Methods qualitative one-to-one semi-structured interviews were conducted predefined stakeholder groups. Inductive thematic analysis employed. Results Thirty-one stakeholders interviewed: six patients, two carers, seven general practitioners, eight pharmacists, four hospital doctors, professional organisation representatives policymakers. Three main themes identified: (i) ADRs cascades—a necessary evil. Healthcare professionals (HCPs) expressed concern that experiencing ADR would negatively impact patients’ confidence their doctor. However, patients viewed pragmatically unpredictable risk. (ii) Balancing risk/benefit tipping point. complexity decisions context made balancing point challenging. Consequently, HCPs avoided medication changes. (iii) minefield reconciliation. Stakeholders, including reconciliation perilous activity due systemic communication deficits. Conclusion Stakeholders believed at certain depth risk being caused by existing becomes incalculable. Therefore, absence harm, changes avoided. post discharge compelled seen high-risk stakeholders.

Language: Английский

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Pharmacy-led interventions to reverse and prevent prescribing cascades in primary care: a proof-of-concept study

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

Published: Feb. 15, 2025

Prescribing cascades occur in clinical practice when a medication causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication. The aim was to provide proof-of-concept for pharmacy-led interventions reverse or prevent cascades. Two community pharmacies each tested two approaches. To cascades, ten were selected from literature. Dispensing records screened identify patients with these who started medications associated five of telephoned one month after their first dispensing discuss ADRs. Pharmacists assessed the need intervene together prescribers. Primary outcome proportion treatment change initiated. Secondary outcomes time investment, potential cost-savings, and pharmacists' experiences. 24 included. For eight prescriber consulted, resulting reversal three Forty-four included Six them experienced ADR that could lead cascade. conducted this. estimated investment possibly intervention 4.5 h reversing approach 4.8 preventing approach, while follow-up actions required 1.8 0.5 h, respectively. Both approaches be cost-saving. considered both relevant but identified knowledge gap on how some Pharmacy-led may more efficient screening methods tools are needed before further implementation.

Language: Английский

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An analysis of protective health behavior and polypharmacy among older patients: a nationwide cohort study

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: July 30, 2024

Abstract Background This study analyzed the relationship between protective health behaviors and polypharmacy in individuals aged 65 years older. Methods We used data from a nationwide survey (KNHANES) 2012 to 2016 conjunction with insurance claims databases. A total of 3297 adults or older were included study. Polypharmacy was defined as more than 30 prescription days 6 months five different drugs. Health-related (BMI, smoking, drinking, regular walking, living alone) extracted for before measuring polypharmacy. multivariable logistic regression on each behavior, well composite score behavior. Subgroup analysis also conducted by age sex. Results Among behaviors, BMI < 25 (OR, 0.76; 95% CI, 0.66–0.88) never smoking 0.78; 0.62–0.98) associated lower risk significantly both sex subgroups (male: OR, 0.71; 0.56–0.88; female: 0.81; 0.67–0.99) 65–79 subgroup 0.74; 0.63–0.86). The association only significant 0.55–0.91). Participants had participants zero one which statistically 0.52; 0.29–0.94). Conclusions finds that such obesity are higher Furthermore, we confirm high is Our findings indicate need geriatric-centered management prevent

Language: Английский

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Which older adults are at highest risk of prescribing cascades? A national study of the gabapentinoid–loop diuretic cascade

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(6), P. 1728 - 1740

Published: March 28, 2024

Abstract Background Prescribing cascades are important contributors to polypharmacy. Little is known about which older adults at highest risk of experiencing prescribing cascades. We explored veterans the gabapentinoid (including gabapentin and pregabalin)–loop diuretic (LD) cascade, given dramatic increase in recent years. Methods Using Veterans Affairs Medicare claims data (2010–2019), we performed a prescription sequence symmetry analysis (PSSA) assess loop initiation before after among (≥66 years). To identify calculated adjusted ratio (aSR), assesses temporality LD relative initiation. explore high‐risk groups, used multivariable logistic regression with order modeled as binary dependent variable. odds ratios (aORs), measuring extent factors associated one versus another. Results Of 151,442 who initiated gabapentinoid, there were 1,981 patients within 6 months initiating compared 1,599 gabapentinoid. In gabapentinoid–LD group, mean age was 73 years, 98% male, 13% Black, 5% Hispanic, 80% White. Patients each group similar across patient health utilization (standardized difference <0.10 for all comparisons). The aSR 1.23 (95% CI: 1.13, 1.34), strongly suggesting cascade's presence. People ≥85 years less likely have cascade (compared 66–74 years; aOR 0.74, 95% 0.56–0.96), people taking ≥10 medications more 0–4 drugs; 1.39, 1.07–1.82). Conclusions Among adults, those younger many may be higher contributing worsening polypharmacy potential drug‐related harms. did not strong predictors this that prevention efforts should widespread rather than focused on specific subgroups.

