Overuse of medications in low- and middle-income countries: a scoping review

Bulletin of the World Health Organization, Год журнала: 2023, Номер 101(1), С. 36 - 61D

Опубликована: Янв. 1, 2023

To identify and summarize the evidence about extent of overuse medications in low- middle-income countries, its drivers, consequences potential solutions.We conducted a scoping review by searching databases PubMed®, Embase®, APA PsycINFO® Global Index Medicus using combination MeSH terms free text words around overtreatment. We included studies any language published before 25 October 2021 that reported on overuse, screened 3489 unique records 367 reporting over 5.1 million prescriptions across 80 countries - with from 58.6% (17/29) all low-, 62.0% (31/50) lower-middle- 60.0% (33/55) upper-middle-income countries. Of studies, 307 (83.7%) medications, estimates ranging 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes antimicrobials, psychotropic drugs, proton pump inhibitors antihypertensive drugs. Drivers limited knowledge harms polypharmacy, poor regulation financial influences. Consequences were patient harm cost. Only 11.4% (42/367) evaluated solutions, which regulatory reforms, educational, deprescribing audit-feedback initiatives.Growing suggests is widespread within multiple drug classes, few data solutions randomized trials. Opportunities exist build collaborations rigorously develop evaluate reduce medications.Identifier et résumer les données démontrant l'ampleur de la surconsommation médicaments dans pays à revenu faible intermédiaire, mais aussi causes cette surconsommation, ses conséquences pistes solution.Nous avons mené une analyse exploratoire en effectuant recherche bases l'Index mondial l'aide d'une combinaison termes mots texte libre liés aux surtraitements. Nous inclus des études rédigées toutes langues publiées avant le octobre 2021, qui mentionnaient causes, passé revue documents uniques conservé faisant état plus 5,1 millions d'ordonnances intermédiaire – ces concernaient 58,6% faible, 62,0 % ceux tranche inférieure 60,0% supérieure. Sur l'ensemble reprises, (83,7%) signalaient médicaments, avec estimations comprises entre 7,3% 98,2% (écart interquartile: 30,2-64,5). Cette s'observait principalement catégories telles que antimicrobiens, substances psychotropes, inhibiteurs pompe protons antihypertenseurs. Plusieurs étaient évoquées: méconnaissance dégâts polypharmacie, mauvaise réglementation influences économiques. Les surtout néfastes pour santé patients coûts engendrés. À peine 11,4% examinaient parmi lesquelles réformes réglementaires, ainsi initiatives sensibilisation, déprescription d'audit–feedback.Un faisceau croissant preuves indique est largement répandue nombreuses substances, peu d'informations circulent quant issues essais randomisés. Il existe néanmoins opportunités collaboration permettraient développer d'évaluer rigoureusement solution lutter contre médicaments.Identificar y resumir evidencia sobre el grado del uso excesivo medicamentos los países ingresos bajos medios, sus causas, consecuencias posibles soluciones.Se realizó una revisión exploratoria mediante búsquedas las datos partir combinación términos palabras texto sobretratamiento. Se incluyeron estudios cualquier idioma publicados antes octubre informaran excesivo, examinaron registros únicos se informaron más millones recetas con 58,6 todos bajos, medios 60,0 altos. De incluidos, (83,7 %) medicamentos, estimaciones oscilaban 7,3 98,2 (rango intercuartil: Las clases usadas exceso incluían antimicrobianos, psicofármacos, inhibidores bomba protones antihipertensores. Los factores causantes conocimiento limitado daños polifarmacia, falta regulación influencias financieras. daño pacientes coste. Solo 11,4 evaluaron soluciones, encontraban reformas normativas, iniciativas educación, desprescripción retroalimentación auditorías.Cada vez hay evidencias está muy extendido múltiples dispone insuficientes soluciones procedentes ensayos aleatorizados. Hay oportunidades crear colaboraciones para desarrollar evaluar rigor reducir medicamentos.