Applicability of explicit potentially inappropriate medication lists to the Australian context: A systematic review

2022 ◽  
Author(s):  
Georgie Lee ◽  
Joy‐Francesca Lim ◽  
Amy T. Page ◽  
Christopher Etherton‐Beer ◽  
Rhonda Clifford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Inappropriate Medication ◽  
Potentially Inappropriate Medication ◽  
Australian Context

Systematic Review and Meta-Analysis on the Associations of Polypharmacy and Potentially Inappropriate Medication With Adverse Outcomes in Older Cancer Patients

2020 ◽  
Author(s):  
Li-Ju Chen ◽  
Kira Trares ◽  
Dana Clarissa Laetsch ◽  
Thi Ngoc Mai Nguyen ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Inappropriate Medication ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medication ◽  
Significance Level ◽  
All Cause Mortality ◽  
Older Cancer Patients

Abstract Background Both polypharmacy and potentially inappropriate medication (PIM) intake are highly prevailing in older cancer patients. However, only studies on the association of polypharmacy and postoperative complications have been meta-analyzed previously. Methods A systematic review and a meta-analysis of prospective/retrospective observational studies reporting associations of polypharmacy or PIM with at least one out of five predefined adverse health outcomes in a population of older cancer patients (≥60 years) were carried out. PubMed and Web of Science were used to search for relevant studies published between January 1991 and March 2020. Data were pooled by adopting a random-effects model. Results Overall, 42 publications were included in the systematic review. Meta-analyses could be performed on 39 studies about polypharmacy and 13 studies about PIM. Polypharmacy was found to be statistically significantly associated with all-cause mortality (risk ratio [95% confidence interval]: 1.37 [1.25–1.50]), hospitalization (1.53 [1.37–1.71]), treatment-related toxicity (1.22 [1.01–1.47]), and postoperative complications (1.73 [1.36–2.20]). The association of polypharmacy with prolongation of hospitalization was not statistically significant at the p < .05 significance level (1.62 [0.98–2.66]). With respect to PIM, a statistically significant association with all-cause mortality (1.43 [1.08–1.88]) was observed but not with other adverse outcomes. Conclusions Polypharmacy was found to be associated with several adverse outcomes and PIM use with all-cause mortality in older cancer patients. However, these results should be interpreted with caution because about three-quarters of the studies identified did not adjust for comorbidity and are prone to confounding by indication.

Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria

2018 ◽  
Vol 74 (6) ◽  
pp. 679-700 ◽  
Author(s):  
Fabiane Raquel Motter ◽  
Janaína Soder Fritzen ◽  
Sarah Nicole Hilmer ◽  
Érika Vieira Paniz ◽  
Vera Maria Vieira Paniz
Keyword(s):  
Systematic Review ◽  
Inappropriate Medication ◽  
The Elderly ◽  
Potentially Inappropriate Medication ◽  
Explicit Criteria

scholarly journals Prevalence of Polypharmacy, Hyperpolypharmacy and Potentially Inappropriate Medication Use in Older Adults in India: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Akshaya S. Bhagavathula ◽  
Kota Vidyasagar ◽  
Manik Chhabra ◽  
Muhammed Rashid ◽  
Rishabh Sharma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
South India ◽  
Meta Analysis ◽  
Inappropriate Medication ◽  
Potentially Inappropriate Medication ◽  
Cross Sectional ◽  
North East India ◽  
North East ◽  
Pooled Prevalence

