Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study

Scientific Reports, Год журнала: 2020, Номер 10(1)

Опубликована: Ноя. 3, 2020

Abstract Polypharmacy is a growing and major public health issue, particularly in the geriatric population. This study aimed to examine association between polypharmacy risk of hospitalization mortality. We included 3,007,620 elderly individuals aged ≥ 65 years who had at least one routinely-prescribed medication but no prior within year. The primary exposures interest were number daily prescribed medications (1–2, 3–4, 5–6, 7–8, 9–10, 11) presence (≥ 5 prescription drugs per day). corresponding comparators lowest (1–2) absence polypharmacy. outcomes all-cause death. median age participants was 72 39.5% men. Approximately, 46.6% experienced Over follow-up 5.0 years, 2,028,062 (67.4%) hospitalizations 459,076 (15.3%) deaths observed. An incrementally higher found be associated with increasingly for These associations consistent across subgroups age, sex, residential area, comorbidities. Furthermore, greater death: adjusted HRs (95% CIs) 1.18 (1.18–1.19) 1.25 (1.24–1.25) overall 1.16 (1.16–1.17) matched cohorts, respectively. Hence, death among individuals.

Язык: Английский

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Perceptions on artificial intelligence-based decision-making for coexisting multiple long-term health conditions: protocol for a qualitative study with patients and healthcare professionals

BMJ Open, Год журнала: 2024, Номер 14(2), С. e077156 - e077156

Опубликована: Фев. 1, 2024

Introduction Coexisting multiple health conditions is common among older people, a population that increasing globally. The potential for polypharmacy, adverse events, drug interactions and development of additional complicates prescribing decisions these patients. Artificial intelligence (AI)-generated decision-making tools may help guide clinical in the context conditions, by determining which medication options best. This study aims to explore perceptions healthcare professionals (HCPs) patients on use AI management conditions. Methods analysis A qualitative will be conducted using semistructured interviews. Adults (≥18 years) with living West Midlands England HCPs experience caring eligible purposively sampled. Patients identified from Clinical Practice Research Datalink (CPRD) Aurum; CPRD contact general practitioners who turn, send letter inviting them take part. Eligible recruited through British HCP bodies known contacts. Up 30 recruited, until data saturation achieved. Interviews in-person or virtual, audio recorded transcribed verbatim. topic designed participants’ attitudes towards AI-informed augment clinician-directed decision-making, perceived advantages disadvantages both methods risk management. Case vignettes comprising decision pathway presented during each interview invite opinions how their experiences compare. Data analysed thematically Framework Method. Ethics dissemination has been approved National Health Service Committee (Reference: 22/SC/0210). Written informed consent verbal obtained prior interview. findings this disseminated peer-reviewed publications, conferences lay summaries.

Язык: Английский

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Perspectives on deprescribing in palliative care

Expert Review of Clinical Pharmacology, Год журнала: 2023, Номер 16(5), С. 411 - 421

Опубликована: Март 30, 2023

Pharmacotherapy plays a critical role in the delivery of high-quality palliative care, but intersection care and deprescribing has received little attention.

Язык: Английский

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A Critical View over the Newest Antidiabetic Molecules in Light of Efficacy—A Systematic Review and Meta-Analysis

International Journal of Molecular Sciences, Год журнала: 2023, Номер 24(11), С. 9760 - 9760

Опубликована: Июнь 5, 2023

The increase in life expectancy without a decrease the years lived disability leads to rise of population aged over 65 prone polypharmacy. novel antidiabetic drugs can improve this global therapeutic and health problem patients with diabetes mellitus (DM). We aimed establish efficacy (A1c hemoglobin reduction) safety newest (considered so due their novelty medical practice use), specifically DPP-4i, SGLT-2i, GLP-1 Ra, tirzepatide. present meta-analysis followed protocol registered at Prospero CRD42022330442 registration number. reduction HbA1c DPP4-i class for tenegliptin was 95% CI −0.54 [−1.1, 0.01], p = 0.06; SGLT2-iclass ipragliflozin −0.2 [−0.87, 0.47], 0.55; tofogliflozin 3.13 [−12.02, 18.28], 0.69, while tirzepatide it 0.15, [−0.50, 0.80] (p 0.65). guidelines treatment type 2 DM are provided from cardiovascular outcome trials that report mainly major adverse events data about efficacy. non-insulinic reported be efficient lowering HbA1c, but effect depends between classes, molecules, or patients’ age. proven molecules terms decrease, weight reduction, safety, more studies needed order characterize exactly profiles.