الغرض تحديد وتلخيص الأدلة على مدى الاستخدام المفرط للأدوية في الدول ذات الدخل المنخفض والمتوسط، ودوافع هذا الاستخدام، وعواقبه، والحلول الممكنة له. الطريقة لقد أجرينا مراجعة عن كثب طريق البحث قواعد البيانات PubMed®‎، وEmbase®‎، وAPA PsycINFO®‎، وGlobal باستخدام مجموعة من مصطلحات MeSH، وكلمات نصية حرة بخصوص والمعالجة المفرطة. وقمنا بتضمين دراسات ‎‎‎نُشرت بأية لغة قبل أكتوبر/تشرين أول 2021، وكنا نُبلغ ودوافعه، وحلوله. النتائج قمنا بفحص سجلاً فريداً، وتضمين دراسة كشفت أكثر مليون وصفة طبية دولة دخل منخفض إلى متوسط مع %58.6 كل المنخفض، و%62.0 المتوسط الأدنى، و%60.0 الأعلى. بين الدراسات المشمولة، (%83.7) للأدوية، تقديرات تتراوح %7.3 %98.2 (المدى الشرائح الربعية: 30.2 64.5). وشملت الفئات الأكثر استخدامًا بشكل شائع مضادات الميكروبات، والعقاقير المؤثرة العقل، ومثبطات مضخة البروتون، والأدوية الخافضة للضغط. تضمنت الدوافع معرفة محدودة بأضرار المفرط، وتعدد الأدوية، وسوء التنظيم، والتأثيرات المالية. كانت العواقب هي حدوث الضرر للمرضى، فضلًا التكلفة. قامت %11.4 فقط بتقييم الحلول، والتي الإصلاحات التنظيمية، والمبادرات التعليمية، ومبادرات الحد الوصفات الطبية، التدقيق والمراجعة. الاستنتاج تشير الدلائل المتزايدة أن هو ظاهرة منتشرة والدخل المتوسط، عبر فئات عديدة بيانات قليلة الحلول التجارب العشوائية. توجد فرص لبناء علاقات تعاون لتطوير، وتقييم فعال للحد للأدوية.旨在确定和概述关于中低收入国家药物滥用的程度、其驱动因素、后果和潜在解决方案的证据。.我们通过搜索 PubMed®、Embase®、APA 和 数据库,结合使用 主题词和自由词,对药物滥用和过度治疗情况进行了一项范围审查。我们纳入了 年 10 月 日之前以任何语言发表的研究,并报告了药物滥用的程度、其驱动因素、结果和解决方案。.我们筛选了 项独特记录,纳入了 份研究,报告涉及 个中低收入国家的 510 多万份处方,其中所有低收入国家的研究占 (17/29)、所有中下收入国家的研究占 以及中上收入国家的研究占 (33/55)。纳入的研究中,307 份研究报告了药物滥用的程度,估计范围为 至 98.2%(四分位距:30.2–64.5)。常见的滥用药物包括抗菌药物、精神治疗药物、质子泵抑制剂和抗高血压药。驱动因素包括对药物滥用危害的认识有限、多重用药、监管不力以及财务影响。后果是患者受到伤害并承担费用。只有 研究评估了解决方案,其中包括监管改革、教育、取消处方和审查反馈方案。.越来越多的证据表明中低收入国家普遍存在药物滥用情况,涉及多种药物类别,但有关随机试验中得出的解决方案的数据却很少。应创建机会建立合作,严格开发和评估潜在解决方案,以减少药物滥用情况。.Определить и обобщить данные о масштабах чрезмерного использования лекарственных средств в странах с низким средним уровнем дохода, его движущих факторах, последствиях возможных способах решения проблемы.Авторы провели предварительный обзор путем поиска данных базах Medicus, используя комбинацию терминов слов произвольного текста, касающихся употребления передозировки ими. Были включены исследования на всех языках, опубликованные до октября г., которых сообщалось употребления, причинах, проанализировали уникальных записей включили исследований, более чем млн рецептов дохода. Среди них были из стран 62,0% дохода ниже среднего выше среднего. Из включенных исследований степени средств, при этом оценки колебались от (межквартильный диапазон: 30,2–64,5). Как правило, к числу классов чрезмерно используемых относятся: противомикробные препараты, психотропные средства, ингибиторы протонной помпы антигипертензивные препараты. К движущим факторам ограниченные знания вреде использования, полипрагмазия, слабое регулирование финансовое влияние. Последствия для пациентов заключаются во вреде, причиненном их здоровью, дополнительных затратах. Только оценивались способы проблемы, которые включали программу по реформированию нормативно-правовой базы, инициативы области образования, а также направлении постепенного прекращения определенных внедрения аудита обратной связью.Все больше свидетельствуют том, что чрезмерное использование широко распространено отношении нескольких лекарств, полученных ходе рандомизированных немного. Существуют возможности налаживания сотрудничества целью тщательной разработки потенциальных способов сокращения средств.

