Inappropriate Prescribing Predicts Adverse Drug Events in Older Adults

Lund, Brian C.; Carnahan, Ryan M.; Egge, Jason A.; Chrischilles, Elizabeth A.; Kaboli, Peter J.

doi:10.1345/aph.1m657

Cited by 184 publications

(151 citation statements)

References 23 publications

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“…However, the two published studies on the predictive validity of the MAI both indicate that this tool can reliably predict clinical patient outcomes [33,34]. Lund et al showed that inappropriate prescribing, according to a modified MAI score [33], is associated with adverse drug events in older men, and Schmader et al demonstrated an association between worse MAI scores and poorer blood pressure control and use of more health services [34].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Hellström

Bondesson

Höglund

et al. 2011

Eur J Clin Pharmacol

138

169

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The study was funded by Apoteket AB and the County of Skåne, Sweden. Abstract PurposeTo examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drugrelated hospital revisits in elderly patients. MethodsThis was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management (LIMM) model (medication reconciliation at admission and discharge, and medication reviews and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation at discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria). ResultsThere was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-2 52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as 'possibly, probably or certainly drug-related', compared with 12 in the control group (p=0.0469). ConclusionIn this study, medication reconciliation and reviews provided by a clinical pharmacist in a multiprofessional team significantly reduced the number of inappropriate drugs and unscheduled drugrelated hospital revisits among elderly patients.

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Section: Discussionmentioning

confidence: 99%

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Hellström

Bondesson

Höglund

et al. 2011

Eur J Clin Pharmacol

138

169

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“…Although polypharmacy has no generally accepted definition, most often it is defined by cut-offs, in terms of the number of medications taken, ranging from two to ten (9)(10)(11)(12). However, regardless of the definition, its prevalence has been reported to rise with age, and is associated with an increased risk of inappropriate drug prescription, under-use of effective treatment, medication errors, poor adherence to pharmacological therapies, drug/drug and drug/disease interactions, and adverse effects (3,(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of adverse drug reactions (ADRs) rises exponentially rather than linearly with the number of drugs taken, and advanced age and polypharmacy are associated with a substantial increase in the risk of ADRs (4,10,15,(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

“…Many risk factors for polypharmacy have been identified, including demographic aspects such as age, white race, education, sex, poor health, number of chronic diseases, living arrangements, and the number and characteristics health providers (1)(2)(14)(15)(16). Elderly patients with multiple chronic conditions are common in general medicine specialties such as internal and geriatric medicine.…”

Section: Introductionmentioning

confidence: 99%

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Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

Nobili¹,

Licata²,

Salerno³

et al. 2011

Eur J Clin Pharmacol

279

195

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Purposes: We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality. Methods: Thirty-eight internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders. Results: The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p<0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.08; p=0.02), comorbidities (OR 1.18; 95% CI 1.12-1.24; p<0.0001), and AEs (OR 6.80; 95% CI 3.58-12.9; p<0.0001) were significantly associated with in-hospital mortality. Conclusions: Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk. © 2011 Springer-Verlag

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“…[8][9][10][11][12] Inappropriate prescribing, as indicated by explicit criterion-based or implicit judgment-based measures, increases the occurrence of adverse drug events. 9,10,[13][14][15] Therefore, the identification of inappropriate prescribing is important, as it can allow avoidance of preventable adverse drug events and optimization of pharmacotherapy for the frail older individual.…”

Section: Introductionmentioning

confidence: 99%

Innovative Collaborative Practice to Optimize Pharmacotherapy for Frail Older Patients

Trenaman

Bowles

Mallery

et al. 2014

CJHP

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Inappropriate Prescribing Predicts Adverse Drug Events in Older Adults

Abstract: Implicit measurement of actual inappropriate prescribing predicted ADE risk, an important clinical outcome. This finding helps confirm the validity of prior studies that have relied on explicit measures to link potentially inappropriate prescribing to adverse health outcomes.

Cited by 184 publications

References 23 publications

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

Innovative Collaborative Practice to Optimize Pharmacotherapy for Frail Older Patients

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