Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Healthcare (Basel) ; 12(12)2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38921300

RESUMO

INTRODUCTION: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. OBJECTIVE: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. METHOD: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. RESULTS: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. CONCLUSIONS: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings.

2.
Diabetes Metab Syndr Obes ; 15: 1563-1575, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35619798

RESUMO

Objective: The main aim is to compare the risk of severe hypoglycemia associated with the modified-release (MR) gliclazide against glimepiride in diabetic older adults. Methods: All older adult diabetic patients who attended the emergency department (ED) between the 1st of Aug. 2017 and the end of Mar 2020 on gliclazide MR or glimepiride are included in two cohorts. We compared baseline differences between cohorts in demographics, lab results, diabetes complications, comorbidities, and drugs using the chi-squared test for categorical variables and unpaired t-test for continuous variables. All the baseline variables are used in a logistic regression to produce the propensity scores for receiving gliclazide MR. The primary outcome was Severe Hypoglycemia requiring Emergency Admission (SHEA). We used documented hypoglycemia, falls, fractures, Cardiovascular ED Admission (CVEA), and recurrent ED admissions as secondary outcomes. We used a univariate logistic regression followed by a propensity score-adjusted logistic regression to identify the adjusted odds ratio. We did a subgroup analysis for low and moderate-high doses users. Results: We included 2320 patients, 1786 were on gliclazide MR while 534 were on glimepiride. The risk of SHEA (Adjusted Odds Ratio AOR 6.74, p=0.002), falls (AOR 1.43, p=0.003), fractures (AOR 1.43, p=0.01), CVEA (AOR 1.66, p<0.001), recurrent ED admission (AOR 1.39, p=0.002) were significantly higher. At the same time, documented hypoglycemia was insignificantly higher (AOR 1.17, p= 0.444) with gliclazide MR compared to glimepiride. The low doses of both treatments did not show any SHEA cases, while the results with higher doses showed the same pattern of increased risk with gliclazide MR as the principle analysis. Conclusion: Using gliclazide MR for older patients may not be a relatively safer alternative to avoid severe hypoglycemia and its possible consequences compared to glimepiride. It may be added to glimepiride in the Beers list of medications to be avoided in older adults.

3.
Clin Interv Aging ; 14: 1889-1899, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31802859

RESUMO

PURPOSE: To assess the prevalence and associated risk of potentially inappropriate prescribing (PIP) in older adults. METHODS: This was a national 3-year retrospective study of outpatient older adults exposed to potentially inappropriate medication (PIM) or polypharmacy. We used the Beers Criteria 2019 list to identify PIM to be avoided in older adults. We define moderate polypharmacy (MoP) and major polypharmacy (MaP) as using 6-10 or >10 chronic medications, respectively. Determinants of PIP included patients' demographics, lab results, medications, comorbidities, and home healthcare services. We used Chi-square (for categorical variables), Unpaired t-test and ANOVA (for continuous variables as applicable) to assess the association of these determinants with PIP. Univariate followed by multivariate logistic regression models were used to get the crude and adjusted odds ratios of exposure to PIM or polypharmacy within patients who had emergency department (ED) admissions, bone fractures, falls, or constipation, compared to those who had not. RESULTS: 3537 patients were included. 62.6%, 40.4%, and 27.2% were exposed to PIM, MoP and MaP, respectively. Determinants of PIP included age, gender, ethnicity, weight, kidney function, sodium levels, hypertension, diabetes, heart failure, CAD, and home healthcare services (all with p-value < 0.05). PIM was associated with risk of ED admission, bone fracture and constipation with adjusted OR (p-values) of 1.27 (0.002), 1.33 (0.005), and 1.40 (<0.001), respectively. MoP was associated with the risk of ED admission, bone fracture, and constipation, with adjusted OR (p-values) of 1.27 (0.012), 1.34 (0.019), and 1.47 (<0.001), respectively. MaP was associated with a higher risk of ED admission, bone fracture, falls, and constipation with adjusted OR (p-values) of 1.46 (0.001), 1.59 (0.002), 1.39 (0.023), and 2.07 (<0.001), respectively. CONCLUSION: PIP is common and is associated with an increased risk of poor clinical outcomes in older adults.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Prescrição Inadequada/estatística & dados numéricos , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Prevalência , Catar , Estudos Retrospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...