Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index DOI Open Access
Alexander Ferro Uriguen,

Idoia Beobide-Tellería,

Javier Gil-Goikouria

et al.

International Journal of Environmental Research and Public Health, Journal Year: 2023, Volume and Issue: 20(4), P. 3542 - 3542

Published: Feb. 17, 2023

This study aimed to comparatively analyze the effect of person-centered prescription (PCP) model on pharmacotherapeutic indicators and costs pharmacological treatment between a dementia-like trajectory an end-stage organ failure trajectory, two states frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted subacute hospital identified by Necessity Palliative Care test require palliative care. Data were collected from February 2018 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, several 28-day medication cost. Fifty-five 26 recruited observing significant differences at admission in mean number medications (7.6 vs. 9.7; p < 0.004), proportion people more than 10 (20.0% 53.8%; 0.002), drug-drug interactions (2.7 5.1; 0.006), Medication Regimen Complexity Index (MRCI) (25.7 33.4; respectively. Also, regarding patients, after application PCP model, these improved significantly intervention group compared control chronic medications, STOPP Frail Criteria, MRCI cost regular (p 0.05) discharge. As for failure, we did not observe statistically differences. On other hand, when different degrees evaluated, no unequal behavior observed.

Language: Английский

The Impact of Deprescribing Interventions on the Drug Burden Index and Other Outcomes: A Systematic Review DOI

Bonnie M. Liu,

Mitchell R. Redston, Kenji Fujita

et al.

Journal of the American Medical Directors Association, Journal Year: 2024, Volume and Issue: 25(7), P. 105021 - 105021

Published: May 17, 2024

Language: Английский

Citations

4
Medication reviews in hospitalised patients for reduced hospital readmission and mortality. Systematic review, meta-analysis and meta-regression of RCTs DOI Creative Commons
M. Degen, Li‐Ju Chen, Ben Schöttker

et al.

Ageing Research Reviews, Journal Year: 2025, Volume and Issue: 104, P. 102661 - 102661

Published: Jan. 11, 2025

Efforts to reduce preventable medication-related harm through medication reviews have increased, but interventions often yield null-results regarding clinical outcomes. We conducted a systematic literature search in four data bases and summarised the available evidence from randomised controlled trials (RCTs) comparing usual care hospitalised patients hospital readmissions all-cause mortality by random-effects meta-analyses. Effect size differences methodological study were of special interest. The meta-analysis all 24 on readmissions, including 12,539 participants, showed statistically significant 8% decrease (risk ratio (RR) [95% confidence interval]: (0.92 [0.88-0.97], p=0.002). number patient contacts was most prominent effect modifier meta-regression (p=0.003) approximately twice as strong (15%) 11 with 2 or more (0.85 [0.78-0.92], p<0.001). No reduction observed 22 for this outcome (0.95 [0.86-1.04], p=0.24), 12,350 participants. method assessment identified an (p=0.01). A 10 complete ascertainment via registries primary significantly 19% reduced (0.81 [0.70-0.94], p<0.01)). In conclusion, risk readmission might also mortality. Comprehensive essential successful trials. Clinical guidelines should recommend multiple contacts, involving pharmacists, either repeated improve adherence.

Language: Английский

Citations

0
Pharmacist-led deprescribing interventions for cancer patients in a specialist palliative care setting DOI Creative Commons
Chloe McAdam,

Eimear O’Dwyer,

Kieran Dalton

et al.

Supportive Care in Cancer, Journal Year: 2025, Volume and Issue: 33(4)

Published: March 26, 2025

Abstract Purpose This study aimed to determine the prevalence of potentially inappropriate medications (PIMs) among adult cancer patients in palliative care, rate at which physicians implemented pharmacists’ deprescribing recommendations, and some cost implications deprescribing. Methods Medication reconciliation was performed for each eligible patient, with both OncPal guideline clinical judgement applied identify PIMs. PIM evaluated medication class. The physician recommendation implementation savings were calculated. Results In 48 included patients, 25.2% PIMs (mean 2.4/patient) - 86.7% OncPal-defined PIMs, most commonly vitamins, gastro-oesophageal reflux disease (GORD), lipid-modifying agents. Pharmacist recommendations 71.7% time, equivalent 1.7 fewer per patient. 28-day €948.27 deprescribed Implementation rates varied based on patient admission type, a significantly higher ( p <0.05) those admitted end-of-life care (83.3%) versus symptom control (65.1%) respite (30%) admissions. Recommendations deprescribe GORD had lower (26.7%) compared all other <0.0001). Conclusion underscores benefits pharmacist-led inpatient resulting reduced burden. There is notable need proactive before reaching care. Different across types highlight significance reviewing may have role management. omission from emphasises importance refining future guidelines

Language: Английский

Citations

0
Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals DOI Creative Commons
Carlotta Lunghi, Marco Domenicali,

Stefano Vertullo

et al.

