Medication in older patients reviewed multiple ways (MORE) study

Abstract

Background Polypharmacy in older patients can lead to potentially inappropriate prescribing. The risk of the latter calls for effective medication review to ensure proper medication usage and safety. Objective Provide insight on the similarities and differences of medication review done in multiple ways that may lead to future possibilities to optimize medication review. Setting This study was conducted in Zuyderland Medical Centre, the second largest teaching hospital in the Netherlands. Method This descriptive study compares the quantity and content of remarks identified by medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System. The content of remarks is categorized in seven categories of possible pharmacotherapeutic problems: 'indication without medication', 'medication without indication', 'contra-indication/interaction/side-effect', 'dosage problem', 'double medication', 'incorrect medication' and 'therapeutic drug monitoring'. Main outcome measure Number and content of remarks on medication review. Results The Clinical Decision Support System (1.8 ± 0.8 vs. 0.9 ± 0.9, p < 0.001) and outpatient pharmacist (1.8 ± 0.8 vs. 0.9 ± 0.9, p = 0.045) both noted remarks in significantly more categories than the geriatricians. The Clinical Decision Support System provided more remarks on 'double medication', 'dosage problem' and 'contraindication/interaction/side effects' than the geriatrician (p < 0.050), while the geriatrician did on 'medication without indication' (p < 0.001). The Clinical Decision Support System noted significantly more remarks on 'contraindication/interaction/side effects' and 'therapeutic drug monitoring' than the outpatient pharmacist, whereas the outpatient pharmacist reported more on 'indication without medication' and 'medication without indication' than the Clinical Decision Support System (p ≤ 0.007). Conclusion Medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System provides different insights and should be combined to create a more comprehensive report on medication profiles.

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

“…Yokukansan (TJ‐54), which consists of seven dried herbs, including licorice, is reportedly effective for dementia, insomnia, and schizophrenia ( Figure 1D ) 3,4 . Moreover, polypharmacy, an unresolved issue in the aging population, is associated with drug side effects, including fatal arrhythmia due to QT interval prolongation 5 . We herein report a cautionary case of licorice‐induced pseudoaldosteronism that precipitated the onset of TCM and subsequent fatal arrhythmia in an octogenarian patient on polypharmacy.…”

Duplicate prescriptions in the emergency department: a retrospective cohort study

“…However, the internal validity should be comparatively high because we systematically analyzed the medications of all patients presenting to the ED over the course of 2 years, thereby minimizing selection bias. Even though we did not formally evaluate interrater reliability, we are convinced that the application of our new DP categorization markedly reduced subjective bias and terminated the blending of clinically desired and undesired DPs, which was a substantial limitation of previous studies in the field [30][31][32][33][34]36]. Our DP categorization was specifically devised by physicians for physicians with direct patient contact.…”

“…Zwietering et al investigated the prevalence of “double medications” in a cohort of 200 patients in a geriatric outpatient clinic in The Netherlands [ 30 ]. The prevalence of double medications was low, ranging from 0 to 1.9%, depending on the mode of the medication review [ 30 ].…”

“…Zwietering et al investigated the prevalence of “double medications” in a cohort of 200 patients in a geriatric outpatient clinic in The Netherlands [ 30 ]. The prevalence of double medications was low, ranging from 0 to 1.9%, depending on the mode of the medication review [ 30 ]. Of note, the study cohort was considerably older than in our investigation (mean age (± standard deviation) 82 (± 6) years) vs. median age (IQR) 63 (48–77) years), suggesting that the presence of double medications/PIDPs is not associated with advanced age.…”

Potentially inappropriate medications according to PRISCUS list and FORTA (Fit fOR The Aged) classification in geriatric psychiatry: a cross-sectional study

“…In our opinion, this can also serve as an explanation for the relatively low proportion of PIM prescriptions in relation to total prescriptions in our study. Although medication reviews have been demonstrated to be clinically useful, there are no uniform recommendations about which aspects of pharmacotherapy should be discussed during medication reviews (Anderson et al 2014 ; Zwietering et al 2019 ). Limitations of our study are the monocentric design and the limited number of enrolled patients.…”