Retrospective evaluation of medication appropriateness in older adults with hepatic cirrhosis

Science Progress, Journal Year: 2025, Volume and Issue: 108(2)

Published: April 1, 2025

Objective To assess medication appropriateness using the index (MAI) criteria, prevalence of potentially inappropriate (PIM) prescribing, and factors associated with increased PIM use in elderly ambulatory patients cirrhosis. Methods A cross-sectional study 70 cirrhosis (≥65 years old), from January to December 2021. Two clinical pharmacists evaluated MAI tool. Data were analyzed SPSS version 27.0. Descriptive statistics used present patient demographics, characteristics, responses. Regression analysis was identify predictive for prescribing. The kappa statistic interrater agreement. Results All participants had at least one ≥ 1 criterion, most common issue being incorrect treatment duration (18%). Of 610 medications, 44.1% classified as PIMs. mean scores per 15.97 (±10.48) 1.83 (±3.18), respectively, consistent other studies. However, PIMs higher, likely due specific disease population studied, this is first evaluate cirrhotic patients. Good agreement observed (kappa = 0.74), indicating good reliability. Increased prescribing number age severe renal impairment. Conclusions are cirrhosis, highlighting need better practices ensure safety. Involving geriatrics expertise tools can reduce drug-related problems. Further, healthcare team training essential improve practices. Assessing could enhance outcomes, adverse drug reactions, lower costs. Incorporating comprehensive management into routine care a key strategy safety quality life.

Language: Английский

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Polypharmacy Management in Chronic Conditions: A Systematic Literature Review of Italian Interventions

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(12), P. 3529 - 3529

Published: June 17, 2024

Background: Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims identify existing interventions implemented monitor manage in Italian setting. Methods: A systematic literature review (PROSPERO: CRD42023457049) was carried out according PRISMA statement guidelines. PubMed, Embase, ProQuest, Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed PICO model: patients with polypharmacy; monitor/manage regimen versus no/any intervention; outcomes terms intervention effectiveness cost variation. Results: After duplicate deletion, 153 potentially relevant publications extracted. Following abstract full-text screenings, nine articles met inclusion criteria. Overall, 78% (n = 7) observational studies, 11% 1) experimental two-phase studies. total 44% 4) studies involved aged ≥ 65 years, while 56% 5) disease-specific. Monitoring most prevalent choice (67%; n 6). Outcomes mainly related levels (29%; 6) comorbidities 6), rates (14%; 3), avoidable costs (9%; 2). Conclusions: outlines that Italy still lacking PIP, addressing an unmet need developing patient-tailored strategies for reducing health-system burden.

Language: Английский

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Polypharmacy and Elevated Risk of Severe Adverse Events in Older Adults Based on the Korea Institute of Drug Safety and Risk Management-Korea Adverse Event Reporting System Database

Journal of Korean Medical Science, Journal Year: 2024, Volume and Issue: 39(28)

Published: Jan. 1, 2024

Older adults are at a higher risk of severe adverse drug events (ADEs) because multimorbidity, polypharmacy, and lower physiological function. This study aimed to determine whether defined as the use ≥ 5 active ingredients, was associated with ADEs in this population. We used ADE reports from Korea Institute Drug Safety Risk Management-Korea Adverse Event Reporting System Database, national spontaneous report system, 2012 2021 examine compare strength association between polypharmacy older (≥ 65 years) younger (20-64 using disproportionality analysis. found significant cardiac renal/urinary Medical Dictionary for Regulatory Activities Organ Classes (MedDRA SOC) adults. Regarding individual-level included these MedDRA SOCs, acute arrest renal failure were more significantly compared The addition new drugs regimens warrants close monitoring symptoms.