Language: Английский

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Gyógyszerrosta: a racionális gyógyszeres terápia meghatározó eleme

Orvosi Hetilap, Journal Year: 2023, Volume and Issue: 164(24), P. 931 - 941

Published: June 18, 2023

A gyógyszerrosta (az angol deprescribing magyar megfelelője) tervezett, szisztematikus gyógyszerleépítési folyamat, amely egészségügyi szakember felügyeletével zajlik, és lényegében a helyes gyógyszerrendelési gyakorlat részének tekintendő. nemcsak teljes gyógyszerelhagyást jelentheti, hanem dóziscsökkentés folyamata is lehet. Megtervezése során létfontosságú figyelembe venni terápiás célkitűzéseket, valamint beteg egészségi állapotát, időbeli életkilátását, értékrendjét igényeit. célja betegenként változhat, alapvetően azonban prioritásnak tekinthető számára fontos célok elérése, életminőségének javítása. Közleményünkben nemzetközi szakirodalom alapján áttekintjük folyamatának lehetséges célpontjait: azokat nagy kockázatú betegcsoportokat, amelyeknél előnyös lehet gyógyszerleépítés; gyógyszereket gyógyszercsoportokat, amelyek szedése esetén szükség terápia felülvizsgálatára; összefoglaljuk folyamat színtereit. Ezenkívül kitérünk általános lépéseire, előnyeire, kockázataira, ismertetjük rendelkezésre álló specifikus irányelveket, algoritmusokat. Részletesen tárgyaljuk folyamatot segítő hátráltató tényezőket, mind az szakemberek, pedig betegek szemszögéből, végül kezdeményezésekre jövőjére is. Orv Hetil. 2023; 164(24): 931–941.

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Research on prescribing cascades: a scoping review

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

Published: July 3, 2023

Background: The concept of prescribing cascades has been proposed for more than 20 years, but the research progress and cognitive level varied in different countries. aim this study was to systematically evaluate current status relevant original on cascades, provide references further continuous improvement clinical practice. Methods: We searched three English databases four Chinese from inception until January 2022. Relevant studies about meeting eligibility criteria were extracted independently by two reviewers, a descriptive analysis conducted compare methods outcomes included studies. Results: A total 32 involving 7,075,200 patients 11 countries included, including 13 cross-sectional studies, case reports, 7 cohort 1 case-control study. target population mainly elderly people (24 studies). purpose could be divided into categories: prevention (4 studies), identification (17 resolution (11 studies) cascades. 49 cascade routes identified attributed cardiovascular system, most primary diseases which dementia, initial medications calcium channel blockers, six drugs involved routes. Conclusion: Prescribing have attracted attention internationally focused their nervous diseases, still not yet formed integral other special populations drug use, such as children pregnant women. It is necessary conduct in-depth with broader range, establish series effective measures decrease incidence high-risk group use.

Language: Английский

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Association of a calcium channel blocker and diuretic prescribing cascade with adverse events: A population‐based cohort study

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(2), P. 467 - 478

Published: Nov. 27, 2023

Abstract Background Prescribing cascades occur when a drug adverse event is misinterpreted as new medical condition and second, potentially unnecessary drug, prescribed to treat the event. The population‐level consequences of prescribing remain unknown. Methods This population‐based cohort study used linked health administrative databases in Ontario, Canada. included community‐dwelling adults, 66 years age or older with hypertension no history heart failure (HF) diuretic use prior year, newly dispensed calcium channel blocker (CCB). Individuals subsequently within 90 days incident CCB dispensing were classified cascade group, compared those not diuretic, non‐prescribing group. Those without matched one‐to‐one on propensity score sex. primary outcome was serious (SAE), which composite emergency room visits hospitalizations 90‐day follow‐up period. We estimated hazard ratios (HRs) 95% confidence intervals (CI) for SAE using an Andersen–Gill recurrent events regression model. Results Among 39,347 adults HF who CCB, 1881 (4.8%) had after initiation. Compared group higher rates SAEs (HR: 1.21, CI: 1.02–1.43). Conclusions CCB‐diuretic associated increased rate SAEs, suggesting harm beyond second therapy. Our raises awareness downstream impact at population level provides opportunity clinicians identify this review their patients' medications determine if they can be optimized.

Language: Английский

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Community pharmacists’ awareness, identification, and management of prescribing cascades: A cross-sectional survey

Research in Social and Administrative Pharmacy, Journal Year: 2024, Volume and Issue: 20(6), P. 102 - 112

Published: May 18, 2024

Prescribing cascades can lead to unnecessary medication use, healthcare costs, and patient harm. Pharmacists oversee prescriptions from multiple prescribers are well positioned identify such cascades, making pharmacists key stakeholders address them.

Language: Английский

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