Background and aim: Aging is often accompanied by chronic diseases, comorbidity, and polypharmacy. Use of prescription/nonprescription drugs, and over-the-counter (OTC) drugs seen frequently in the...

https://journals.sagepub.com/doi/pdf/10.1177/2333721419874274

Assessment of Comorbidity and Use of Prescription and Nonprescription Drugs in Patients Above 65 Years Attending Family Medicine Outpatient Clinics

Introduction: Drug-drug interactions may lead to poor health outcomes, as well as increased costs and utilization of healthcare services. Unfortunately, real-world data continuously prove high prevalence of potential drug-drug interactions (pDDIs) worldwide. Among identified drivers, ageing, multimorbidity and polypharmacy play a very important role. With these factors being widespread, the need for implementation of strategies minimizing the burden of pDDIs becomes an urgency. This, however, requires a better understanding of the prevalence of pDDIs and the underlying causative factors. Aim of study: To assess the real-world prevalence of pDDIs and its characteristics in the general population of Poland, using analgesic drugs as a model, and to find out whether pDDIs are caused by prescribing coming from the very same prescribers (co-prescribing). Methods: A retrospective analysis of the 2018 dispensation data of the National Health Fund (NHF) - the only Polish public healthcare payer organization with nationwide coverage. We searched for selected pDDIs of non-steroidal anti-inflammatory drugs (NSAIDs) with antihypertensives, other NSAIDs (double use), oral glucocorticoids, oral anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and antiplatelet drugs; as well as opioides with SSRIs, SNRIs, gabapentinoids, and benzodiazepines. A pDDI was deemed present if two drugs standing in a possible conflict were dispensed within the same calendar month. Results: Out of 38.4 million citizens of Poland, 23.3 million were dispensed prescribed drugs reimbursed by NHF in 2018. In this cohort, we have identified 2,485,787 cases of analgesic drug pDDIs, corresponding with 6.47% of the Polish population. Out of these, the most prevalent pDDI was caused by "NSAIDs + antihypertensives" (1,583,575 cases, i.e., 4.12% of the Polish population), followed by "NSAIDs + NSAIDs" (538,640, 1.40%) and "NSAIDs + glucocorticoids" (213,504, 0.56%). The most persistent pDDIs among those studied were caused by "Opioids + Gabapentinoids" (2.19, 95%CI: 2.16-2.22 months). On average, 76.63% of all cases of pDDIs were caused by drugs prescribed by the very same prescribers. Conclusion: Based on high-quality, nationwide data, we have found a high prevalence of analgesic drugs-related pDDIs in Poland. Over ¾ of the identified pDDIs were caused by co-prescribing, i.e., prescriptions issued by the same prescribers. The significance of the problem, illustrated with our findings on analgesic drugs-related pDDIs in Poland, deserves much more scientific and policymaker attention.

/pdf/the-prevalence-of-selected-potential-drug-drug-interactions-pziofo1890.pdf

The Prevalence of Selected Potential Drug-Drug Interactions of Analgesic Drugs and Possible Methods of Preventing Them: Lessons Learned From the Analysis of the Real-World National Database of 38 Million Citizens of Poland.

<h3>Purpose:</h3> To review the literature on medication safety in primary care in the electronic health record era. <h3>Methods:</h3> Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias. <h3>Results:</h3> Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking &gt; 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm. <h3>Conclusions:</h3> This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms. 

