American Journal Geriatric Pharmacotherapy最新文献

{"title":"Trajectory Classes of Depression in a Randomized Depression Trial of Heart Failure Patients: A Reanalysis of the SADHART-CHF Trial","authors":"Maragatha N. Kuchibhatla PhD ,&nbsp;Gerda G. Fillenbaum PhD","doi":"10.1016/j.amjopharm.2011.09.001","DOIUrl":"10.1016/j.amjopharm.2011.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>The objective of this article was to determine whether, in drug intervention trials, growth mixture modeling (GMM) is able to identify drug-responsive trajectory classes that are not evident in traditional growth modeling approaches.</p></div><div><h3>Methods</h3><p>We reanalyzed acute phase (biweekly data up to 7 occasions) and longitudinal (12 months) data on the 469 patients in the SADHART-CHF study of the safety and efficacy of sertraline for depression in patients with heart failure. GMM was used to identify the trajectory classes present in the treatment and placebo groups, based on Hamilton Depression Rating Scale scores.</p></div><div><h3>Results</h3><p>Two distinct trajectory classes were identified in the treatment group: (1) chronic depressives (12%), who remained depressed through the treatment phase; and (2) responders (88%), who had scores indicating nondepression at the conclusion of the acute phase. At baseline, chronic depressives were distinguished by higher Hamilton Depression Rating Scale scores, the presence of implantable cardioverter defibrillators, and a history of anxiety. During follow-up, they were more likely to have unstable angina. Only responders remitted (70%). Three distinct trajectories were identified in the placebo group: (1) moderating depressives (19%), (2) temporary improvers (13%), and (3) responders (68%). At baseline, the classes differed in mean Hamilton Depression Rating Scale scores, responders' scores falling between the other 2 classes, and the proportion with renal disease. Only remission differed at follow-up: responders (76%), moderating depressives (21%), and temporary improvers (3%). Where the traditional analytic approach found improvement from moderate to mild depression but no significant treatment effect, GMM found response in 20% more people in the treatment group than in the placebo group.</p></div><div><h3>Conclusions</h3><p>Unlike conventionally used, standard analytic approaches, which focus on intervention impact at study end or change from baseline to study end, GMM enables maximum use of repeated data to identify unique trajectories of latent classes that are responsive to the intervention. <span>ClinicalTrials.gov</span><svg><path></path></svg> identifier: <span>NCT00078286</span><svg><path></path></svg>.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 483-494"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30238364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially Harmful Drug–Drug Interactions in the Elderly: A Review","authors":"Lisa E. Hines PharmD ,&nbsp;John E. Murphy PharmD","doi":"10.1016/j.amjopharm.2011.10.004","DOIUrl":"10.1016/j.amjopharm.2011.10.004","url":null,"abstract":"<div><h3>Background</h3><p>Elderly patients are vulnerable to drug interactions because of age-related physiologic changes, an increased risk for disease associated with aging, and the consequent increase in medication use.</p></div><div><h3>Objective</h3><p>The purpose of this narrative review was to describe findings from rigorously designed observational cohort and case-control studies that have assessed specific drug interactions in elderly patients.</p></div><div><h3>Methods</h3><p>The PubMed and International Pharmaceutical Abstracts databases were searched for studies published in English over the past 10 years (December 2000–December 2010) using relevant Medical Subject Headings terms (<em>aged; aged, 80 and over;</em> and <em>drug interactions</em>) and search terms (<em>drug interaction</em> and <em>elderly</em>). Search strategies were saved and repeated through September 2011 to ensure that the most recent relevant published articles were identified. Additional articles were found using a search of review articles and reference lists of the identified studies. Studies were included if they were observational cohort or case-control studies that reported specific adverse drug interactions, included patients aged ≥65 years, and evaluated clinically meaningful end points. Studies were excluded if they used less rigorous observational designs, assessed pharmacokinetic/pharmacodynamic properties, evaluated drug-nutrient or drug-disease interactions or interactions of drug combinations used for therapeutic benefit (eg, dual antiplatelet therapy), or had inconclusive evidence.