Background: Older people often receive multiple medications for chronic conditions, which often result in polypharmacy (concomitant use of 5‒9 medicines) and hyperpolypharmacy (concomitant use of ≥10 medicines). A limited number of studies have been performed to evaluate the prevalence of polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) use in older people of developing countries. The present study aimed to investigate regional variations in the prevalence of polypharmacy, hyperpolypharmacy, and PIM use in older people (60 + years) in India.Methods: Studies were identified using Medline/PubMed, Scopus, and Google Scholar databases published from inception (2002) to September 31, 2020. Out of the total 1890 articles, 27 were included in the study.Results: Overall, the pooled prevalence of polypharmacy was 49% (95% confidence interval: 42–56; p < 0.01), hyperpolypharmacy was 31% (21–40; p < 0.01), and PIM use was 28% (24–32; p < 0.01) among older Indian adults. Polypharmacy was more prevalent in North-east India (65%, 50–79), whereas hyperpolypharmacy was prevalent in south India (33%, 17–48). Region-wize estimates for the pooled prevalence of PIM use in India were as follows: 23% (21–25) in East, 33% in West (24–42), 17.8% in North (11–23), and 32% (26–38) in South India. The prevalence of PIM use in adults aged ≥70°years was 35% (28–42), in those taking more medications (≥5.5/day) was 27% (22–31), and in adults using a high number of PIMs (≥3) was 29% (22–36). Subgroup analysis showed that cross-sectional studies had a higher pooled prevalence of polypharmacy 55% (44–65) than cohorts 45% (37–54). Hyperpolypharmacy in inpatient care settings was 37% (26–47), whereas PIM use was higher in private hospitals 31% (24–38) than government hospitals 25% (19–31).Conclusion: Polypharmacy and hyperpolypharmacy are widely prevalent in India. About 28% of older Indian adults are affected by PIM use. Thus, appropriate steps are needed to promote rational geriatric prescribing in India.Systematic Review Registration: https://clinicaltrials.gov, identifier [CRD42019141037].

scholarly journals Comparison of adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing potentially inappropriate medication use in Hong Kong older patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu ZHANG ◽  
Eliza L. Y. WONG ◽  
Samuel Y. S. WONG ◽  
Patsy Y. K. CHAU ◽  
Benjamin H. K. YIP ◽  
...  
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Older Patients ◽  
Inappropriate Medication ◽  
Female Gender ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Beers Criteria ◽  
Medical Conditions ◽  
Cross Sectional

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

scholarly journals Development of an explicit tool assessing potentially inappropriate medication use in Hong Kong elder patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu Zhang ◽  
Eliza LY Wong ◽  
Eng-kiong Yeoh ◽  
Bosco HM Ma
Keyword(s):  
Hong Kong ◽  
Inappropriate Medication ◽  
Delphi Process ◽  
Potentially Inappropriate Medication ◽  
Medical Conditions ◽  
Modified Delphi ◽  
Adverse Health Outcomes ◽  
Elder Patients ◽  
Prescribing Quality ◽  
Prescribing Practice

Abstract Background Potentially inappropriate medication (PIM) use has adverse effects on health, particularly in elder patients. Various country-specific explicit criteria have been developed to measure the appropriateness of prescribing worldwide. However, it is difficult to apply the criteria developed from other regions to measure and guide the local prescribing practice in Hong Kong. This study aims to develop a Hong Kong-specific PIM assessing tool from previously published criteria and validate this tool using the modified Delphi method. Methods A disease-oriented Hong Kong-specific preliminary PIM list was developed based on nine sets of reference criteria selected from a literature review. Any medication or medication class appeared in at least two sets of the reference criteria as well as its related medical conditions were selected as PIM candidates. After examining the availability of PIM candidates by the Hong Kong Hospital Authority drug formulary, the Hong Kong-specific preliminary PIM list was validated by a two-round of modified Delphi process. Eight experts from different specialties were invited to rate the degree of inappropriateness of each PIM candidate using a five-point Likert scale. The experts were also encouraged to propose therapeutic alternatives and new PIM candidates not covered by the preliminary PIM list. The PIM candidates that the expert panel didn’t reach consensus on were excluded from the final Hong Kong-specific PIM list. Results After two rounds of the Delphi process, eight PIM candidates remained questionable and thus were excluded from the PIM list. The final Hong Kong-specific PIM list included a total of 164 statements applicable to older adults aged 65 years or above, among which 77 were under PIMs independent of diagnoses, and 87 were under PIMs considering specific medical conditions. Conclusions The Hong Kong-specific PIM list can be used as a quality measure and an educational tool to improve the local prescribing quality. Further studies should validate its association with adverse health outcomes in clinical and research settings.

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