Язык: Английский

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Patient reported tools for assessing potential medicine-related symptoms: A systematic review.

Research in Social and Administrative Pharmacy, Год журнала: 2025, Номер unknown

Опубликована: Янв. 1, 2025

Язык: Английский

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Unpacking excessive polypharmacy patterns among individuals living with chronic pain in Quebec: a longitudinal study

Frontiers in Pain Research, Год журнала: 2025, Номер 6

Опубликована: Фев. 21, 2025

Excessive polypharmacy, which can be defined as the concurrent use of ≥10 medications, is prevalent among individuals with chronic pain. However, it remains unclear how may vary between or over time. This study aimed to describe and identify factors associated trajectories excessive polypharmacy. A retrospective longitudinal was conducted using TorSaDE Cohort, links Canadian Community Health Surveys (2007-2016) Quebec health administrative databases. Among 9,156 adults living pain covered by public prescribed drug insurance, presence polypharmacy (yes/no) assessed monthly for one-year post-survey completion (12 time points). Group-based trajectory modelling applied groups similar patterns (trajectories). Multivariable multinomial regression used membership. Four were obtained: (1) "No polypharmacy" (74.8%); (2) "Sometimes in (8.6%); (3) "Often (6.1%); 4) "Always (10.5%). Factors "always membership were: being older, born Canada, having a lower income, higher comorbidity index score, more severe intensity, daily activities prevented pain, reporting arthritis back poorer perceived general health, family physician. Using opioids benzodiazepines, alcohol consumption, doing less physical activity, number prescribers visits physician also predicted always identifies distinct emphasizing key sociodemographic clinical need tailored interventions effective medication management.

Язык: Английский

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Implementation of a Standardized Palliative Care Pharmacist Deprescribing Assessment

Journal of Palliative Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 20, 2025

Background: Palliative care (PC) patients are at high risk of polypharmacy, thereby imposing a substantial burden on patients, including increased pill burden, adverse drug events, and falls. PC pharmacists play critical role in deprescribing aligning medications with goals for this population, but few studies demonstrate opportunities.

Язык: Английский

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Deprescribing in palliative care

Clinical Medicine, Год журнала: 2019, Номер 19(4), С. 311 - 314

Опубликована: Июль 1, 2019

ABSTRACT

The use of multiple medications is common in palliative care, putting patients at risk adverse events and a high tablet burden. Deprescribing the process reviewing stopping potentially inappropriate order to improve quality life. Barriers deprescribing exist meaning many will take despite being final months OncPal guideline useful tool support for with limited life expectancy. There evidence safety certain medications, particularly those aimed primary prevention. A systematic individual their appropriateness recommended.

Язык: Английский

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Evaluation of deprescription by general practitioners in elderly people with different levels of dependence: cross-sectional study

BMC Primary Care, Год журнала: 2024, Номер 25(1)

Опубликована: Март 2, 2024

Abstract Background Polypharmacy is easily achieved in elderly patients with multimorbidity and it associated a higher risk of potentially inappropriate medication use worse health outcomes. Studies have shown that deprescription safe, however, some barriers been identified. The aim this study was to analyse Portuguese General Practitioners (GP) deprescription’s attitudes using clinical vignettes. Methods Cross-sectional an online survey 3 sections: demographic professional characterization; two vignettes patient polypharmacy which the dependency level varies; factors influencing deprescription. Frequencies, means, standard deviations were calculated describe GPs. Analysis attitude, globally for each drug, vignette applying McNeemar’s test. Results A sample 396 GP obtained mean age 38 years, most them female. statistically significant difference ( p < 0.01) observed deprescribing according level, more GPs (80.4% versus 75.3%) dependent patient. found all drugs except antihypertensive drugs. All medications deprescribed often anti-dementia More than 70% participants considered life expectancy quality as “very important” 90% classified existence guidelines risks benefits or “important”. In open question, reported by those related (52,9%). Conclusions This largest on topic carried out Portugal vignettes, representative GP. dependence significatively influenced attitude majority life, expectancies, potential negative effects “important” while deprescribing. It important develop test real studies analyze if these are same daily practice.

Язык: Английский

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Measuring Quality of Life in Deprescribing Trials: A Scoping Review

Drugs & Aging, Год журнала: 2024, Номер 41(5), С. 379 - 397

Опубликована: Май 1, 2024

Язык: Английский

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