</p></div><div><h3>Results</h3><p>Seventeen studies met the inclusion criteria. Sixteen studies reported an elevated risk for hospitalization in older adults associated with adverse drug interactions. The drug interactions included: angiotensin-converting enzyme (ACE) inhibitors and potassium-sparing diuretics, ACE inhibitors or angiotensin receptor blockers and sulfamethoxazole/trimethoprim, benzodiazepines or zolpidem and interacting medications, calcium channel blockers and macrolide antibiotics, digoxin and macrolide antibiotics, lithium and loop diuretics or ACE inhibitors, phenytoin and sulfamethoxazole/trimethoprim, sulfonylureas and antimicrobial agents, theophylline and ciprofloxacin, and warfarin and antimicrobial agents or nonsteroidal anti-inflammatory drugs. One study reported the risk for breast cancer-related death as a function of paroxetine exposure among women treated with tamoxifen.</p></div><div><h3>Conclusions</h3><p>Several population-based studies have reported significant harm associated drug interactions in elderly patients. Increased awareness and interventions aimed at reducing exposure and minimizing the risks associated with potentially harmful drug combinations are needed.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 364-377"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30249032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Note of Thanks","authors":"","doi":"10.1016/j.amjopharm.2011.11.002","DOIUrl":"https://doi.org/10.1016/j.amjopharm.2011.11.002","url":null,"abstract":"","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Page A4"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.11.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137393586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Streptococcus pneumoniae Vaccination in Older Adults","authors":"Elizabeth Rightmier PharmD ,&nbsp;Vanessa Stevens PhD ,&nbsp;Jack Brown PharmD, MS","doi":"10.1016/j.amjopharm.2011.09.008","DOIUrl":"10.1016/j.amjopharm.2011.09.008","url":null,"abstract":"<div><h3>Background</h3><p><em>Streptococcus pneumoniae</em> infections are a major cause of morbidity and mortality in older adults. Vaccination in older adults is intended to prevent <em>S pneumoniae</em> infections, yet little information is available regarding its efficacy in this patient population.</p></div><div><h3>Objective</h3><p>The aim of this article was to review the current literature to determine the efficacy and tolerability of <em>S pneumoniae</em> vaccination in older adults.</p></div><div><h3>Methods</h3><p>PubMed (1950–present) and EMBASE (1974–present) were searched using the search terms <em>Streptococcus pneumoniae immunization, pneumococcus immunization, pneumococcus vaccine</em>, and <em>aged</em>. Additional articles were identified from the reference lists of included studies. Studies were included if they reported information in older (55–&lt;65 years) and elderly (≥65 years) adults and were related to at least 1 of the following topics: epidemiology of <em>S pneumoniae</em>, estimates of vaccine coverage, recommendations for vaccination, tolerability, and efficacy and/or effectiveness of vaccination against <em>S pneumoniae.</em></p></div><div><h3>Results</h3><p>Six randomized controlled trials and 18 observational studies that evaluated the efficacy of pneumococcal vaccination in older and elderly adults were reviewed. Findings from evaluations of efficacy, as measured by clinical outcomes and immunogenicity, in older adults have been conflicting, with some subsets of prospective, well-controlled studies finding little benefit, whereas findings from several retrospective studies have suggested significant benefit. This discord may have been a result of the limited power of the prospective subanalyses to detect significant differences.</p></div><div><h3>Conclusions</h3><p>In light of the potential clinical benefit and few reports of serious adverse events, vaccination in older adults is likely warranted. Prospective, well-controlled studies are needed to better quantitatively evaluate the benefit of pneumococcal vaccine in older adults.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 392-404"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40123908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Utilization Patterns and Cardiovascular Outcomes in Elderly Patients Newly Initiated on Atorvastatin or Simvastatin","authors":"Jason P. Swindle PhD ,&nbsp;Jesse Potash PhD ,&nbsp;Mahesh Kulakodlu MS ,&nbsp;Andreas Kuznik PhD ,&nbsp;Ami Buikema MPH","doi":"10.1016/j.amjopharm.2011.09.004","DOIUrl":"10.1016/j.amjopharm.2011.