Proton pump inhibitors and risk of readmission and mortality in older patients discharged from a tertiary hospital to residential aged care facilities

Pegoli, Matthew; Dedigama, Maneesha; Mangoni, Arduino A.; Russell, Patrick; Grzeskowiak, Luke E.; Thynne, Tilenka

doi:10.1177/2042098616679814

Cited by 7 publications

(3 citation statements)

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“…Evidence published in 2007 by Garfinkeland colleagues from a nonrandomised group of older institutionalised people in Israel suggested that a 50% relative reduction in mortality was possible through deprescribing. 8 The sample size needed to detect a difference in mortality was estimated based on this latter study and on our own pilot data, 9 assuming a 1-year mortality of 50%. A power procedure using a Pearson Chi-square test for two proportions was performed.…”

Section: Methodsmentioning

confidence: 99%

A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital

Russell

Laubscher

Roberts

et al. 2019

Therapeutic Advances in Drug Safety

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Background: Patients from residential aged care facilities are commonly exposed to inappropriate polypharmacy. Unplanned inpatient admissions can provide an opportunity for review of complex medical regimens and deprescribing of inappropriate or nonbeneficial medications. The aim of this study was to assess the efficacy, safety and sustainability of in-hospital deprescribing. Methods: We followed a prospective, multi-centre, cohort study design, with enrolment of 106 medical inpatients age 75 years and older (mean age was 88.8 years) who were exposed to polypharmacy prior to admission and with a planned discharge to a nursing home for permanent placement. Descriptive statistics were calculated for relevant variables. The Short Form-8 (SF-8) health survey was used to assess changes in health-related quality of life (HRQOL) at 90-day follow up, in comparison with SF-8 results at day 30. Results: Deprescribing occurred in most, but not all patients. There were no differences between the groups in principal diagnosis, Charlson index, number of medications on admission or number of Beers list medications on admission. At 90 days, mortality and readmissions were similar, though the deprescribed group had significantly higher odds of better emotional wellbeing than the nondeprescribed group [odds ratio (OR) = 5.08, 95% confidence interval (CI): 1.93, 13.39; p = 0.001]. In the deprescribing group, 31% of the patients still alive at 90 days had medications restarted in primary care. One-year mortality rates were similar. Conclusions: Deprescribing medications during an unplanned hospital admission was not associated with mortality, readmissions, or overall HRQOL.

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Section: Methodsmentioning

confidence: 99%

A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital

Russell

Laubscher

Roberts

et al. 2019

Therapeutic Advances in Drug Safety

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“…Studies have shown associations between PPIs and enteric infections [17,18], pneumonic pathologies [18,19], calcium malabsorption leading to an increased risk of osteoporotic fractures [20,21], and iron or vitamin B12 malabsorption causing anemia [18,21,22] and hyponatremia [23]. The use of PPIs for older adults has been associated with functional decline, more hospitalizations, and early death [24-26]. Another problem with prescribing PPIs, mainly among elderly polymedicated patients, is the existence of drug interactions that can lead to greater numbers of adverse effects of inactivated drugs (eg, citalopram) and, conversely, the decreased efficacy of prodrugs metabolized by this cytochrome [18,27,28].…”

Section: Introductionmentioning

confidence: 99%

Using a Triple Aim Approach to Implement “Less-is-More Together” and Smarter Medicine Strategies in an Interprofessional Outpatient Setting: Protocol for an Observational Study

Hagen¹,

Julen²,

Buchs³

et al. 2019

JMIR Res Protoc

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Background Increased awareness of the world’s problematic growing health care expenditure and health care shortages requires sustainable use of available resources. To promote cultural changes in medical mindsets, societies representing medical specialties have developed new Choosing Wisely strategies. The Valais Medical Society and the Valais Pharmacy Association have developed an interprofessional collaboration project entitled “Less-is-more Together-PPI” to analyze and optimize change management practices focusing on the prescription and deprescription of proton pump inhibitors (PPIs). Objective This study aims to enhance interprofessional collaboration between physicians, pharmacists, and patients to optimize PPI use, avoid unnecessary treatments and improve therapeutic adherence to indicated therapies, and to analyze hindrances and facilitators to implementing interprofessional Less-is-more strategies in the field. Methods Home-dwelling adults domiciled in Valais and prescribed PPIs in the last 6 months will be invited to participate in this observational study. The studied subpopulation will be constituted of consenting patients whose physicians and pharmacists also voluntarily agree to participate. The process of collecting, pooling, transmitting, evaluating, and protecting data has been validated by the Human Research Ethics Committee of the Canton Vaud. Results The Primary Triple Aim outcome measures will be (1) population health: patient’s assessment of their own health, functional status, and disease burden using a monthly questionnaire for 6 months; Behavioral/physiological factors will be investigated using a final questionnaire at 6 months, (2) experience of care: assessment using a final questionnaire for participating patients, pharmacists and physicians, and an analysis of negative/positive experiences via 6 follow-up questionnaires, and (3) Per capita cost: participants’ fluctuating or decreasing PPI intake (number of pills/dosage) and an analysis of participants’ different categories following their medical prescription, in relation to possible bias effects on the overall drug intake of the population studied. Secondary outcomes will be participation rates; patient, physician, and pharmacist follow-up; and evaluations of participants' experiences and their perceived benefits, as well as whether the interprofessional process can be improved. Conclusions This project seeks a deeper understanding of how Less-is-more and smarter-medicine strategies are perceived by patients and health care providers in their daily lives in a very specific context. It will reveal some of the hindrances to and facilitators for efficient cultural change toward a more sustainable health care system. The results will be useful to optimize and scale up further Choosing Wisely approaches. International Registered Report Identifier (IRRID) DERR1-10.2196/13896

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“…The potential risk of adverse outcomes with specific drug classes has also been extensively investigated over the last 10–15 years. These studies have shown that the long‐term use of drugs affecting the CNS, for example, sedatives and anticholinergics, and, albeit with less robust evidence, proton pump inhibitors, is significantly associated with various adverse effects in older adults, including cognitive and functional decline 12–14 . Notably, CNS drugs and proton pump inhibitors, in addition to cardiovascular drugs, were also significantly associated with 12‐month functional decline in the study by Arends et al 9 This suggests that targeted deprescribing interventions might be particularly beneficial, although it is important to emphasise that, in this study, no assessment of individual medication appropriateness was conducted 9 …”

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confidence: 99%

Preoperative polypharmacy assessment for risk stratification and management

Mangoni

Russell

Jarmuzewska

2022

Brit J Clinical Pharma

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Proton pump inhibitors and risk of readmission and mortality in older patients discharged from a tertiary hospital to residential aged care facilities

Cited by 7 publications

References 6 publications

A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital

A pilot cohort study of deprescribing for nursing home patients acutely admitted to hospital

Using a Triple Aim Approach to Implement “Less-is-More Together” and Smarter Medicine Strategies in an Interprofessional Outpatient Setting: Protocol for an Observational Study

Preoperative polypharmacy assessment for risk stratification and management

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