The Prognostic Utility of Anticholinergic Burden Scales: An Integrative Review and Gap Analysis

Drugs & Aging, Год журнала: 2023, Номер 40(9), С. 763 - 783

Опубликована: Июль 18, 2023

Язык: Английский

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Multicomponent intervention to tailor prescriptions to patients with dementia in an intermediate care hospital: pre-post quasi experimental study

BMC Geriatrics, Год журнала: 2025, Номер 25(1)

Опубликована: Фев. 27, 2025

In persons with dementia, polypharmacy may be discordant the goals of care. It is necessary to design interventions that align treatment regimens patient's situation, prognosis and preferences. The objectives this study conducted at an intermediate care were to: i) identify inappropriate prescribing per main goal; ii) compare pharmacotherapy data pre post a medication review based on degree cognitive impairment; iii) assess implementation proposed recommendations three months after discharge. Pre-post quasi-experimental study. Patients dementia discharged from hospital between November 2021 April 2022. Demographic, clinical evaluated admission. Medication reviews interviews caregivers pharmacologic therapies overall At discharge, information was shared primary team in discharge summary. Follow up evaluate during performed months. Of 97 patients included, 94.8% had least one inappropriately prescribed medication. mean number chronic medications taken patient decreased by 29.6%, 8.05(SD 3.5) 5.67(SD 2.7) (p < 0.001); anticholinergic burden 18.6%, 1.59(SD 1.0) 1.29(SD 0.9) therapeutic complexity 28.4%, 29.23(SD 13.8) 20.94(SD 11.3) 0.001). 3 90.0%. Admission provides ideal setting for multicomponent intervention, tailoring prescriptions preferences, improving parameters related side effects, ensuring are maintained over medium term.

Язык: Английский

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Understanding potentially inappropriate medication: A focus group study with general practitioners

International Journal of Medical Informatics, Год журнала: 2025, Номер unknown, С. 105899 - 105899

Опубликована: Март 1, 2025

Язык: Английский

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Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper

European Journal of Internal Medicine, Год журнала: 2023, Номер 109, С. 97 - 106

Опубликована: Янв. 17, 2023

Язык: Английский

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Efficacy of surgical treatment on polypharmacy of elderly patients with lumbar spinal canal stenosis: retrospective exploratory research

BMC Geriatrics, Год журнала: 2023, Номер 23(1)

Опубликована: Март 24, 2023

Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low back and neuropathic pain have high frequency of comorbidity are predicted to take many drugs. However, no studies reported polypharmacy elderly LSS. Thus, we aimed review the among LSS elective surgeries examine how surgical treatment reduces polypharmacy.We retrospectively enrolled aged ≥ 65 years underwent surgery for between April 2020 March 2021. The prescribed drugs participants were directly checked by pharmacists outpatient department preoperatively 6-month 1-year postoperatively. baseline characteristics collected beside patient-based outcomes including Roland-Morris Disability Questionnaire, Zurich Claudication Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). cutoff number was defined as 6. prescription divided into 9 categories: neuropsychiatric, cardiovascular, respiratory, digestive, endocrine metabolic, urinary renal diseases; blood products; relief medication; others.A total 102 cases finally analyzed, follow-up rate 78.0%. Of participants, preoperative prevalence 66.7%. postoperatively significantly less than one. proportions at 6 months 1 year after decreased 57.8% 55.9%, respectively. When categories, digestive diseases reduced surgery. multi-variable analysis revealed that higher score psychological disorder JOABPEQ associated 3 or more (OR, 2.5; 95% CI: 1.0-6.1).Polypharmacy indicated Additionally, our data showed effective reducing patients. Finally, better condition reduction

Язык: Английский

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Patient and general practitioner experiences of implementing a medication review intervention in older people with multimorbidity: Process evaluation of the SPPiRE trial

Health Expectations, Год журнала: 2022, Номер 25(6), С. 3225 - 3237

Опубликована: Окт. 17, 2022

Abstract Introduction The SPPiRE cluster randomized controlled trial found that a general practitioner (GP)‐delivered medication review incorporated screening for potentially inappropriate prescriptions (PIP), brown bag and patient priority assessment, resulted in significant but small reduction the number of medicines no PIP. This process evaluation aims to explore experiences GPs patients potential system‐wide implementation. Methods included 51 practices 404 participants with multimorbidity aged ≥65 years, prescribed ≥15 medicines. used mixed methods ran parallel trial. Quantitative data was collected from intervention website analysed descriptively. Qualitative on changes were (18/26) purposive sample (27/208) via semi‐structured telephone interviews. All interviews transcribed verbatim using thematic analysis. quantitative integrated triangulation protocol. Results analysis generated two themes, implementation mechanisms action, both underpinned by theme context. Intervention delivery varied among 45 (28%) had review, primarily due insufficient GP time. 80% reviewed ≥1 PIP identified, 59% problem identified during 79% recorded. most deprescription medications. responded positively did not engage priority‐setting process. lack integration into practice software resources as barriers future Conclusion effect reducing this mediated through review. context resource shortages deep‐seated views around medical decision‐making influenced Patient or Public Contribution their wider older people Clinical Trial Registration registered prospectively ISRCTN registry (ISRCTN12752680).