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Hydroxymethylglutaryl coenzyme-A reductase inhibitors simvastatin and atorvastatin are effective at lowering LDL-C levels and reducing the risk of cardiovascular (CV) events.</p></div><div><h3>Objective</h3><p>The objective of this study was to examine differences in drug utilization and CV event risk among elderly patients newly initiated on simvastatin versus atorvastatin.</p></div><div><h3>Methods</h3><p>This was a retrospective analysis using pharmacy and medical claims from a US health plan database. Enrollees aged ≥65 years, newly initiated on simvastatin or atorvastatin (index drugs) from July 1, 2006 to November 30, 2008 were identified for study inclusion. Patients were excluded if they had any prescriptions for clopidogrel, nitrates, or other dyslipidemia medication, or any CV events before index drug initiation. Adherence was calculated by proportion of days covered with index medication. CV events (myocardial infarction, ischemic heart disease, cerebrovascular disease, peripheral vascular disease, aortic aneurysm, revascularization, or heart failure) were identified from medical claims.</p></div><div><h3>Results</h3><p>There were 11,470 atorvastatin initiators and 20,132 simvastatin initiators identified. Mean age of these patients was 72 years; 40% were male; nearly half had hypertension; and more than a quarter had diabetes. The majority of statin therapy (77%) was prescribed by primary care physicians. Forty-nine percent of atorvastatin patients were initiated on a 10 mg-dose and 61% of simvastatin patients on 5-, 10-, or 20-mg doses. A larger percentage of patients in the simvastatin cohort were adherent to index therapy than patients in the atorvastatin cohort (43% vs 36%, respectively). Multivariate regression adjusting for patient characteristics revealed no significant difference in CV events between patients receiving atorvastatin versus simvastatin.</p></div><div><h3>Conclusions</h3><p>In this study of elderly statin patients without recent evidence of CV events, the majority of patients started on low-dose therapy and did not achieve sufficient adherence. After controlling for patient and clinical characteristics, no statistically significant difference in risk of CV event was observed based on initiation with atorvastatin versus simvastatin.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 471-482"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30226099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Predictors of Anticholinergic Agents in Elderly Outpatients with Dementia","authors":"Rituparna Bhattacharya MS ,&nbsp;Satabdi Chatterjee MS ,&nbsp;Ryan M. Carnahan PharmD, MS ,&nbsp;Rajender R. Aparasu PhD, MPharm","doi":"10.1016/j.amjopharm.2011.10.001","DOIUrl":"10.1016/j.amjopharm.2011.10.001","url":null,"abstract":"<div><h3>Background</h3><p>Anticholinergic medications, although frequently used in elderly populations, are associated with cognitive impairment and constitute significant concern for patients with dementia.</p></div><div><h3>Objective</h3><p>The purpose of our study was to examine patterns and predictors of prescribing anticholinergic agents for elderly outpatients with dementia.</p></div><div><h3>Methods</h3><p>We combined data from the 2006–2007 National Ambulatory Medical Care Survey and the outpatient department component of National Hospital Ambulatory Medical Care Survey to analyze patient visits by elderly persons (aged ≥65 years) with dementia. Anticholinergic drugs were identified using the Anticholinergic Drug Scale, which classifies anticholinergic drugs into four levels (0–3) in increasing order of anticholinergic activity. Descriptive analysis using sampling weights was used to evaluate patterns of anticholinergic drug prescription, especially prescribing of medications with clinically significant anticholinergic activity (ie, levels 2 or 3). Multiple logistic regression was used in the conceptual framework of the Andersen Behavioral Model to examine the predisposing, enabling, and need factors associated with prescribing of medications with clinically significant anticholinergic activity.