Marcelo Schapira1, Pablo Calabró1, Manuel Montero-Odasso2,3,4, Abdelhady Osman3,4, María Elena Guajardo1, Bernardo Martínez1, Javier Pollán1,5, Luis Cámera1, Miguel Sassano1, Gastón Perman6,7. 1. Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina. 2. Geriatric Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada. 3. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada. 4. Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada. 5. Department of Public Health, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina. 6. Hospital Italiano de Buenos Aires (Internal Medicine Service), Tte. Gral. Juan Domingo Perón 4190 (CP 1199ABB), Buenos Aires, Argentina. gaston.perman@hospitalitaliano.org.ar. 7. Department of Public Health, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina. gaston.perman@hospitalitaliano.org.ar.
Abstract
BACKGROUND: Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults. AIMS: To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults. METHODS: We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65 years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient's electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6 months prior to the intervention) and final (12 months after) prevalence of PIM use using a test of proportions. RESULTS: There was a significant reduction (p < 0.05) in all drug classes evaluated. Non-Steroidal Anti-Inflammatory Drugs (basal prevalence 5.92%; final 1.59%); benzodiazepines (10.13%; 6.94%); histamine antagonists (7.74%; 3.07%); opioids (2.16%; 1.25%); tricyclic antidepressants (8.08%; 4.10%); muscle relaxants (7.74%; 3.41%), anti-hypertensives (3.53%; 1.82%) and oxybutynin (2.96%; 1.82%). The absolute reduction in the overall prevalence was 8.5 percentage points (relative reduction of 51.4%). CONCLUSION: This multifactorial intervention is feasible and effective in reducing the use of potentially inappropriate medication in all drug classes evaluated.
BACKGROUND: Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults. AIMS: To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults. METHODS: We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65 years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient's electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6 months prior to the intervention) and final (12 months after) prevalence of PIM use using a test of proportions. RESULTS: There was a significant reduction (p < 0.05) in all drug classes evaluated. Non-Steroidal Anti-Inflammatory Drugs (basal prevalence 5.92%; final 1.59%); benzodiazepines (10.13%; 6.94%); histamine antagonists (7.74%; 3.07%); opioids (2.16%; 1.25%); tricyclic antidepressants (8.08%; 4.10%); muscle relaxants (7.74%; 3.41%), anti-hypertensives (3.53%; 1.82%) and oxybutynin (2.96%; 1.82%). The absolute reduction in the overall prevalence was 8.5 percentage points (relative reduction of 51.4%). CONCLUSION: This multifactorial intervention is feasible and effective in reducing the use of potentially inappropriate medication in all drug classes evaluated.
Authors: Jerry H Gurwitz; Terry S Field; James Judge; Paula Rochon; Leslie R Harrold; Cynthia Cadoret; Monica Lee; Kathleen White; Jane LaPrino; Janet Erramuspe-Mainard; Martin DeFlorio; Linda Gavendo; Jill Auger; David W Bates Journal: Am J Med Date: 2005-03 Impact factor: 4.965
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Authors: Munir Pirmohamed; Sally James; Shaun Meakin; Chris Green; Andrew K Scott; Thomas J Walley; Keith Farrar; B Kevin Park; Alasdair M Breckenridge Journal: BMJ Date: 2004-07-03