Язык: Английский

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The outcomes of considering goals of care in medication reviews for older adults: a systematic review

Expert Review of Clinical Pharmacology, Год журнала: 2023, Номер 17(1), С. 33 - 56

Опубликована: Ноя. 21, 2023

This is a systematic review of prescribing, clinical, patient-reported, and health utilization outcomes goal-directed medication reviews in older adults.

Язык: Английский

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Characteristics of clinical-pharmacological recommendations in psychiatry in Germany

The International Journal of Psychiatry in Medicine, Год журнала: 2023, Номер 59(3), С. 393 - 405

Опубликована: Май 16, 2023

Objective Psychiatric patients in general, and elderly psychiatric particular, are at risk of adverse drug reactions due to comorbidities inappropriate polypharmacy. Interdisciplinary clinical-pharmacologist-led medication reviews may contribute safety the field psychiatry. In this study, we reported frequency characteristics clinical-pharmacological recommendations psychiatry, with a particular focus on geriatric Method A clinical pharmacologist, collaboration attending psychiatrists consulting neurologist, conducted interdisciplinary general ward geropsychiatric university hospital over 25-week period. All pharmacological were recorded evaluated. Results total 316 made during 374 reviews. Indications/contraindications drugs most frequently discussed topics (59/316; 18.7 %), followed by dose reductions (37/316; 11.7 temporary or permanent discontinuation medications (36/316; 11.4 %). The frequent for reduction involvedbenzodiazepines (9/37; 24.3 An unclear absent indication was common reason recommending (6/36; 16.7 Conclusion pharmacologist-led represented valuable contribution management patients, particularly ones.

Язык: Английский

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What do primary care providers want to know when caring for patients living with frailty? An analysis of eConsult communications between primary care providers and specialists

BMC Health Services Research, Год журнала: 2024, Номер 24(1)

Опубликована: Янв. 16, 2024

Abstract Background Frailty is a complex condition that primary care providers (PCPs) are managing in increasing numbers, yet there no clear guidance or training for frailty care. Objectives The present study examined eConsult questions PCPs asked specialists about patients with frailty, the specialists’ responses, and impact of on these patients. Design Cross-sectional observational study. Setting ChamplainBASE™ located Eastern Ontario, Canada. Participants Sixty one cases closed by 2019 use terms “frail” “frailty” to describe 65 years age older. Measurements Taxonomy Generic Clinical Questions (TGCQ) was used classify PCP International Classification Primary Care 3 (ICPC-3) clinical content each eConsult. patient measured responses mandatory survey. Results most frequently directed their cardiology ( n = 7; 11%), gastroenterology endocrinology 6; 10%). Specialist answers often pertained medications 63, 46%), recommendations investigation 24, 17%), diagnoses 22, 16%). resulted avoiding referral 57% 35) whereas referrals were still required 15% 9) cases. Specialists responded eConsults median 1.11 days (IQR 0.3–4.7), 95% 58) received response within 7 days. recorded 15 min respond 10–20), cost $50.00 CAD 33.33 – 66.66) per Conclusions Through analysis submitted eConsult, this provides novel information knowledge gaps approaches living frailty. Furthermore, analyses provide evidence feasible valuable tool improving settings.

Язык: Английский

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Exploring the impact of pharmacist-supported medication reviews in dementia care: experiences of general practitioners and nurses

BMC Geriatrics, Год журнала: 2024, Номер 24(1)

Опубликована: Июнь 14, 2024

Abstract Background Dementia is a major global public health challenge, and with the growing elderly population, its prevalence expected to increase in coming years. In Sweden, municipalities are responsible for providing special housing (SÄBO), which offers services care older individuals needing specific support. SÄBO both person´s home environment workplace. Polypharmacy patients dementia common increases risk of medication interactions. Involving clinical pharmacists reviews has been shown enhance safety improve prescribing practices. However, views standard team involved prescribing, administration, monitoring documentation on integrating pharmacist have received less attention. Thus, this study aims explore how pharmacists’ contributions can safety, patient efficiency, potentially alleviate workload general practitioners people living housing. Methods This descriptive qualitative design using semi-structured interviews content analysis. The was conducted southern Swedish included nurses, assistant (GPs), pharmacist. Due COVID-19 pandemic, were over phone. Ethical Review Authority approved study. Results analysis revealed three main categories, eleven subcategories.: (1) Integrating multidisciplinary approaches holistic care, (2) Strengthening through effective management (3) Advancing integration role expansion. Nurses focused non-pharmacological treatments, while GPs emphasized importance assessing benefits side-effects prescribed medication. Pharmacists valued their reliable expertise, appreciated by saving time recommendations prior consultations next-of-kin. Although considered beneficial, there skepticism about ability solve all medication-related problems associated care. Conclusions highlights critical play enhancing efficiency dementia. Despite value contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential expansion essential ensure collaborative practices better outcomes.

Язык: Английский

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