Drug Safety, Journal Year: 2024, Volume and Issue: 47(11), P. 1061 - 1074

Published: July 11, 2024

The growing complexity of geriatric pharmacotherapy necessitates effective tools for mitigating the risks associated with polypharmacy. Screening Tool Older Persons' Potentially Inappropriate Prescriptions (STOPP)/Screening to Alert doctors Right Treatment (START) criteria have been instrumental in optimizing medication management among older adults. Despite their large adoption improving reduction potentially inappropriate medications (PIM) and patient outcomes, implementation STOPP/START faces notable challenges. extensive number latest version time constraints primary care pose practical difficulties, particularly settings a high patients. This paper critically evaluates challenges evolving implications applying third across various clinical settings, focusing on European healthcare context. Utilizing "Questions & Answers" format, it examines criteria's discusses relevant suitability potential adaptations address diverse needs different environments. By emphasizing these aspects, this aims contribute ongoing discourse enhancing safety efficacy population, promote more person-centred an aging society.

Language: Английский

Citations

2
Strategies employed and experiences associated with the implementation of pharmaceutical services and interventions in geriatric wards: A scoping review DOI Open Access
Alan Maicon de Oliveira, João Paulo Vilela Rodrigues,

Isabella do Vale de Souza

et al.

British Journal of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 22, 2024

Evidence indicates a lack of clarity regarding the contributions interventions aimed at optimizing pharmacotherapy, primarily guided by pharmaceutical care, for clinically significant improvements in older individuals. Thus, there is need to deepen understanding this scenario and factors involved. Therefore, study aims map summarize scientific evidence experiences strategies employed providing services geriatric wards. A scoping review was conducted based on 3 electronic databases (PubMed, EMBASE Web Science). Studies meeting inclusion criteria, published up September 2024, English, Spanish or Portuguese were selected. Experimental observational studies eligible inclusion. Screening, eligibility, extraction assessment carried out 2 independent researchers. The exploration bibliographic yielded 3,976 references, 40 deemed suitable Predominantly countries with high human development, these categorized as: (i) medication review; (ii) reconciliation; (iii) counselling. Highlighted tools included STOPP START Beers Medication Appropriateness Index, facilitating identification issues such as potentially inappropriate medications (27.6–90.8% individuals using least 1 medication), drug‐related problems (34.5–98.2% patients problem) adverse drug events (58–88.4% event). acceptance rate exhibited considerable variation (13–95.3%). Only 10 evaluated clinical outcomes patients. Barriers additional training pharmacists geriatrics, time investment, continuity assessments recognition other members multiprofessional team. There clear trend towards improving prescription adequacy contributing quality pharmacotherapy through However, several gaps still be addressed, emphasizes identifying obstacles overcome, guidance future investigations.

Language: Английский

Citations

0
Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index DOI Open Access
Alexander Ferro Uriguen,

Idoia Beobide-Tellería,

Javier Gil-Goikouria

et al.

International Journal of Environmental Research and Public Health, Journal Year: 2023, Volume and Issue: 20(4), P. 3542 - 3542

Published: Feb. 17, 2023

This study aimed to comparatively analyze the effect of person-centered prescription (PCP) model on pharmacotherapeutic indicators and costs pharmacological treatment between a dementia-like trajectory an end-stage organ failure trajectory, two states frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted subacute hospital identified by Necessity Palliative Care test require palliative care. Data were collected from February 2018 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, several 28-day medication cost. Fifty-five 26 recruited observing significant differences at admission in mean number medications (7.6 vs. 9.7; p < 0.004), proportion people more than 10 (20.0% 53.8%; 0.002), drug-drug interactions (2.7 5.1; 0.006), Medication Regimen Complexity Index (MRCI) (25.7 33.4; respectively. Also, regarding patients, after application PCP model, these improved significantly intervention group compared control chronic medications, STOPP Frail Criteria, MRCI cost regular (p 0.05) discharge. As for failure, we did not observe statistically differences. On other hand, when different degrees evaluated, no unequal behavior observed.

Language: Английский

Citations

1