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The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review

Therapeutic Advances in Drug Safety, Год журнала: 2022, Номер 13

Опубликована: Янв. 1, 2022

In the context of an ageing population, burden disease and medicine use is also expected to increase. As such, safety preventing avoidable medicine-related harm are major public health concerns, requiring further research. Potentially suboptimal regimens umbrella term that captures a range indicators may increase risk harm, including polypharmacy, underprescribing high-risk prescribing, such as prescribing potentially inappropriate medicines. This narrative review aims provide background broad overview patterns implications among older adults. Original research published between 1990 2021 was searched for in MEDLINE, using key search terms medication lists, errors, drug interactions prescriptions, along with manual checking reference lists. The summarizes prevalence, factors clinical outcomes A synthesis evidence regarding longitudinal polypharmacy provided. With existing literature, we highlight number gaps literature. Directions future include investigation into extended focusing on studies evaluate applicability tools measuring medicines study settings. Plain Language Summary Medicine age common. Older adults more than one chronic condition likely multiple manage their health. However, there times when taking be unsafe medicines, or combination used, poor outcomes. used describe all individual takes. There several ways measure regimen and, therefore, harmful. Much has been looking regimens. To bring together current research, this provides different measures It how many people experience regimens, impact it having who at greater risk. doing so, found evidence, indicating our understanding incomplete. highlights knowledge can addressed by improved able better identify those prevent minimize poorer related use.

Язык: Английский

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Does Abdominal Obesity Increase All-Cause, Cardiovascular Disease, and Cancer Mortality Risks in Older Adults? A 10-Year Follow-Up Analysis

Nutrients, Год журнала: 2022, Номер 14(20), С. 4315 - 4315

Опубликована: Окт. 15, 2022

There is insufficient evidence on the impact of abdominal obesity (AO) mortality in older adults. Therefore, objective to analyze 10-year AO, assessed using different diagnostic criteria, all-cause, cardiovascular disease (CVD), and cancer In this prospective cohort study adults (≥60 years), sociodemographic, lifestyle, clinical history, laboratory test, anthropometric data were analyzed. The considered used for AO diagnostic: waist circumference (WC) ≥88 cm women ≥102 men; WC ≥77.8 ≥98.8 increased waist-to-hip ratio (WHR), being highest tertile distribution by sex. Multivariate Cox regression Kaplan-Meier analyses performed. A total 418 individuals, with an average age 70.69 ± 7.13 years, participated study. analysis adjusted sex age, WHR was associated a high risk all-cause (p = 0.044). Both cutoff points CVD risk. None parameters mortality. An higher factor, while factor

Язык: Английский

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Risk factors for potentially inappropriate medication use in older adults: a cohort study

International Journal of Clinical Pharmacy, Год журнала: 2022, Номер 44(5), С. 1132 - 1139

Опубликована: Июль 27, 2022

Язык: Английский

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Low muscle mass and mortality risk later in life: A 10-year follow-up study

PLoS ONE, Год журнала: 2022, Номер 17(7), С. e0271579 - e0271579

Опубликована: Июль 28, 2022

Introduction Little is known about the impact of low muscle mass (MM) assessed by calf circumference (CC), arm (AC), (AMC), and corrected (CAMC)—on mortality risk later in life. We aimed to investigate MM CC, AC, AMC and, CAMC on all-cause, cardiovascular, cancer risk. Methods Data came from 418 older adults who participated a 10-year follow-up prospective cohort study. Low was defined as CC < 33 cm for women 34 men lowest tertile AMC, stratified sex. The log rank test, Kaplan-Meier curves, Cox regression were used. Results There 147 deaths: 49 related CVD 22 cancer. A small (HR = 1.57, 95% CI, 1.12–2.20), 1.61, 1.13–2.30) 1.45, 1.03–2.04) associated with all-cause mortality. protective factor 0.46, 0.22–0.98). In analysis, LMM presented survival, AC (p 0.05), 0.005), 0.002), 0.001). Cancer 0.020). Conclusions anthropometric measures (AC, CC) increased decreased