Language: Английский

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Barriers and facilitators to implementing polypharmacy management frameworks: a theory based qualitative exploration of key stakeholders

International Journal of Clinical Pharmacy, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 12, 2024

Abstract Background Inappropriate polypharmacy arises through many factors including deficiencies in prescribing processes. Most research has focused on solutions at the clinician/patient levels with less organisational level. Aim To explore key stakeholder identified barriers and facilitators to implementation of an level management framework. Method Qualitative data were collected within Ministry Health Oman. Key stakeholders purposively sampled encompassing senior representatives pharmacy, medicine, nursing directors; healthcare policymakers; patient safety leaders; academic leaders. A semi-structured interview schedule was developed informed by a recent scoping review underpinned Consolidated Framework for Implementation Research (CFIR). Interviews, which continued until saturation, audio-recorded, transcribed analysed using Approach. Results Thirteen interviewed, representation each target group. Facilitators largely mapped CFIR domain inner setting (i.e., aspects awareness, electronic health system national leadership), intervention characteristic (evidence gaps), characteristics individuals (stakeholders champions) process (change strategy). Barriers also (policy absence, communication professional practice) outer (resource needs). Conclusion This study illuminated Further work is required translate these themes into actionable plan implement Particular attention internal context occurs) as most this domain.

Language: Английский

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Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

BMJ Open, Journal Year: 2024, Volume and Issue: 14(5), P. e081698 - e081698

Published: May 1, 2024

Introduction Polypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches targeting patients for intervention. Objectives To explore how are targeted intervention by examining the literature with respect to: understanding polypharmacy is defined; identifying problematic practice; addressing through interventions. Design We performed a scoping review as defined Joanna Briggs Institute. Setting The focus was on primary care settings. Data sources Medline, Embase, Cumulative Index Nursing Allied Health Literature Cochrane along ClinicalTrials.gov, Science.gov WorldCat.org were searched from January 2004 February 2024. Eligibility criteria included all articles that had care, incorporating multiple types of evidence, such reviews, quantitative trials, qualitative studies policy documents. Articles focussing single index disease or not written English excluded. Extraction analysis narrative synthesis, comparing themes findings across collective evidence draw contextualised insights conclusions. Results In total, 157 included. Case-finding methods often rely basic medication counts (often five more) without considering medical history whether individual medications clinically appropriate. Other highlight specific drug indicators interactions potentially inappropriate prescribing, failing capture proportion fitting criteria. Different prescribing also significant inconsistencies determining appropriateness medications, neglecting consider underprescribing. This hinder identification precise population requiring Conclusions Improved strategies needed target polypharmacy, which should patient perspectives, factors clinical appropriateness. development cross-cutting measure consistently incorporates adjustment valuable next step address frequent confounding.

Language: Английский

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Mental Health in Later Life: Clinical Insights and Management Strategies for Late-Onset Psychiatric Conditions

European Journal of Medical and Health Research, Journal Year: 2024, Volume and Issue: 2(5), P. 173 - 190

Published: Sept. 1, 2024

Late-onset psychiatric conditions, which emerge or are first diagnosed in older adulthood, present unique challenges. This review examines their prevalence, risk factors, and clinical presentations, providing a comprehensive overview of impact on adults. disorders, including schizophrenia, bipolar disorder, major depressive disorder (MDD), increasingly recognized as significant health concerns among Epidemiological trends show rising incidence, influenced by an aging population demographic changes. Variability prevalence rates due to gender differences aging-related factors highlights the need for tailored research approaches. Risk include genetic predispositions, environmental exposures, lifestyle factors. Genetic emphasizes hereditary components, while influences, such stress social isolation, add complexity picture. Comorbidities, common adults, further complicate diagnosis treatment. Clinical presentations late-onset conditions often differ from early-onset forms, with symptoms that may overlap age-related changes, making challenging. Accurate evaluation is necessary distinguish these cognitive neurodegenerative disorders. Managing treating effectively requires comprehensive, individualized approach integrating pharmacological interventions, psychotherapy, behavioral therapies Pharmacological treatment should consider changes drug metabolism, sensitivity age, risks polypharmacy. Essential psychotherapies cognitive-behavioral therapy (CBT) interpersonal (IPT), integrated care involving multidisciplinary teams address both physical health. Neurologists geriatricians crucial managing neurological manifestations overall geriatric care. Addressing critical given growing old adult population. The ongoing innovation, focusing early detection, refining diagnostic criteria, exploring new therapeutic approaches enhance

Language: Английский

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