Medication management at home: medication-related risk factors associated with poor health outcomes

Sörensen, Lene; Stokes, Julie; Purdie, David M.; Woodward, Mark; Roberts, Michael S.

doi:10.1093/ageing/afi202

Cited by 123 publications

(146 citation statements)

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“…Although the few number of studies including exclusively elderly patients would hinder drawing any conclusion regarding the increase of preventability of ADRs with age, this is in accordance with previous evidence about the challenge to ensure appropriate and safe use of medications among the elderly population (94,101 (207). Thus, interventions to prevent ADRs, implemented exclusively in hospital settings to target serious ADRs, would omit an important proportion of ADRs, which may be less serious but cause discomfort and worsen perceived quality of life of patients (29,30).…”

Section: Discussion Preventable Adverse Drug Reactions In Healthcare supporting

confidence: 84%

“…Previous studies on DRMs, mainly conducted in emergency and inpatient settings, have found that ADRs and STEs are the most common DRMs (22)(23)(24)(25)(26)(27). DRMs have been associated with worsening of quality of life of patients (28)(29)(30), mortality (31)(32)(33), and increased costs for healthcare and society (20,34,35).…”

Section: Drug-related Morbiditiesmentioning

confidence: 99%

“…Yet, the majority of research on PIPs has focused on estimating the prevalence and investigating the risk factors for PIPs (101,123,(127)(128)(129)(130), or the association between PIPs and serious adverse health outcomes, such as hospitalisations and death (98,99). Although nonserious ADRs may be more tolerable than the severe symptoms associated with the underlying condition, they should still be considered, as they are associated with worsening quality of life, and increase use of healthcare (28,30,34), especially if safer and more tolerated therapeutic alternatives exist. The few studies that have investigated the association between PIPs and ADRs have been mainly conducted in hospital settings and nursing homes, and only a few of them found a significant association between PIPs and ADRs (95,117,(131)(132)(133).…”

Section: Explicit Potentially Inappropriate Prescriptions Criteriamentioning

confidence: 99%

“…However, even non-serious ADRs are important to consider as they are associated with lower quality of life and may cause prescribing cascades to treat symptoms of unrecognised ADRs (29,30,198), especially if safer therapies exist. …”

Section: Potentially Inappropriate Prescribing and Adverse Drug Reactmentioning

confidence: 99%

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Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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Aim:The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods:A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period;PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete vi non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions:A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention.Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs.Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice.In summary, this thesis shows a significant potential for improvements of medication use and outcomes.Key words: Drug-related morbidity, medica...

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Section: Discussion Preventable Adverse Drug Reactions In Healthcare supporting

confidence: 84%

Section: Drug-related Morbiditiesmentioning

confidence: 99%

Section: Explicit Potentially Inappropriate Prescriptions Criteriamentioning

confidence: 99%

Section: Potentially Inappropriate Prescribing and Adverse Drug Reactmentioning

confidence: 99%

See 2 more Smart Citations

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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“…75 An Australian study also found that having multiple prescribers increased patients' key medicationrelated risk factors and was associated with poor health outcomes. 76 Non-medical prescribing can lead to too many specialist health professionals, each prescribing medicines, without the oversight of a general practitioner. 77 General practitioners typically have a comprehensive and holistic approach to health and illness, which differentiates them from specialists.…”

Section: Issues With Expanded Roles For Pharmacistsmentioning

confidence: 99%

Doctor and pharmacist — back to the apothecary!

Liaw¹,

Peterson²

2009

Aust. Health Review

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The Australian National Medicines Policy embodies four tenets: availability, quality, safety and efficacy of medicines; timely access to affordable medicines; quality use of medicines (QUM); and a responsible and viable medicines industry. The promotion of QUM requires a multidisciplinary approach, including contributions from government, the pharmaceutical industry, health professionals, consumers and academia. However, there are significant tensions and unintended effects associated with the multidisciplinary approach, especially with the relationships between prescribers and dispensers of medicines.The general practitioner and the pharmacist share a common ancestor -the apothecary. The separation of dispensing from prescribing, which began in medieval Europe and 19th century England, reframed and confined the patient-doctor relationship to one of diagnosis, prescription and non-drug management. The role of pharmacists was limited to dispensing, though the present trend is for their responsibilities to be widened. Historical antecedents, the contribution of an increasing number of actors to the costs of health care, universal health insurance and an evolving regulatory framework, are among the factors influencing doctor-pharmacist relations.The prescribing and dispensing of medicines must be guided by an ethical clinical governance structure encompassing health professionals, regulators, the pharmaceutical industry and consumers. There must be close monitoring of safety and effectiveness, and promotion of quality use of medicines and improved patient outcomes. Ongoing training and professional development, within and across professional boundaries, is essential to support harmonious and cost-effective interprofessional practice. The approach must be "apothecarial" with complementary roles and responsibilities for the prescriber and dispenser within the patient-clinician therapeutic relation- ship, and not adversarial.

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Adherence to Depression Treatment in Primary Care

et al. 2017

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Medication management at home: medication-related risk factors associated with poor health outcomes

Abstract: The findings support the theory that polypharmacy and medication-related risk factors as a result of polypharmacy are correlated to poor health outcomes.

Cited by 123 publications

References 13 publications

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Doctor and pharmacist — back to the apothecary!

Adherence to Depression Treatment in Primary Care

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Medication management at home: medication-related risk factors associated with poor health outcomes

Abstract: The findings support the theory that polypharmacy and medication-related risk factors as a result of polypharmacy are correlated to poor health outcomes.

Cited by 123 publications

References 13 publications

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Doctor and pharmacist &mdash; back to the apothecary!

Adherence to Depression Treatment in Primary Care

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Product

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Doctor and pharmacist — back to the apothecary!