Potential prescribing omissions according to START criteria at the time of hospital discharge

The purpose of this study is to describe the frequency of potential drug prescribing omissions (PPOs) for elderly patients at the time of hospital discharge and to compare the frequency PPOs among different medical specialities. This cross-sectional study examined data from elderly patients when they were admitted for >24 h to a northeastern Brazil teaching hospital during June-December 2016. Were included in the study 227 patients, of whom 36.9% had at least one PPO. The highest number of PPOs was identified among those with at least 5 prescribed drugs. In total, 153 PPOs were identified at hospital discharge. In most cases (78.4%), patients were not evaluated by the specialist physician.The most commonly identified PPOs on discharge were: the omission of statin therapy in cases of diabetes mellitus plus one or more cardiovascular-associated factor; calcium and vitamin D supplements in patients with known osteoporosis; and angiotensin converting enzyme inhibitors in cases of chronic heart failure. The results of this study suggest that the frequency of prescribing omissions PPOs during patient discharge was high. This can be avoided by the careful evaluation by prescribers with experience in certain specialties where several prescribed omissions would be common.

Potentially inappropriate medications according to STOPP-J criteria and risks of hospitalization and mortality in elderly patients receiving home-based medical services.

BACKGROUND: Although potentially inappropriate medications (PIMs) have been linked to poor health outcomes, country-specific PIM criteria have not been compared. Thus, we compared the identification of PIMs between the Screening Tool for Older Person's Appropriate Prescriptions for Japanese (STOPP-J) and the 2015 American Geriatrics Society Beers Criteria in elderly patients receiving home-based medical services. METHODS: A 5-year prospective cohort study was conducted with 196 patients receiving home-based medical services. Data were collected using questionnaires and chart reviews and included detailed information on prescription medication. STOPP-J and the Beers Criteria were used to categorize PIM and non-PIM recipients. All-cause mortality and first hospitalization were compared using a multivariate Cox regression model. RESULTS: PIMs were detected in 132 patients (67.3%) by STOPP-J and in 141 patients (71.9%) by the Beers Criteria, and the mean numbers of PIMs were 1.3 ± 1.3 and 1.2 ± 1.1, respectively. The three most frequently prescribed STOPP-J PIMs were hypnotics (26.8%), diuretics (25.6%), and NSAIDs (12.6%), compared with proton pump inhibitors (PPIs) (29.8%), hypnotics (26%), and NSAIDs (8.1%) according to the Beers Criteria. STOPP-J PIMs were associated with all-cause mortality (HR 3.01, 95% CI 1.37-6.64) and hospitalization (HR 1.91, 95% CI 1.17-3.09); neither was associated with Beers Criteria PIMs. Using a modified Beers Criteria (excluding PPIs), PIMs were correlated with first hospitalization (HR 1.91, 95% CI 1.17-3.09). CONCLUSIONS: PIMs categorized by STOPP-J are associated with hospitalization and mortality in Japanese patients receiving home-based medical services. PPIs, commonly used for acid-related diseases, do not seem to have deleterious effects on health outcomes. Country-oriented, medication-specific criteria would be of considerable clinical utility.

Turn back crime: medicamentos ilegales y papel del farmacéutico comunitario / Turn back crime: illicit products and the role of the community pharmacist

El objetivo del presente trabajo fue describir y analizar la situación en España de los productos de venta ilícita, tanto medicamentos como complementos alimenticios, poniendo en conocimiento las principales acciones realizadas en los últimos meses y su contextualización a nivel mundial. Asimismo, servir de alerta sobre la magnitud del problema y la importancia del papel del farmacéutico comunitario. Se realizó una búsqueda de información tanto a nivel nacional como internacional y se realizó un análisis descriptivo de las Notas Informativas de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) (medicamentos ilegales, uso humano, 2015). Los productos de venta ilícita representan un problema grave para la salud pública que no ha parado de aumentar. En España, en 2015 se publicaron 20 notas donde se prohibió y retiró un total de 35 productos. Dichos productos estaban comercializados como complemento alimenticio y presentaban un principio activo en cantidad suficiente para conferirle legalmente la condición de medicamento. El 86% se dirigía a la disfunción eréctil. Para minimizar este problema, es imprescindible la colaboración internacional, siendo la última y más importante operación PANGEA VIII, en junio del 2015, implicando a 115 países. En enero del 2016 entró en vigor la Convención Medicrime, tratado internacional sobre la falsificación de productos médicos y delitos similares. Por otro lado, también es necesario concienciar a la ciudadanía y dotarla de mecanismos para identificar el riesgo potencial. Los productos adquiridos fuera de los canales legales de distribución no aseguran el cumplimiento de las normas de correcta fabricación, distribución, ni posterior conservación y carecen de la información adecuada (AU)

The objective of this article was to describe and analyze the situation of illicit products in Spain, both medicines and dietary supplements, notifying main actions taken in recent months and their worldwide contextualization. Also serve as a warning about the magnitude of the problem and the importance of the role of the community pharmacist. Searches of information were looked at a national and international level. A descriptive analysis of the Information Notes published by the Spanish Agency of Medicines and Medical Devices (AEMPS, Illegal Drugs, Human Use, 2015) was also conducted. Illicit sale products constitute a major problem for public health that has not stopped increasing. Specifically, in Spain, 20 Notes were published in 2015. These included the prohibition and withdrawal of a total of 35 products. Marketed as dietary supplement, they contained an active ingredient enough to be legally considered as a medicine. 86% were aimed at treating erectile dysfunction. It is essential international collaboration to minimize this issue. The last and most important operation was PANGEA VIII in June 2015, which involved 115 countries. In January 2016, the «Medicrime Convention» entered into force, an international agreement on counterfeiting of medical products and similar crimes. In addition, it is necessary to raise awareness and provide the citizens with mechanisms to identify potential risks inherent to the illicit sale products. Products purchased outside the permitted distribution channels do not ensure compliance with good manufacturing practice, distribution or subsequent storage, and they lack of adequate information (AU)

[Inappropriate medication use among Chilean older people]. / Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010.

BACKGROUND: Inappropriate medication use in older people is an important source of adverse events and complications. AIM: To determine the frequency of inappropriate medication use in the general population. MATERIAL AND METHODS: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. RESULTS: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. CONCLUSIONS: Inappropriate medication use is common among Chilean older people and should be discouraged.

Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010 / Inappropriate medication use among Chilean older people

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and Methods: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.