A Study on Drug Use and Medication Management Perspectives among Elderly and the Impact of Professional Oversight (original) (raw)
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Drug-related problems in elderly general practice patients receiving pharmaceutical care
International Journal of Pharmacy Practice, 2005
Objective To describe the types of drug-related problems identified by pharmacists providing pharmaceutical care to elderly patients in the primary care or general medicine setting, and the impact of their recommendations on drug-related outcomes. Methods Searches of the MEDLINE, EMBASE, CINAHL, HealthSTAR, and International Pharmaceutical Abstracts electronic databases from 1990 to 2002 were conducted and a manual search of references from retrieved articles and references on file was performed. Large (n > 100) randomised, controlled studies comparing the provision of pharmaceutical care to usual care in seniors in primary care or general medicine settings were included. Two reviewers evaluated articles based on inclusion criteria and extracted data from the intervention arm of each study, resolving discrepancies by consensus. Nine original articles were included for analysis. Key findings The mean number of drug-related problems (DRPs) identified per patient was 3.2 and the mean number of recommendations made per patient was 3.3. The most common DRP identified was not taking/receiving a prescribed drug appropriately (35.2%, range 4.7-49.3%). The most common recommendations made involved patient education (37.2%, range 4.6-48.2%). Implementation rates were generally high for all types of recommendations, with the highest being for provision of patient education (81.6%). The small number of studies available examining measures of drug utilisation and costs, health services utilisation, and patient outcomes produced inconsistent results, making it difficult to draw conclusions. Conclusions Substantial numbers and a wide range of DRPs were identified by pharmacists who provided pharmaceutical care to seniors in the primary care and general medicine setting. Pharmacists' drug-therapy recommendations were well accepted; however, further study is needed to determine the impact of these recommendations on health-related outcomes.
A concerning trend in geriatric pharmacy that merits evidence-based intervention
Baylor University Medical Center Proceedings
The effects of polypharmacy on geriatric populations are an emerging concern that merits more exploration. The primary goal of this review was to evaluate the current body of knowledge on polypharmacy and explore the preventive and corrective measures to avoid negative outcomes. Even if a medication has an appropriate indication, polypharmacy in the geriatric population is associated with an increased risk of drug-drug or drug-condition interactions. Recent efforts to prevent polypharmacy include the development of interprofessional teams in clinics dedicated to medication review and reconciliation, deprescription plans aimed to safely discontinue potentially inappropriate medications, and inpatient screening tools that provide prescribing recommendations. In conclusion, polypharmacy affects a high percentage of the geriatric population. Current efforts to address and prevent polypharmacy are ongoing but have not been widely adopted.
Physicians' Non-Uniform Approach to Prescribing Drugs to Older Patients - A Qualitative Study
Basic & Clinical Pharmacology & Toxicology
Multi-morbidity and polypharmacy are common in older patients and increase their susceptibility to adverse drug events and hospitalizations. Rational drug prescription is critical; however, little is known about physicians' perspectives on how to prescribe drugs for older patients. The aim of this study was to explore physicians' approach to prescribe drugs to older patients, including identifying the drugs that physicians perceive to be risk drugs for older patients and comparing them with established lists of potentially inappropriate medications. Short semi-structured interviews were conducted with 50 medical specialists in 23 different specialities throughout Denmark who had contact with older patients. Content analysis was performed to identify the relevant themes. Regardless of their medical or surgical background and how often they prescribed drugs for older patients in daily work, all physicians expressed a cautious approach when prescribing risk drugs. Despite their shared caution, physicians had different strategies for prescribing drugs to older patients. The following strategies were identified: (1) 'Start low, go slow', (2) 'Trial and error', (3) 'Dose reduction', and (4) 'Never prescribe'. The most frequently mentioned risk drugs considered to cause hospitalization were vitamin K antagonists, opioids and diuretics; these drugs are relatively highly consistent with established lists of PIMs. Physicians were relatively knowledgeable about risk drugs. Although the physicians agreed that a cautious approach was needed when prescribing drugs for older people, there was no consensus about how to best accomplish this in practice.
2016
Background: Prescribing to the older people is challenging. Pharmacokinetics and pharmacodynamic changes, chronic diseases, polypharmacy prescribing, potentially inappropriate medication (PIMs) prescribing, medication errors, adverse drug reactions, drug interactions, inappropriate prescribing or suboptimal prescribing are causes for challenge. It may lead to non-adherence, increase morbidity, length of hospitalization, poor quality of life, and finally death may occur. Method: A Prospective observational study was conducted in General Medicine department, for a period of 6 months. Patients of either gender who are above 65 years of age in general medicine in-patient ward with or without co-morbidities were included in the study; we excluded seriously ill and patients unable to communicate and Patients unwilling to participate in the study. Results: Total 140 geriatrics patients were admitted. In this study we observed that almost all prescriptions were with polypharmacy. PIMs obser...