</p></div><div><h3>Results</h3><p>According to the national surveys there were a total of 6.8 million (95% CI, 5.27–8.44 million; 0.32%) ambulatory care visits for dementia. Approximately 43% (42.86%; 95% CI, 35.24–50.48) of these visits involved prescribing at least one anticholinergic drug; and 10.07% of visits involved prescribing levels 2 or 3 anticholinergic medications. The predisposing factor, age (75–84 years; odds ratio [OR] = 0.25; 95% CI, 0.07–0.87), and the need factors, acetylcholinesterase inhibitor use (OR = 0.25; 95% CI, 0.07–0.86) and comorbid mood disorders (OR = 0.12; 95% CI, 0.02–0.73), were associated with decreased likelihood of prescribing medications with clinically significant anticholinergic activity. The need factor total number of medications prescribed (OR = 1.45, 95% CI, 1.20–1.75) increased the likelihood of these prescriptions being administered.</p></div><div><h3>Conclusions</h3><p>One in 10 outpatient visits by elderly persons with dementia involved prescribing medications with clinically significant anticholinergic activity. Given their adverse cognitive effects, there is a strong need to optimize anticholinergic drug prescribing in vulnerable elderly outpatients with dementia.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 434-441"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30235795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Errors During Patient Transitions into Nursing Homes: Characteristics and Association With Patient Harm","authors":"Rishi Desai MS ,&nbsp;Charlotte E. Williams MPH ,&nbsp;Sandra B. Greene DrPH ,&nbsp;Stephanie Pierson MSHI ,&nbsp;Richard A. Hansen PhD","doi":"10.1016/j.amjopharm.2011.10.005","DOIUrl":"10.1016/j.amjopharm.2011.10.005","url":null,"abstract":"<div><h3>Background</h3><p>Patients transitioning to a nursing home from their home or other facility are at high risk for medication errors.</p></div><div><h3>Objective</h3><p>Our aim was to describe characteristics of medication errors occurring during transitions to nursing homes, to compare characteristics of transition errors with errors not involving a transition, and to evaluate the impact of these errors on patient harm.</p></div><div><h3>Methods</h3><p>This was a cross-sectional analysis of individual medication error incidents reported by North Carolina nursing homes to the Medication Error Quality Initiative during fiscal years 2007 through 2009. Bivariate associations between errors in transition with patient factors, error-related factors, reported causes of errors, and impact on patients were tested using a χ² test. Multivariate logistic regression explored whether medication errors during transitions were more harmful than errors not occurring during transitions. Patient-related factors included in the model were age, sex, and cognitive ability. Error-related factors were primary type of error, process phase when error began, primary personnel involved, and an indicator for repeat error.</p></div><div><h3>Results</h3><p>A total of 27,759 individual medication error incidents were reported over a 3-year period in North Carolina nursing homes. Of these errors, 2919 incidents (11%) involved a patient transitioning to a nursing home. Errors involved in transitions were found to have higher odds of patient harm compared with errors not involved in transitions (odds ratio = 1.85; 95% CI, 1.30–2.63). Staff communication, order transcription, medication availability, pharmacy issues, and name confusion were particularly important contributors to medication errors during transitions (<em>P</em> &lt; 0.05 for comparison with nontransition errors).</p></div><div><h3>Conclusions</h3><p>Transitions across care settings introduce risk for patient harm, and medication errors are an important area for improvement during transitions.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 6","pages":"Pages 413-422"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30249696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient Impact of Automated Glomerular Filtration Rate Reporting on Drug Dosing for Hospitalized Older Adults With Concealed Renal Insufficiency","authors":"Jessica L. Kalender-Rich MD ,&nbsp;Jonathan D. Mahnken PhD ,&nbsp;James B. Wetmore MD ,&nbsp;Sally K. Rigler MD, MPH","doi":"10.1016/j.amjopharm.2011.08.003","DOIUrl":"10.1016/j.amjopharm.2011.08.003","url":null,"abstract":"<div><h3>Background</h3><p>Older adults with concealed renal insufficiency are at risk of medication dosing errors. It is not known whether automated estimated glomerular filtration rate (eGFR) reporting is associated with reduced dosing errors in this population.</p></div><div><h3>Objective</h3><p>The goal of the present study was to examine the impact on prescribing patterns in older adults with concealed renal insufficiency for a variety of renally cleared medications before and after the addition of automated eGFR reporting.