/pdf/ambulatory-medication-safety-in-primary-care-a-systematic-2l5ko7kc.pdf

Ambulatory Medication Safety in Primary Care: A Systematic Review

La prescription medicamenteuse est un geste excessivement courant mais pourtant pas denue de consequences, notamment chez les sujets âges qui ont souvent des ordonnances comportant de nombreux medicaments. Cela les expose donc au risque d’interactions medicamenteuses entre deux molecules interferant l’une avec l’autre. C’est pourquoi nous avons mene cette etude observationnelle transversale entre le 1er septembre 2016 et le 31 aout 2017 afin de determiner la prevalence des interactions medicamenteuses de niveau 3 et 4 chez les sujets âges de 75 ans et plus admis au sein des urgences de Bordeaux. Sur le large echantillon de 5059 patients admis avec une ordonnance comportant deux medicaments ou plus, nous avons retrouve une prevalence elevee de 7,4%, ce qui represente un peu plus d’une ordonnance par jour et qui nous pousse a reflechir sur le role direct a jouer de l’urgentiste. Ce resultat nous sensibilise egalement a une prescription plus raisonnee notamment en tant que medecin generaliste. Il sera egalement interessant de s’interroger par la suite sur les motifs d’admission aux urgences de ces patients pour savoir s’ils sont lies aux interactions medicamenteuses retrouvees sur leurs ordonnances.

https://dumas.ccsd.cnrs.fr/dumas-02492136/document

Prévalence des interactions médicamenteuses potentielles de niveaux 3 et 4 figurant sur l’ordonnance des sujets âgés de 75 ans ou plus, admis aux urgences du CHU de Bordeaux entre le 1er septembre 2016 et le 31 août 2017

Objectives Health disparities across different socioeconomic subgroups have been reported in previous studies. Mortality with potentially inappropriate medication (PIM) use may be subject to similar disparities. We aimed to assess the association between PIM use and all-cause mortality and the effect of disparity parameters (sex, race, income, education, and location of residence) on this relationship. Methods This longitudinal cohort study included 26,399 U.S. adults aged 45 years and older from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, of which 13,475 participants were aged 65 years and older (recruited 2003–2007). PIM use and drug-drug interactions (DDIs) were identified through the 2015 Beers Criteria and a clinically significant DDIs list by the American Family Physicians, respectively. Cox regression was used to assess disparities in mortality with PIM use, iteratively adjusting for disparity parameters and other covariates. The full models included interaction terms between PIM use and other covariates. A similar method was used for the analyses of disparities in mortality with DDIs. Results Approximately 87% of older adults used at least 1 drug listed in the Beers Criteria, and 3.8% of all participants used 2 or more drugs with DDIs. In the adjusted analysis, an increased risk of mortality was observed among whites with PIM use (hazard ratio [HR] = 1.27 [95% CI 1.10–1.47]). The higher mortality rate was observed among blacks without PIM use (1.34 [1.09–1.65]). Lower income and education were independent predictors for higher mortality. Conclusion Racial differences in all-cause mortality with PIM use were observed. Further research is needed to better understand the contributing factors of such disparities to develop appropriate interventions.

Disparities in all-cause mortality with potentially inappropriate medication use: Analysis of the Reasons for Geographic and Racial Differences in Stroke study.

Background/aim Elderly patients are at high risk from drug-drug interactions (DDIs). This study evaluates the potential DDIs in Turkish elderly patients at a primary health care outpatient clinic. Materials and methods Online database systems were used to examine DDIs on the prescriptions of patients (n = 1206). The clinical severity of DDIs was classified by the Lexi-Interact Online database. Results Of the 5059 prescriptions, 33% were found to have DDIs. We detected 29 (0.9%) A, 380 (11.8%) B, 2494 (77.7%) C, 289 (9%) D, and 18 (0.6%) X risk rating category DDIs among the prescriptions. Prescriptions of female patients and patients aged between 65 and 72 years showed significantly higher number of DDIs. The frequency of DDIs increased both with the number of drugs and combined preparations per prescription. Acetylsalicylic acid and salbutamol were the most frequently prescribed drugs contributing to clinically important DDIs. Additionally, acetylsalicylic acid and escitalopram, which interact with each other, were found on the list of Beers criteria. The most predicted clinical outcomes of DDIs were increase in therapeutic efficacy and adverse/toxic reactions. Conclusions: Prediction of DDIs in elderly patients will provide better prescribing and drug safety. Use of nonsteroidal anti-inflammatory agents, selective serotonin reuptake inhibitors, and beta-2 adrenergic receptor agonists should be closely monitored.

/pdf/potential-drug-drug-interactions-among-prescriptionsfor-3mlwmt4o1j.pdf

Potential drug-drug interactions among prescriptionsfor elderly patients in primary health care.

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Potential drug-drug interactions among prescriptionsfor elderly patients in primary health care.