Measure of inappropriate prescribing predicts risk of adverse drug events in older adults

2010 ◽  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Inappropriate Prescribing

Challenges in pharmacotherapy for older adults: a framework for pharmacogenomics implementation

2020 ◽  
Vol 21 (9) ◽  
pp. 627-635
Author(s):  
Youssef M Roman ◽  
Dave L Dixon ◽  
Teresa M Salgado ◽  
Elvin T Price ◽  
Kristin M Zimmerman ◽  
...  
Keyword(s):  
Older Adults ◽  
Patient Care ◽  
Healthcare Professionals ◽  
Adverse Drug Events ◽  
Inappropriate Prescribing ◽  
Interdisciplinary Approach ◽  
Provider Education ◽  
Curriculum Redesign ◽  
Optimal Patient Care ◽  
Poor Treatment

Older adults are at high risk for inappropriate prescribing, developing polypharmacy, adverse drug events and poor treatment outcomes due to multimorbidity and geriatric syndromes. Pharmacogenomics could allow healthcare professionals to provide optimal patient care while minimizing the risk of adverse drug events and simplifying complex medication regimens. The implementation of pharmacogenomics in geriatrics medicine requires a broad multilayered bottom-up approach. These include curriculum redesign, rethinking experiential education and patient and provider education. There are barriers associated with adopting pharmacogenomics into clinical practice. These barriers may include economic factors, workflow and informatics support. However, addressing these barriers primarily requires creating a culture of innovative practices in patient care, ongoing interprofessional continuing education and an interdisciplinary approach for patient care.

Inappropriate Prescribing Predicts Adverse Drug Events in Older Adults

2010 ◽  
Vol 44 (6) ◽  
pp. 957-963 ◽  
Author(s):  
B. C. Lund ◽  
R. M. Carnahan ◽  
J. A. Egge ◽  
E. A. Chrischilles ◽  
P. J. Kaboli
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Inappropriate Prescribing

scholarly journals Rationale and design of the Novel Uses of adaptive Designs to Guide provider Engagement in Electronic Health Records (NUDGE-EHR) pragmatic adaptive randomized trial: a trial protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Julie C. Lauffenburger ◽  
Thomas Isaac ◽  
Lorenzo Trippa ◽  
Punam Keller ◽  
Ted Robertson ◽  
...  
Keyword(s):  
Older Adults ◽  
Usual Care ◽  
Behavioral Science ◽  
Inappropriate Prescribing ◽  
The Novel ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health ◽  
Stage 1

Abstract Background The prescribing of high-risk medications to older adults remains extremely common and results in potentially avoidable health consequences. Efforts to reduce prescribing have had limited success, in part because they have been sub-optimally timed, poorly designed, or not provided actionable information. Electronic health record (EHR)-based tools are commonly used but have had limited application in facilitating deprescribing in older adults. The objective is to determine whether designing EHR tools using behavioral science principles reduces inappropriate prescribing and clinical outcomes in older adults. Methods The Novel Uses of Designs to Guide provider Engagement in Electronic Health Records (NUDGE-EHR) project uses a two-stage, 16-arm adaptive randomized pragmatic trial with a “pick-the-winner” design to identify the most effective of many potential EHR tools among primary care providers and their patients ≥ 65 years chronically using benzodiazepines, sedative hypnotic (“Z-drugs”), or anticholinergics in a large integrated delivery system. In stage 1, we randomized providers and their patients to usual care (n = 81 providers) or one of 15 EHR tools (n = 8 providers per arm) designed using behavioral principles including salience, choice architecture, or defaulting. After 6 months of follow-up, we will rank order the arms based upon their impact on the trial’s primary outcome (for both stages): reduction in inappropriate prescribing (via discontinuation or tapering). In stage 2, we will randomize (a) stage 1 usual care providers in a 1:1 ratio to one of the up to 5 most promising stage 1 interventions or continue usual care and (b) stage 1 providers in the unselected arms in a 1:1 ratio to one of the 5 most promising interventions or usual care. Secondary and tertiary outcomes include quantities of medication prescribed and utilized and clinically significant adverse outcomes. Discussion Stage 1 launched in October 2020. We plan to complete stage 2 follow-up in December 2021. These results will advance understanding about how behavioral science can optimize EHR decision support to improve prescribing and health outcomes. Adaptive trials have rarely been used in implementation science, so these findings also provide insight into how trials in this field could be more efficiently conducted. Trial registration Clinicaltrials.gov (NCT04284553, registered: February 26, 2020)

Risk factors for opioid‐related adverse drug events among older adults after hospital discharge

2021 ◽  
Author(s):  
Shoshana J. Herzig ◽  
Timothy S. Anderson ◽  
Yoojin Jung ◽  
Long H. Ngo ◽  
Ellen P. McCarthy
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Hospital Discharge ◽  
Adverse Drug Events

scholarly journals A TRIAL TO IMPROVE MEDICATION SAFETY IN OLDER ADULTS: RECRUITMENT CHALLENGES HAVE GENERALIZABILITY IMPLICATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S711-S711
Author(s):  
Kathryn Anzuoni ◽  
Terry Field ◽  
Kathleen Mazor ◽  
Yanhua Zhou ◽  
Timothy Konola ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Odds Ratio ◽  
Adverse Drug Events ◽  
Functional Decline ◽  
Post Discharge ◽  
Recruitment Challenges ◽  
Hospital To Home ◽  
The Impact ◽  
Visiting Nurse

Abstract For older adults, the transition from hospital to home is a high-risk period for adverse drug events, functional decline, and hospital readmission. Randomized trials of interventions to improve this transition must recruit potential subjects immediately after hospital discharge, when people are recovering and tired. Within a randomized trial assessing the impact of a pharmacist home visit to provide medication assistance immediately post-discharge, we determined whether individuals who enrolled were comparable to those who were invited but did not enroll, and described reasons for not enrolling. Individuals ≥50 years of age discharged from the hospital and prescribed a high-risk medication were eligible. We attempted to recruit individuals by phone within 3 days of discharge, and recorded reasons for not enrolling. Of 3,606 eligible individuals reached, 3,147 (87%) declined, 361 (10%) were enrolled, and 98 (3%) were initially recruited but did not complete a consent form. Individuals ≥80 years of age (odds ratio 0.45, CI 0.25, 0.78) and those with an assigned visiting nurse (odds ratio 0.64, CI 0.48, 0.85) were least likely to enroll. Among those who provided a reason for declining (2,473) the most common reason given was the belief they did not need medication assistance (22%). An additional 332 (13%) declined because they were receiving visiting nurse services. Recruiting older adults recently discharged from the hospital is difficult and may under-enroll the oldest individuals, limiting the ability to generalize findings across older patient populations. Researchers planning RCTs among newly discharged older adults may need creative approaches to overcome resistance.

scholarly journals Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting – a scoping review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sabrina Lau ◽  
Penny Lun ◽  
Wendy Ang ◽  
Keng Teng Tan ◽  
Yew Yoong Ding
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Theoretical Domains Framework ◽  
Ambulatory Setting ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Prescribing Behaviour ◽  
The Impact

Abstract Background As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results A total of 5731 articles were screened. Twenty-nine studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

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