</p></div><div><h3>Methods</h3><p>We performed a retrospective chart review at a single tertiary academic medical center among hospitalized patients aged ≥70 years with concealed renal insufficiency. Data were examined from the months of July, December, and May before and after the hospital initiated automated eGFR reporting, in 2006–2007 and 2008–2009, respectively. Doses of selected renally cleared medications were classified as appropriate or inappropriate on the basis of published recommendations. Regression models were used to identify demographic, clinical, and care factors associated with dosing appropriateness.</p></div><div><h3>Results</h3><p>Before implementation of automated eGFR reporting, we observed 260 persons in whom 42.2% of relevant prescriptions were inappropriately dosed; after implementation, there were 280 subjects in whom 36.6% of relevant prescriptions were inappropriately dosed. The multivariable model suggested an overall trend toward less inappropriate dosing after automated eGFR reporting began, compared with rates before (adjusted odds ratio [AOR] = 0.75 [95% confidence interval: 0.52–1.07], <em>P</em> = 0.11). However, a gradient was observed as the academic year progressed. A marked reduction in the rate of inappropriate medication dosing was seen in July after initiation of eGFR reporting compared with the July before initiation (AOR = 0.28; <em>P</em> &lt; 0.01). This effect was attenuated in December (AOR = 0.45; <em>P</em> = 0.05) and gone by May (AOR = 0.85; <em>P</em> = 0.67).</p></div><div><h3>Conclusion</h3><p>Automated eGFR reporting alone, without any order entry intervention, was associated only transiently with improved dosing appropriateness for these older adults with concealed renal insufficiency.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 5","pages":"Pages 320-327"},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30143857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric Pharmacotherapy Updates","authors":"David R.P. Guay PharmD","doi":"10.1016/j.amjopharm.2011.09.005","DOIUrl":"10.1016/j.amjopharm.2011.09.005","url":null,"abstract":"","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 5","pages":"Pages 354-360"},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.09.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129057435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Reconciliation: Identifying Medication Discrepancies in Acutely Ill Hospitalized Older Adults","authors":"Diane Villanyi BSc Pharm, MD, FRCPC,&nbsp;Mark Fok BSc Pharm, MD,&nbsp;Roger Y.M. Wong BMSc, MD, FRCPC, FACP","doi":"10.1016/j.amjopharm.2011.07.005","DOIUrl":"10.1016/j.amjopharm.2011.07.005","url":null,"abstract":"<div><h3>Background</h3><p>Medication discrepancies may occur during transitions from community to acute care hospitals. The elderly are at risk for such discrepancies due to multiple comorbidities and complex medication regimens. Medication reconciliation involves verifying medication use and identifying and rectifying discrepancies.</p></div><div><h3>Objective</h3><p>The aim of this study was to describe the prevalences and types of medication discrepancies in acutely ill older patients.</p></div><div><h3>Methods</h3><p>Patients who were ≥70 years and were admitted to any of 3 acute care for elders (ACE) units over a period of 2 nonconsecutive months in 2008 were prospectively enrolled. Medication discrepancies were classified as intentional, undocumented intentional, and unintentional. Unintentional medication discrepancies were classified by a blinded rater for potential to harm. This study was primarily qualitative, and descriptive (univariate) statistics are presented.</p></div><div><h3>Results</h3><p>Sixty-seven patients (42 women; mean [SD] age, 84.0 [6.5] years) were enrolled. There were 37 unintentional prescription-medication discrepancies in 27 patients (40.3%) and 43 unintentional over-the-counter (OTC) medication discrepancies in 19 patients (28.4%), which translates to Medication Reconciliation Success Index (MRSI) of 89% for prescription medications and 59% for OTC medications. The overall MRSI was 83%. More than half of the prescription-medication discrepancies (56.8%) were classified as potentially causing moderate/severe discomfort or clinical deterioration.</p></div><div><h3>Conclusion</h3><p>Despite a fairly high overall MRSI in these patients admitted to ACE units, a substantial proportion of the prescription-medication discrepancies were associated with potential harm.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"9 5","pages":"Pages 339-344"},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29974799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}