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Polypharmacy

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201. A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care Full Text available with Trip Pro

A feasibility study of a theory-based intervention to improve appropriate polypharmacy for older people in primary care A general practitioner (GP)-targeted intervention aimed at improving the prescribing of appropriate polypharmacy for older people was previously developed using a systematic, theory-based approach based on the UK Medical Research Council's complex intervention framework. The primary intervention component comprised a video demonstration of a GP prescribing appropriate (...) polypharmacy during a consultation with an older patient. The video was delivered to GPs online and included feedback emphasising the positive outcomes of performing the behaviour. As a complementary intervention component, patients were invited to scheduled medication review consultations with GPs. This study aimed to test the feasibility of the intervention and study procedures (recruitment, data collection).GPs from two general practices were given access to the video, and reception staff scheduled

2017 Pilot and feasibility studies Controlled trial quality: uncertain

202. Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy Full Text available with Trip Pro

Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy This study investigates the antipsychotic use patterns of patients with schizophrenia and its correlations in their daily drug use patterns.Patients with schizophrenia who have regular records at two different community counselling centres (CCS) were included in the study. Information about their medications and sociodemographic data was recorded through face-to-face interviews and supporting information about (...) antipsychotic. Clinical severity, regular visits to a CCS and use of depot antipsychotics were independent predictors for polypharmacy.The rate of polypharmacy use is high in Turkey. There are multiple risk factors related with polipharmacy. New studies should focus risk factors for preventing polypharmacy.

2017 Clinical practice and epidemiology in mental health : CP & EMH

203. Polypharmacy and potential drug–drug interactions in emergency department patients in the Caribbean Full Text available with Trip Pro

Polypharmacy and potential drug–drug interactions in emergency department patients in the Caribbean Background Potential Drug-Drug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-income countries. Objective To compare the incidence of drug-drug interactions and polypharmacy in older and younger patients attending (...) the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micromedex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of ≥5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275 (42.3%) were ≥65 years and 381 (58.7

2017 International journal of clinical pharmacy

204. Psychotropic polypharmacy in Australia, 2006 to 2015: a descriptive cohort study Full Text available with Trip Pro

Psychotropic polypharmacy in Australia, 2006 to 2015: a descriptive cohort study To describe psychotropic polypharmacy in Australia between 2006 and 2015.We used pharmaceutical claims from a national 10% sample of people with complete dispensing histories to estimate the annual prevalence of the combined use (overlap of >60 days exposure) of ≥2 psychotropics overall and within the same class or subclass (class and subclass polypharmacy). We also estimated the proportion of polypharmacy episodes (...) involving one, two, three and four or more unique prescribers.The prevalence of class polypharmacy between 2006 and 2015 in people dispensed specific psychotropic classes was 5.9-7.3% for antipsychotics, 2.1-3.7% for antidepressants and 4.3-2.9% for benzodiazepines. The prevalence of antipsychotic polypharmacy was higher than expected given the prevalence of antipsychotic exposure and combinations of sedating agents were notably common. Overall, 26.7% of polypharmacy episodes involved multiple

2017 British journal of clinical pharmacology

205. Development of a core outcome set for medication review in older patients with multimorbidity and polypharmacy: a study protocol Full Text available with Trip Pro

Development of a core outcome set for medication review in older patients with multimorbidity and polypharmacy: a study protocol Medication review has been advocated to address the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. Heterogeneity of outcomes reported in clinical trials can hinder the comparison of clinical trial findings in systematic reviews. Moreover, the outcomes that matter most to older patients might be under

2017 Clinical interventions in aging

206. The polypharmacy challenge: time for a new script? Full Text available with Trip Pro

The polypharmacy challenge: time for a new script? 28860279 2018 07 09 2018 11 13 1478-5242 67 662 2017 09 The British journal of general practice : the journal of the Royal College of General Practitioners Br J Gen Pract The polypharmacy challenge: time for a new script? 388-389 10.3399/bjgp17X692189 Swinglehurst Deborah D Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London. Fudge Nina N Centre for Primary Care and Public Health, Blizard (...) Institute, Queen Mary University of London, London. eng Editorial England Br J Gen Pract 9005323 0960-1643 IM Age Factors General Practice methods standards trends Humans Medication Therapy Management organization & administration standards Multimorbidity Polypharmacy Risk Factors United Kingdom 2017 9 2 6 0 2017 9 2 6 0 2018 7 10 6 0 ppublish 28860279 67/662/388 10.3399/bjgp17X692189 PMC5569714 Br J Gen Pract. 2017 Jul;67(660):e501-e506 28347987 BMJ Open. 2013 Sep 13;3(9):e003610 24038011 Br J Gen

2017 The British Journal of General Practice

207. Gut microbiota composition is associated with polypharmacy in elderly hospitalized patients Full Text available with Trip Pro

