Comparison of haloperidol, non-haloperidol antipsychotics, and no pharmacotherapy for the management of delirium in an inpatient geriatric palliative care population.

Antipsychotics are frequently used for treatment of delirium, although little evidence exists that they improve delirium outcomes. Our objective was to evaluate haloperidol (HAL) compared to non-haloperidol antipsychotics (NHAP) or no pharmacologic treatment (NP) in the management of delirium in older adults under the care of a palliative care consult service across a large, integrated health care system. A retrospective chart review examined data from September 2014-September 2015. All hospitalized patients ≥65 years old with a diagnosis of delirium during palliative care consultation were included (n = 304). Primary outcome was length of stay after delirium diagnosis. Secondary outcomes included delirium symptom length, sedation, and QTc prolongation. Univariate statistical tests, analysis of covariance, and multiple regression methods were used to compare groups. Post-delirium length of stay in the HAL, NHAP, and NP groups were 8.5, 7.0, and 6.8 days, respectively (p = 0.19). Delirium duration in the HAL, NHAP, and NP groups were 6.7, 6.0, and 4.9 days, respectively (p = 0.05). Safety outcomes were statistically different than the reference group (NHAP). Congruent with existing literature in other generalized patient populations, no significant difference in post-delirium length of stay existed in geriatric, palliative care population.

Geriatric care curriculum in US PharmD programs: What's happening?

OBJECTIVES: Current Accreditation Council for Pharmacy Education (ACPE) Standards are not explicit regarding geriatrics content. The objective of this review is to describe published examples of how care for older adults is integrated into Doctor of Pharmacy (PharmD) curricula at accredited schools/colleges of pharmacy across the United States. METHODS: PubMed and Embase databases were searched. Manuscripts addressing care for older adults in pharmacy curriculum in the United States were included in the review. RESULTS: Thirteen PharmD programs have thirteen published examples of how geriatric care was integrated into their curriculum. The most common way geriatric care is integrated into PharmD programs is through Introductory Pharmacy Practice Experiences (IPPE) followed by existing course content and elective course content. CONCLUSION: There is a wide variety of curriculum strategies currently being utilized to incorporate geriatric education into PharmD programs in the United States. However, this may not be sufficient to support the care of the growing older adult population.

Physician Factors Associated with Polypharmacy and Potentially Inappropriate Medication Use.

BACKGROUND: Despite accumulating evidence about the harm of polypharmacy in family medicine, few studies have investigated factors related to polypharmacy. The objective of this study was to explore factors related to physicians' prescribing behavior. METHODS: We conducted a survey of physicians at 5 family medicine residency practices and a linked health record review of their patients ≥65 years old. The determinants of physicians' mean number of prescriptions and potentially inappropriate medications (PIMs) were examined using a generalized linear model. RESULTS: A total of 61 physicians (38 residents, 23 fellows/faculty) completed the survey, and 2103 visits by 932 patients seen by these physicians were analyzed. The mean numbers of prescriptions and PIMs per visit per physician were 9.50 and 0.46, respectively. After controlling for patient race and age, low prescribers were more likely to consider the number of medications (P = .007) and benefit/risk information for deprescribing (P = .017) when making prescribing decisions. Use of the Beers List was marginally significant in lower PIM prescribing (P = .05). Physicians' sex, duration of experience, and perceived confidence were not associated with prescribing patterns. CONCLUSIONS: Conscious consideration concerning the number of medications and benefit/risk information, as well as using the Beers List, were associated with less polypharmacy and fewer PIMs.

Medication adherence to oral cancer therapy: The promising role of the pharmacist.

Medication adherence to oral cancer therapy is a critical component to achieving optimal patient outcomes. As the US population ages, growing numbers of patients will be prescribed oral cancer therapy regimens, highlighting the need for innovative and scalable solutions. Clinical pharmacists offer tremendous promise to help patients improve their adherence to oral cancer therapy. Moreover, addition of oral chemotherapy to Centers for Medicare & Medicaid Services (CMS) medication adherence quality measures has the potential to improve care and result in better therapeutic outcomes with fewer costs for patients and payers. Future research is needed to test the use of pharmacist-managed interventions to improve adherence to oral cancer therapy.

Racial differences in anticholinergic use among community-dwelling elders.

OBJECTIVE: Few studies have examined racial differences in potentially inappropriate medication use. The objective of this study was to examine racial disparities in using prescription and/or nonprescription anticholinergics, a type of potentially inappropriate medication, over time. DESIGN: Longitudinal. SETTING: Data from the Health, Aging, and Body Composition Study (years 1, 5, and 10). PARTICIPANTS: Three thousand fifty-five community-dwelling older adults, both blacks and whites, at year 1. MAIN OUTCOME MEASURE: Highly anticholinergic medication use per the 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. RESULTS: Blacks represented 41.4% of the participants at year 1. At year 1, 13.4% of blacks used an anticholinergic medication compared with 17.8% of whites, and this difference persisted over the ensuing 10-year period. Diphenhydramine was the most common anticholinergic medication reported at baseline and year 5, and meclizine at year 10, for both races. Controlling for demographics, health status, and access to care factors, blacks were 24% to 45% less likely to use any anticholinergics compared with whites over the years considered (all P < 0.05). CONCLUSION: The use of prescription and/or nonprescription anticholinergic medications was less common in older blacks than whites over a 10-year period, and the difference was unexplained by demographics, health status, and access to care.

Published cases of adverse drug reactions: has the quality of reporting improved over time?

PURPOSE: A previous study of cases published approximately 10-30 years ago reveals that substantial improvement in the quality of adverse drug reaction (ADR) case reports is needed. Since that evaluation, recommendations are available concerning the content and formatting of case reports. OBJECTIVE: To compare the quality of recently published ADR case reports to a previously published study of the quality of ADR case reports from 10-30 years ago. A secondary objective is to determine the quality of reporting by specialty journal. METHODS: This was a two-phase study. Phase 1 included an assessment of the 23 patient, drug and ADR variables evaluated in the previous study to allow comparison with recently published case reports in specialty journals. Phase 2 mimicked the methods of Phase 1 with a random selection of available case reports in a 1-year period from a variety of journals. RESULTS: For Phase 1, 19 of the 23 variables had significant differences in reporting compared with the previous study. Reporting of active diseases, social history, weight, race, other drugs and dose had frequencies ranging from 25 to 80%, which was an improvement, but affording an opportunity for greater improvement. For Phase 2, 21 of the 23 variables had significant differences compared with the previous evaluation; however illicit drug use, mechanism for ADR and route of administration had significant reductions in reporting. CONCLUSION: Progress has been made in ADR case reporting quality for a variety of journals, but more improvement is required to ensure data are understandable and relatable to patient care.