Polimedication: applicability of a computer tool to reduce polypharmacy in nursing homes

García‐Caballero, Tomás; Lojo, Juan; Menendez, Carlos E.; Fernández-Álvarez, Roberto; Mateos, Raimundo; García-Caballero, Alejandro

doi:10.1017/s1041610217002411

Cited by 16 publications

(38 citation statements)

References 32 publications

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“…Polypharmacy, the use of five or more medicines (Lee et al, 2020), is quite common in patients with multiple comorbidities and is considered a factor for functional decline in older adults, which increases the chance of medication-related problems (Garcia-Caballero et al, 2018;Lee et al, 2020). Overall, polypharmacy is associated with increased consumption of potentially inappropriate medication (PIM) (Oktora et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

et al. 2021

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Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM.Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant.Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria.Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.

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Section: Introductionmentioning

confidence: 99%

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

et al. 2021

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“…It is impossible to keep in mind all the relevant interactions described, but knowledge of the main types of drugs most frequently involved in interactions can be crucial for establishing an alert system that contributes to improving prescription of drug therapy. Several methods that allow the reduction in the risks associated with interactions and thus improve the therapeutic risk/benefit ratio have been described, including among others the reduction in the number of drugs administered, avoiding unnecessary polymedication, the selection of alternative drugs with low AE rate, an adequate dosing regimen adjusted to the individualized characteristics of every patient, pharmacokinetic monitoring of serum concentrations of drugs in those cases in which this is possible and constant clinical observations in order to detect the consequences of an interaction as quickly as possible [ 62 , 63 , 64 , 65 ].…”

Section: Final Considerationsmentioning

confidence: 99%

Pharmacological Interactions of Nintedanib and Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis in Times of COVID-19 Pandemic

et al. 2021

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The discovery of antifibrotic agents have resulted in advances in the therapeutic management of idiopathic pulmonary fibrosis (IPF). Currently, nintedanib and pirfenidone have become the basis of IPF therapy based on the results of large randomized clinical trials showing their safety and efficacy in reducing disease advancement. However, the goal of completely halting disease progress has not been reached yet. Administering nintedanib with add-on pirfenidone is supposed to enhance the therapeutic benefit by simultaneously acting on two different pathogenic pathways. All this becomes more important in the context of the ongoing global pandemic of coronavirus disease 2019 (COVID-19) because of the fibrotic consequences following SARS-CoV-2 infection in some patients. However, little information is available about their drug–drug interaction, which is important mainly in polymedicated patients. The aim of this review is to describe the current management of progressive fibrosing interstitial lung diseases (PF-ILDs) in general and of IPF in particular, focusing on the pharmacokinetic drug-drug interactions between these two drugs and their relationship with other medications in patients with IPF.

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“…All 40 studies had been published in the period 2011-19, and the majority (n = 31) had been published in the 5 years immediately prior to the conduct of the synthesis (Table 5). The studies had been conducted in Europe [mainly Spain (n = 13), 51,53,56,58,60,61,73,79,[84][85][86][87][88] Belgium (n = 5) 49,55,57,74,78 and Ireland (n = 3)],…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

“…The majority of studies had been conducted in hospitals, most frequently across multiple departments (n = 25). 49,52,[54][55][56][57][58]60,64,[66][67][68][69][70][71][72][73][74]77,78,80,82,83,85,87 Other studies were conducted in nursing homes (n = 9), 59,61,62,65,75,79,81,84,88 primary care (n = 5) 50,51,53,63,86 or a community pharmacy (n = 1) 76 . The majority of studies (n = 29) 49, 51-53,56-59,62,65,68-71,73-77,79,81-88 used both STOPP and START tools.…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Gangannagaripalli

Porter

Davey

et al. 2021

Health Serv Deliv Res

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Background Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults. Objectives To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts. Design A realist synthesis. Setting Primary care, hospital care and nursing homes. Patients Patients aged ≥ 65 years. Interventions Any intervention based on the use of the STOPP/START tools. Review methods Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies. Results We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs. Limitations None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse. Conclusions No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings. Study registration This study is registered as PROSPERO CRD42018110795. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.

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Polimedication: applicability of a computer tool to reduce polypharmacy in nursing homes

Cited by 16 publications

References 32 publications

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

Pharmacological Interactions of Nintedanib and Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis in Times of COVID-19 Pandemic

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

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