Gut microbiota composition is associated with polypharmacy in elderly hospitalized patients Reduced biodiversity and increased representation of opportunistic pathogens are typical features of gut microbiota composition in aging. Few studies have investigated their correlation with polypharmacy, multimorbidity and frailty. To assess it, we analyzed the fecal microbiota from 76 inpatients, aged 83 ± 8. Microbiome biodiversity (Chao1 index) and relative abundance of individual bacterial taxa were (...) was associated with the average relative abundance of 15 taxa. The drug classes exhibiting the strongest association with single taxa abundance were proton pump inhibitors, antidepressants and antipsychotics. Conversely, frailty and multimorbidity were not significantly associated with gut microbiota biodiversity. Very low Chao1 index was also a significant predictor of mortality, but not of rehospitalizations and sepsis, at follow-up. In aging, polypharmacy may thus represent a determinant of gut microbiota

2017 Scientific reports

208. Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System Full Text available with Trip Pro

Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System To characterize the polypharmacy in primary health care patients and to identify its associated factors.This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The variable (...) of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson's Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p < 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test.The prevalence of polypharmacy among medicine users was 9.4% (95

2017 Revista de saúde pública

209. Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome Full Text available with Trip Pro

Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome Atypical antipsychotics (AAP) are the prevailing form of schizophrenia treatment today due to their low side effects and superior efficacy. Nevertheless, some issues still need to be addressed. First, there are still a large number of patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy with few side (...) effects. Most clinical treatment guidelines recommend clozapine monotherapy in TRS, but around one third of schizophrenic patients fail to respond to clozapine. For these patients, with clozapine-resistant schizophrenia AAP polypharmacy is a common strategy with a continually growing evidence base. Second, AAP generally have great risks for developing metabolic syndrome, such as weight gain, abnormality in glucose, and lipid metabolism. These metabolic side effects have become huge stumbling blocks

2017 International journal of molecular sciences

210. A dataset quantifying polypharmacy in the United States Full Text available with Trip Pro

A dataset quantifying polypharmacy in the United States Polypharmacy is increasingly common in the United States, and contributes to the substantial burden of drug-related morbidity. Yet real-world polypharmacy patterns remain poorly characterized. We have counted the incidence of multi-drug combinations observed in four billion patient-months of outpatient prescription drug claims from 2007-2014 in the Truven Health MarketScan® Databases. Prescriptions are grouped into discrete windows (...) of polypharmacy in a large US cohort, which can prioritize common drug combinations for future safety and efficacy studies.

2017 Scientific data

211. Poly-de-prescribing to treat polypharmacy: efficacy and safety Full Text available with Trip Pro

Poly-de-prescribing to treat polypharmacy: efficacy and safety The aim of this study was to evaluate efficacy and safety of poly-de-prescribing (PDP) based on the Garfinkel method in older people with polypharmacy.A longitudinal, prospective, nonrandomized study in Israel was carried out between 2009 and 2016. Comprehensive geriatric assessments were performed at home in people age ⩾66 years consuming ⩾6 prescription drugs. Exclusion criteria were life expectancy <6 months and a seeming (...) reduced (p < 0.002 in all). The rate of hospitalizations and mortality was comparable. Health improvement occurred within 3 months after de-prescribing in 83%, and persisted for ⩾2 years in 68%.This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. PDP is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all

2017 Therapeutic advances in drug safety

212. Antipsychotic polypharmacy prescribing and risk of hospital readmission Full Text available with Trip Pro

Antipsychotic polypharmacy prescribing and risk of hospital readmission The aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care.Using data from the South London and Maudsley (SLAM) case register, service users with serious mental illness (SMI), discharged between 1st January 2007 and 31th December 2014, were followed up for 6 months. Patients were classified (...) as receiving either monotherapy or polypharmacy at index discharge. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical and service use factors.We identified 5523 adults who had been admitted at least once to SLAM, of whom 1355 (24.5%) were readmitted into secondary mental health care. In total, 15% (n = 826) of patients were discharged on APP and 85% (n = 4697) on monotherapy. Of these, 30.9% (n = 255) and 23.4% (n = 1100) were readmitted

2017 Psychopharmacology

213. The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Full Text available with Trip Pro

The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs.This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies (...) -related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018].MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy.© 2016 The British Pharmacological Society.

2017 British journal of clinical pharmacology Controlled trial quality: uncertain

214. Polypharmacy in Zoological Medicine Full Text available with Trip Pro

Polypharmacy in Zoological Medicine Polypharmacy is a term that describes the inappropriate, concurrent use of multiple drugs in an individual patient. Zoological medicine practitioners must take approved agents (veterinary or human) and extrapolate their use to non-approved species often with little species-specific pharmacological evidence to support their decisions. When considering polypharmacy, even less information exists concerning multi-drug pharmacokinetics, pharmacodynamics (...) , or potential drug-drug interactions in non-domestic species. Unfortunately, captive, zoological species are susceptible, just like their domestic counterparts, to chronic diseases and co-morbidities that may lead to the usage of multiple drugs. Polypharmacy is a recognized and important issue in human medicine, as well as an emerging issue for veterinarians; thus, this paper will discuss the novel, potential risks of polypharmacy in zoological medicine. Hopefully, this discussion will help bring