Язык: Английский

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Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada

Drugs & Aging, Год журнала: 2023, Номер 40(6), С. 573 - 583

Опубликована: Май 6, 2023

Язык: Английский

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Categorization of deprescribing communication tools: A scoping review

Basic & Clinical Pharmacology & Toxicology, Год журнала: 2023, Номер 133(6), С. 640 - 652

Опубликована: Май 12, 2023

Deprescribing can be beneficial to a wide variety of patients but is often not done due barriers including lack time and challenges starting conversations.This study aimed identify broadly categorize existing deprescribing communication tools for clinicians patients.Our scoping review protocol was based on the Arksey O'Malley methods incorporated Levac Joanna Briggs Institute recommendations. EMBASE, CINAHL, PsycINFO, MEDLINE, grey literature were searched, with two independent reviewers assessing eligibility. A backwards search texts chosen full text screen completed. Two independently completed data extraction using pre-specified collection form.Databases identified 1121 results, searching 49 1323 results. After screening, 32 resources included which contained 40 unique tools. Most Canadian targeted adults over 65 years old living in community. had been tested intended patient audience or evaluated effectiveness.Deprescribing have developed facilitate conversations by providing structure, education, decision-making approaches. More research needed test effectiveness

Язык: Английский

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Telehealth for Supporting Referrals to Specialized Care During COVID-19

Telemedicine Journal and e-Health, Год журнала: 2021, Номер 28(4), С. 544 - 550

Опубликована: Июль 27, 2021

Introduction: The coronavirus disease 2019 (COVID-19) pandemic led to the suspension or postponement of care for non-urgent conditions worldwide. Regula Mais Brasil is an initiative Unified Health System (SUS) in Brazil optimize management referrals specialized by using telehealth. Objectives: To report expansion telehealth activities response COVID-19 and assess qualification primary health (PHC) units as well added value teleconsultation qualifying referral cases. Methods: Descriptive study teleconsultations carried out additional strategy remotely operated system, responsible navigating cases from PHC Recife, Brazil, between May 6, 2020 September 30, 2020. Teleconsultation was implemented a tool reducing delays access due ultimately allowed reclassification adequacy priority. Changes priority ratings decisions after were analyzed. Results: A total 622 Approved represented 51.9% main reason approved need diagnostic resources. There reduction 449 (72.2%) teleconsultation. statistically significant association change decision on (Pearson's χ2, p-value <0.0001). Results show that telemedicine had impact prioritization referred services. Conclusions: detected rapidly adapt tools available Brazil. Our results demonstrate system has contributed toward improving equitable

Язык: Английский

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Geriatrician-led multidisciplinary team management improving polypharmacy among older inpatients in China

Frontiers in Pharmacology, Год журнала: 2023, Номер 14

Опубликована: Апрель 28, 2023

Background/Aim: Polypharmacy is prevalent among older inpatients and associated with adverse outcomes. To determine whether a geriatrician-led multidisciplinary team (MDT) management mode could reduce medications use inpatients. Methods: A retrospective cohort study was conducted in geriatric department of tertiary hospital China 369 inpatients, including 190 patients received MDT (MDT cohort), 179 usual treatment (non-MDT cohort). The primary outcome to compare the changes amount before after hospitalization two cohorts. Results: We reported that significantly reduced number used at discharge (at home: n = 7 [IQR: 4, 11] vs discharge: 6 8], p < 0.05). Hospitalization had significant effect on change (F 7.813, partial-η2 0.011, 0.005). discontinuance polypharmacy home (OR: 96.52 [95% CI: 12.53-743.48], 0.001), addition diagnosis chronic obstructive pulmonary disease (COPD) 2.36 1.02-5.49], 0.046). Conclusion: results indicated during by patients. were more likely "deprescription" management, while COPD be under-prescription home, which made up for management.

Язык: Английский

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Effect of the use of potentially inappropriate medications on the mortality of Brazilian older adults: SABE cohort study

Geriatric Nursing, Год журнала: 2024, Номер 59, С. 256 - 260

Опубликована: Июль 31, 2024

Язык: Английский

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