scholarly journals Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

10.2196/14130 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e14130 ◽  
Author(s):  
Eloisa Rogero-Blanco ◽  
Juan A Lopez-Rodriguez ◽  
Teresa Sanz-Cuesta ◽  
Mercedes Aza-Pascual-Salcedo ◽  
M Jose Bujalance-Zafra ◽  
...  
Keyword(s):  
Primary Care ◽  
Screening Tool ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Beers Criteria ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stopp Criteria ◽  
Electronic Clinical Decision Support

Background Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. Objective This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person’s Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. Results PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. Conclusions There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.

scholarly journals Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Eloisa Rogero-Blanco ◽  
Juan A Lopez-Rodriguez ◽  
Teresa Sanz-Cuesta ◽  
Mercedes Aza-Pascual-Salcedo ◽  
M Jose Bujalance-Zafra ◽  
...  
Keyword(s):  
Primary Care ◽  
Screening Tool ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Beers Criteria ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stopp Criteria ◽  
Electronic Clinical Decision Support

BACKGROUND Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. OBJECTIVE This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person’s Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). METHODS This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. RESULTS PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; <i>P</i>=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; <i>P</i>&lt;.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; <i>P</i>=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; <i>P</i>&lt;.001) were related to a higher frequency of PIP. CONCLUSIONS There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.

scholarly journals Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria

Pharmacia ◽  
2021 ◽  
Vol 68 (4) ◽  
pp. 789-795
Author(s):  
Heba Khader ◽  
Luai Z. Hasoun ◽  
Ahmad Alsayed ◽  
Mahmoud Abu-Samak
Keyword(s):  
Geriatric Patients ◽  
Adverse Drug Events ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Sample Population ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Medications

The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use. This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs. The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.

Association between subjective well‐being and presence of primary care dentists in community‐dwelling elderly people: A cross‐sectional study

Gerodontology ◽  
2019 ◽  
Vol 36 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Shinsuke Mizutani ◽  
Hisae Aoki ◽  
Satoru Haresaku ◽  
Kaoru Shimada ◽  
Michio Ueno ◽  
...  
Keyword(s):  
Primary Care ◽  
Elderly People ◽  
Well Being ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Subjective Well Being ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Frailty prevalence and screening for frailty among elderly community-dwelling, first-time seekers of formal assistance in Norway.

2020 ◽  
Author(s):  
Ingerid Laukli ◽  
Heidi Kristin Ormstad ◽  
Leiv Sandvik
Keyword(s):  
Predictive Value ◽  
Screening Tool ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Test Accuracy ◽  
Sectional Study ◽  
Frailty Phenotype ◽  
Cross Sectional ◽  
Norwegian Version ◽  
First Time

Abstract Background Detection of frailty may be essential to prevent or delay disability in home-dwelling elderly who seek formal assistance for the first time. The prevalence of frailty among elderly, first-time seekers of formal assistance in Norway, is unknown. Simple tests like Short Physical Performance Battery (SPPB) or assessment of gait speed (GS) may identify frailty. The aim of this study was to investigate the prevalence of frailty in this population, and to investigate the test accuracy of GS and SPPB to detect frailty.Methods We conducted a cross-sectional study of 116 home dwelling elderly > 65 years seeking formal assistance for the first time. Frailty was assessed by an adapted version of Fried Frailty Phenotype (FFP), GS was measured over 4 meters, and physical function was assessed by the Norwegian version of SPPB. The test accuracy for frailty (FFP) of GS < 0.8 m/s, SPPB < 10 and SPPB < 10 were assessed.Results 62.1%, 29.3% and 8.6% of the participants were frail, prefrail and non-frail, respectively. No association was found between age and degree of frailty. Both GS and SPPB-scores were significantly lower in the frail group than in the prefrail group, as well as significantly lower in the prefrail group than in the non-frail group (both p < 0.001). Numbers of criteria in FFP were significantly and inversely associated with GS (p < 0.001). GS ≤ 0.8 m/s showed the best test accuracy for frailty, with a sensitivity of 0.99, specificity of 0.37, positive predictive value of 0.76 and negative predictive value of 0.93.Conclusions The present study assessed that over 90% of elderly seeking formal assistance for the first time were either frail or prefrail. This indicates that screening for frailty should be considered for this population in order to enable action to prevent or delay disability. Further, our results indicate that GS with a cut-off at ≤ 0.8 m/s may represent a feasible and easy-to-use screening tool for detecting frailty in this population.

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