2017 Pharmaceutics

215. Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods Full Text available with Trip Pro

Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods Polypharmacy, the concurrent use of multiple medications by one individual is a growing global issue driven by an ageing population and increasing prevalence of multi-morbidity[1]. Polypharmacy can be problematic: interactions between medications, reduced adherence to medication, burden of medication to patients, administration time, increased risk of errors and increased cost (...) . Quality improvement methods were applied to identify and highlight polypharmacy patients with the aim of reducing their average number of regular tablets/capsules per day by 25%. The project was delivered within a UK based 27 bedded hospice inpatient unit. A series of PDSA cycles studied interventions focusing on the identification of patients with polypharmacy, the highlighting of these patients to prescribers for review and the views of patients about their medication. For the purposes of the study

2017 BMJ Quality Improvement Reports

216. Cytochrome P450‐mediated interaction between perazine and risperidone: implications for antipsychotic polypharmacy Full Text available with Trip Pro

Cytochrome P450‐mediated interaction between perazine and risperidone: implications for antipsychotic polypharmacy Although clinically widespread, scientific evidence for antipsychotic polypharmacy is still limited. Combining different drugs increases the potential for drug-drug interactions, enhancing the risk of adverse drug reactions. We aimed to unravel the potential pharmacokinetic interactions between risperidone (RIS) and perazine.Using a therapeutic drug monitoring database containing

2017 British journal of clinical pharmacology

217. Assessing medication burden and polypharmacy: finding the perfect measure Full Text available with Trip Pro

Assessing medication burden and polypharmacy: finding the perfect measure 28271722 2018 05 28 2018 11 13 1751-2441 10 4 2017 04 Expert review of clinical pharmacology Expert Rev Clin Pharmacol Assessing medication burden and polypharmacy: finding the perfect measure. 345-347 10.1080/17512433.2017.1301206 Gnjidic Danijela D a Faculty of Pharmacy and Charles Perkins Centre , University of Sydney , Sydney , NSW , Australia. Tinetti Mary M b Department of Internal Medicine , Yale School of Medicine (...) Prescribing statistics & numerical data Polypharmacy Practice Patterns, Physicians' standards Polypharmacy deprescribing older adults 2017 3 9 6 0 2018 5 29 6 0 2017 3 9 6 0 ppublish 28271722 10.1080/17512433.2017.1301206 PMC5477055 NIHMS863644 Clin Pharmacol Ther. 2012 Mar;91(3):521-8 22297385 J Clin Epidemiol. 2012 Sep;65(9):989-95 22742913 J Gerontol A Biol Sci Med Sci. 2017 Feb;72 (2):259-265 27384327 BMJ. 2016 Jun 15;353:i2868 27306620 Cochrane Database Syst Rev. 2014 Oct 07;(10):CD008165 25288041 J

2017 Expert review of clinical pharmacology

218. Antipsychotic Polypharmacy among Children and Young Adults in Office-Based or Hospital Outpatient Department Settings Full Text available with Trip Pro

Antipsychotic Polypharmacy among Children and Young Adults in Office-Based or Hospital Outpatient Department Settings The purpose of the study was three-fold: (1) to estimate the national trends in antipsychotic (AP) polypharmacy among 6- to 24-year-old patients in the U.S.; (2) to identify frequently used AP agents and mental disorder diagnoses related to AP polypharmacy; and (3) to assess the strength of association between AP polypharmacy and patient/provider characteristics. We used (...) publicly available ambulatory health care datasets to evaluate AP polypharmacy in office-based or hospital outpatient department settings to conduct a cross-sectional study. First, national visit rates between 2007 and 2011 were estimated using sampling weights. Second, common diagnoses and drugs used in AP polypharmacy were identified. Third, a multivariate logistic regression model was developed to assess the strength of association between AP polypharmacy and patient and provider characteristics

2017 Pharmacy: Journal of Pharmacy Education and Practice

219. “Dopamine homeostasis” requires balanced polypharmacy: Issue with destructive, powerful dopamine agents to combat America’s drug epidemic Full Text available with Trip Pro

“Dopamine homeostasis” requires balanced polypharmacy: Issue with destructive, powerful dopamine agents to combat America’s drug epidemic The well-researched pro-dopamine regulator KB220 and variants result in increased functional connectivity in both animal and human brains, and prolonged neuroplasticity (brain cell repair) having been observed in rodents. Moreover, in addition to increased functional connectivity, recent studies show that KB220Z increases overall brain connectivity

2017 Journal of systems and integrative neuroscience

220. Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010–2011 Full Text available with Trip Pro

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010–2011 The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing (...) multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse.We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors.This cross-sectional cohort study examined national data of Iraq and Afghanistan Veterans (N = 311,400) who used the Veterans Health Administration (VHA) during the fiscal year 2011. CNS polypharmacy was defined as five or more

2016 Drugs - real world outcomes

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