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Polypharmacy

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221. Drug information update. Unconventional treatment strategies for schizophrenia: polypharmacy and heroic dosing Full Text available with Trip Pro

Drug information update. Unconventional treatment strategies for schizophrenia: polypharmacy and heroic dosing The majority of patients respond to antipsychotic monotherapy at standard doses, but a subset of patients will require more heroic measures that include antipsychotic polypharmacy and high-dose monotherapy. Indeed, research has shown that roughly 30% of patients with psychosis are prescribed multiple antipsychotic medications. We discuss the potential benefits and challenges

2017 BJPsych bulletin

222. Clinician agreement and influence of medication‐related characteristics on assessment of polypharmacy Full Text available with Trip Pro

Clinician agreement and influence of medication‐related characteristics on assessment of polypharmacy It is not known how clinicians assess polypharmacy or the medication-related characteristics that influence their assessment. The aim of this study was to examine the level of agreement between clinicians when assessing polypharmacy and to identify medication-related characteristics that influence their assessment. Twenty cases of patients with varying levels of comorbidity and polypharmacy (...) were used to examine clinician assessment of polypharmacy. Medicine-related factors within the cases included Beers and STOPP Criteria medicines, falls-risk medicines, drug burden index (DBI) medicines, medicines causing postural hypotension, and pharmacokinetic drug-drug interactions. Clinicians were asked to rate cases on the degree of polypharmacy, likelihood of harm, and potential for the medication list to be simplified. Inter-rater reliability analysis, correlations, and multivariate logistic

2017 Pharmacology research & perspectives

223. Polypharmacy among Underserved Older African American Adults Full Text available with Trip Pro

Polypharmacy among Underserved Older African American Adults The purpose of the present study was to examine correlates of polypharmacy among underserved community-dwelling older African American adults. Methods. This study recruited 400 underserved older African Americans adults living in South Los Angeles. The structured face-to-face interviews collected data on participants' characteristics and elicited data pertaining to the type, frequency, dosage, and indications of all medications used (...) by participants. Results. Seventy-five and thirty percent of participants take at least five and ten medications per day, respectively. Thirty-eight percent of participants received prescription medications from at least three providers. Inappropriate drug use occurred among seventy percent of the participants. Multivariate analysis showed that number of providers was the strongest correlate of polypharmacy. Moreover, data show that gender, comorbidity, and potentially inappropriate medication use are other

2017 Journal of aging research

224. Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries Full Text available with Trip Pro

Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens.To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries.In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy (...) as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV.The prevalence

2017 The Annals of pharmacotherapy

225. Implementing an ICT-Based Polypharmacy Management Program in Italy Full Text available with Trip Pro

Implementing an ICT-Based Polypharmacy Management Program in Italy Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses

2017 Translational medicine @ UniSa

226. Polypharmacy: droxidopa to treat neurogenic orthostatic hypotension in a patient with Parkinson disease and type 2 diabetes mellitus Full Text available with Trip Pro

Polypharmacy: droxidopa to treat neurogenic orthostatic hypotension in a patient with Parkinson disease and type 2 diabetes mellitus 28674868 2018 11 30 1619-1560 27 Suppl 1 2017 07 Clinical autonomic research : official journal of the Clinical Autonomic Research Society Clin. Auton. Res. Polypharmacy: droxidopa to treat neurogenic orthostatic hypotension in a patient with Parkinson disease and type 2 diabetes mellitus. 33-34 10.1007/s10286-017-0435-5 Vernino Steven S Department of Neurology

2017 Clinical Autonomic Research

227. Polypharmacy and Risk of Non-fatal Overdose for Patients with HIV Infection and Substance Dependence Full Text available with Trip Pro

Polypharmacy and Risk of Non-fatal Overdose for Patients with HIV Infection and Substance Dependence People living with HIV (PLWH) are at risk of both polypharmacy and unintentional overdose yet there are few data on whether polypharmacy increases risk of overdose. The study objective was to determine if the number and type of medication (e.g., sedating) were associated with non-fatal overdose (OD) among PLWH with past-year substance dependence or a lifetime history of injection drug use.This (...) opioid medication (OR 2.23; 95% CI 0.93, 5.35).In this sample of PLWH with substance dependence and/or injection drug use, number of sedating medications and any opioid were associated with non-fatal overdose; sedating medications were prescribed to the majority of patients. Polypharmacy among PLWH and substance dependence warrants further research to determine whether reducing sedating medications, including opioids, lowers overdose risk.Copyright © 2017 Elsevier Inc. All rights reserved.

2017 Journal of substance abuse treatment

228. 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

229. 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

230. 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

231. 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

232. 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

233. 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

234. 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

235. 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

236. 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

237. 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

238. 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

239. 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

240. 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

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