Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed-methods study.

Atiya K Mohammad, Jacqueline G Hugtenburg, Joost W Vanhommerig, Patricia M L A van den Bemt, Petra Denig, Fatma Karapinar-Carkıt
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Abstract

Background: A prescribing cascade occurs when medication causes an adverse drug reaction (ADR) that leads to the prescription of additional medication. Prescribing cascades can cause excess medication burden, which is of particular concern in older adults. This study aims to identify and quantify potentially problematic prescribing cascades relevant for clinical practice.

Methods: A mixed-methods study was conducted. First, prescribing cascades were identified through literature search. An expert panel (n = 16) of pharmacists and physicians assessed whether these prescribing cascades were potentially problematic. Next, a cohort study quantified potentially problematic prescribing cascades in adults using Dutch community pharmacy data for the period 2015-2020. Additionally, the influence of multiple medications potentially causing the same ADR was evaluated. Prescription sequence symmetry analysis was used to calculate adjusted sequence ratios (aSRs), adjusting for temporal prescribing trends. An aSR >1.0 indicates the occurrence of a prescribing cascade. In a subgroup analysis, aSRs were calculated for older adults.

Results: Seventy-six prescribing cascades were identified in literature and three were provided by experts. Of these, 66 (83.5%) were considered potentially problematic. A significant positive aSR for the medication sequence was found for 41 (62.1%) of these prescribing cascades. The highest aSR was found for amiodarone potentially causing hypothyroidism treated with thyroid hormones (4.63 [95% confidence interval 4.40-4.85]), based on 565 incident users. The biggest population (n = 34,645) was found for angiotensin converting enzyme-inhibitors potentially causing urinary tract infections treated with antibiotics. Regarding four potential ADRs, the aSRs were higher for people using multiple medications that cause the same ADR as compared to people using only one of those medications. Among older adults the aSRs remained significant for 37 prescribing cascades.

Conclusion: An overview was generated of potentially problematic prescribing cascades relevant for clinical practice. These results can support healthcare providers to intervene and reduce medication burden for older adults.

识别和量化临床实践中可能存在问题的处方级联:混合方法研究。
背景:当药物引起药物不良反应 (ADR) 并导致开具额外的药物处方时,就会出现处方连环效应。处方连环效应会造成过重的用药负担,老年人尤其需要关注。本研究旨在识别和量化与临床实践相关的潜在问题处方级联:方法:采用混合方法进行研究。首先,通过文献检索确定处方级联。由药剂师和医生组成的专家小组(n = 16)对这些处方级联是否存在潜在问题进行了评估。接下来,一项队列研究利用 2015-2020 年期间荷兰社区药房的数据,量化了成人中可能存在问题的处方级联。此外,还评估了多种药物可能导致相同 ADR 的影响。处方序列对称性分析用于计算调整序列比(aSRs),并对时间处方趋势进行调整。aSR >1.0表示出现了处方连环效应。在一项分组分析中,计算了老年人的 aSRs:结果:在文献中发现了 76 个处方级联,专家提供了 3 个处方级联。其中 66 种(83.5%)被认为可能存在问题。在这些处方级联中,有 41 个(62.1%)的用药顺序的 aSR 值呈显着正值。根据 565 名事件用户的数据,可能导致甲状腺功能减退的胺碘酮与甲状腺激素治疗的 aSR 最高(4.63 [95% 置信区间 4.40-4.85])。使用抗生素治疗血管紧张素转换酶抑制剂可能导致尿路感染的人群最多(34,645 人)。关于四种潜在的不良反应,与只使用其中一种药物的人相比,使用多种药物并导致相同不良反应的人的aSRs更高。在老年人中,37 种处方级联的 aSRs 依然显著:本文概述了与临床实践相关的潜在问题处方级联。这些结果可以帮助医疗服务提供者进行干预,减轻老年人的用药负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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