Family Practice, 1999
Background. Elderly patients are particularly vulnerable and most at risk of suffering adverse drug reactions, which are often caused by inappropriate prescribing practice. Gaining insight into physicians' drug prescribing patterns in order to identify prescribing problems is the fundamental first step in trying to improve the quality of prescribing. Objectives. We aimed to describe drug prescribing in general practice for elderly patients, using patients' age and sex, encounters, indications for prescribing and the occurrence of some predefined inappropriate drug prescriptions. Methods. A cross-sectional, descriptive study was conducted in the Norwegian county of Møre & Romsdal. All patient contacts (n = 16 874) and prescriptions (n = 16 774) issued during two months in general practice were recorded. In defining inappropriate prescriptions, explicit criteria were used. Results. Prescriptions (of which 72% were repeat) were issued during two-thirds of all contacts, and 63% were for females. Seventy per cent of all prescriptions were made up by the ten most commonly prescribed therapeutic groups, for which the three most frequent diagnostic indications for prescribing comprised between 47 and 89% of all diagnoses for prescribing each of them. About one in six patients who received a benzodiazepine tranquillizer was concurrently prescribed another benzodiazepine for sleeping problems. In total, 13.5% of all prescriptions met at least one of the criteria listed for pharmacological inappropriateness. Conclusion. Inappropriate drug prescriptions for elderly patients are common in general practice. Since the majority of the prescribing practice is made up by rather few diagnoses and drugs, improved practice for only a few may nevertheless have a large impact on the total profile.
2019
Background : Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients are often excluded from premarketing trials that can further increase the occurrence of DRPs. This study was aimed to identify DRPs and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization.Methods : A prospective observational study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic re...
Indian Journal of Pharmacology, 2010
The elderly population is increasing rapidly world wide. [1] About 55% of community prescriptions dispensed in 2001 in UK were meant for elderly people. However, safe and effective prescribing of medicines in elderly continues to present a major challenge. [2] In spite of the fact that elderly people are reported to be responsible for half the total drug usage, less than 5% of randomized controlled trials have been designed for people over 65 years! With limited evidence available to guide prescribing for elderly, the prescribers tend to depend on data available for younger subjects. Moreover, elderly form a heterogeneous group due to various factors like co-morbidities, interindividual variability in the aging process and interindividual differences in age-related pharmacokinetic and pharmacodynamic changes. [3] Obviously inappropriate use of drugs is expected to be high in this population. Multiple drug use and polypharmacy is highly prevalent in elderly, exposing them not only to adverse drug reactions but also to drug interactions, increased cost of therapy, and compliance errors. [4,5] The prevalence of adverse reactions increased in the older people and reactions are reported to be ABSTRACT Objective: The present study was undertaken with the aim to detect extent of drug use in elderly at medicine outpatient department at tertiary care hospital and to evaluate inappropriate prescribing with the help of Beers' criteria 2002. Materials and Methods: The study was carried out at medicine out patient department of our hospital. 407 geriatric patients were included during the study period of three and half months. The data was collected in a proforma which included the patients' details and the prescriptions. Results: The results reveal that 7.42% of total drugs were prescribed in an inappropriate manner and 23.59% of total patients received at least one inappropriate drug prescription. Administration of a drug which is avoided in elderly forms a common category of inappropriate drug use. Antihistamines, anticholinergic, sedatives and hypnotics and cardiac glycosides are the most common drug groups prescribed in inappropriate manner. Conclusion: To conclude, this study shows high prevalence of inappropriate use of drugs in geriatric practice suggesting urgent need for sincere efforts to improve the situation.
Asian Journal of Pharmaceutical and Clinical Research, 2020
Objective: A sharp increase in chronic diseases for elderly patients has been observed in recent years resulting in polypharmacy, which may lead to drug-drug interactions (DDI's), drug-related problems, adverse drug reactions (ADR's), and many more issues in these patients. The present study was conducted to assess the clinical consequences of polypharmacy and its prevalence in the older adult population. Methods: Our work is a prospective, observational study carried out in a tertiary care teaching hospital. The polypharmacy prescriptions were identified (taking at least five medications), and drug-drug interactions were detected by Micromedex ® DrugReax ® System 2.0 version. The medication profiles were also checked for inappropriate prescribing according to Beers Criteria 2015. Results: In the study, the mean age of patients was found to be 72.4±8.8 years. Most of the patients (81.8%) had more than two and less than five diseases. The mean number of drugs prescribed in all the prescriptions was found to be 7.4±2.6. According to Beers Criteria-2015, 3.83% of the total medications prescribed were inappropriate, 74.1% of moderate DDI's were observed in patients, and 50.2% of the DDI's observed theoretically were documented as fair. Conclusion: The impact of polypharmacy on consequences such as the length of stay, DDI's, and DRP's was also found to be significant. This study concludes that the medication profile of older adult patients should be assessed regularly for the rationality of drug therapy to maximize the therapeutic response positively with the lowest number of medications possible.