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Polypharmacy

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281. Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. Full Text available with Trip Pro

Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. delivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients.to explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver (...) appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia.this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs' perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South

2016 Age and ageing

282. Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Full Text available with Trip Pro

Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals.Observational study.4,987 community-dwelling older men and women with complete data who participated in visit 5

2016 American Journal of Kidney Diseases

283. Contribution of Pharmacogenetic Testing to Modeled Medication Change Recommendations in a Long-Term Care Population with Polypharmacy. Full Text available with Trip Pro

Contribution of Pharmacogenetic Testing to Modeled Medication Change Recommendations in a Long-Term Care Population with Polypharmacy. Among long-term care facility residents, polypharmacy is common, and often appropriate, given the need to treat multiple, complex, chronic conditions. Polypharmacy has, however, been associated with increased healthcare costs, adverse drug events, and drug interactions. The current study evaluates the potential medication cost savings of adding personalized (...) pharmacogenetic information to traditional medication management strategies.One hundred and twelve long-term care residents completed pharmacogenetic testing for targeted variants in the following genes: CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4/CYP3A5, HTR2A, HTR2C, SLC6A4, SLC6A2 COMT, OPRM1, SLCO1B1, VKORC1 and MTHFR. Following reporting of the IDgenetix Polypharmacy® test results, an internal medication management assessment was performed by a licensed clinical pharmacist to identify potential opportunities

2016 Drugs & Aging

284. Impact of polypharmacy on antiretroviral prescription in people living with HIV. Full Text available with Trip Pro

Impact of polypharmacy on antiretroviral prescription in people living with HIV. To evaluate the relationship between polypharmacy and ART, delivered as conventional multi-tablet three-drug regimens, single-tablet regimens or less-drug regimens (simplified mono or dual regimens).We conducted a cross-sectional analysis of electronic data from the prospective Modena HIV Metabolic Clinic Cohort Study. We included the last clinical observation for each patient from January 2006 to December 2015 (...) . Polypharmacy was defined as the use of five or more medications (excluding ART). Multi-morbidity was classified as the presence of two or more non-infectious comorbidities. Factors associated with different ART regimens were analysed using multivariable multinomial logistic regression analyses with multi-tablet three-drug regimens as the reference.A total of 2944 patients (33.7% females) were included in the analysis. Multinomial logistic regression analysis identified polypharmacy to be negatively

2016 Journal of Antimicrobial Chemotherapy

285. Changes in Drug Use and Polypharmacy After the Age of 90: A Longitudinal Study of the Danish 1905 Cohort. Full Text available with Trip Pro

Changes in Drug Use and Polypharmacy After the Age of 90: A Longitudinal Study of the Danish 1905 Cohort. To determine the longitudinal development of drug use in very old adults.Longitudinal cohort study with waves in 1998, 2000, 2002, and 2005.Nationwide study in Denmark.All living Danes born in 1905 were approached in 1998; 2,262 responded at baseline.Self-reported use of regularly taken drugs. Mean and median number of drugs and growth curve models were used to identify the change in number

2016 Journal of the American Geriatrics Society

286. Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study. (Abstract)

Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study. To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period.A 12-month prospective cohort study.A total of 383 residents of 6 Australian long-term care facilities (LTCFs).The primary exposures were (...) polypharmacy (≥9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted

2016 Journal of the American Medical Directors Association

287. Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Full Text available with Trip Pro

Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data.

2016 Age and ageing

288. Polypharmacy-an Upward Trend with Unpredictable Effects. Full Text available with Trip Pro

Polypharmacy-an Upward Trend with Unpredictable Effects. Guideline-oriented treatments can lead to polypharmacy, i.e., the simultaneous long-term use of multiple drugs. Polypharmacy mainly affects elderly patients. The goal of this review is to survey the current scientific evidence about polypharmacy, focusing on clinical endpoints, and to point out implications for medical practice and research.This selective literature review is based on pertinent publications that were retrieved (...) by a selective search in PubMed employing the terms "polypharmacy AND general practice." Selected references were considered as well.In Germany, polypharmacy currently affects approximately 42% of persons over age 65, with an ongoing upward trend. 20-25% of these patients receive potentially inappropriate drugs. Approximately 86% of the daily doses of drugs taken by persons over age 65 are prescribed by general practitioners. There is inconsistent evidence on the question whether polypharmacy affects

2016 Deutsches Arzteblatt international

289. Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. Full Text available with Trip Pro

Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium.Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were (...) prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age

2016 BMC Geriatrics

290. Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial. Full Text available with Trip Pro

Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial.  To determine whether the treatment effect of apixaban versus warfarin differs with increasing numbers of concomitant drugs used by patients with atrial fibrillation. Post hoc analysis performed in 2015 of results from ARISTOTLE (apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation)-a multicentre, double blind, double dummy trial (...) (adjusted for age, sex, and country). Each patient used a median of six drugs (interquartile range 5-9); polypharmacy (≥5 drugs) was seen in 13 932 (76.5%) patients. Greater numbers of concomitant drugs were used in older patients, women, and patients in the United States. The number of comorbidities increased across groups of increasing numbers of drugs (0-5, 6-8, ≥9 drugs), as did the proportions of patients treated with drugs that interact with warfarin or apixaban. Mortality also rose significantly

2016 BMJ (Clinical research ed.) Controlled trial quality: predicted high

291. Does Polypharmacy in Nursing Homes Affect Long-Term Mortality? (Abstract)

Does Polypharmacy in Nursing Homes Affect Long-Term Mortality? To investigate the association between polypharmacy and mortality in nursing home (NH) residents.Prospective observational cohort study.Six NHs in central Israel.Mobile with dementia and fully dependent residents (N = 764; n = 558 (73%) fully dependent, n = 206 (27%) mobile residents with dementia requiring institutional care; mean age 82.2 ± 5.9).Two-year mortality and its association with number of drugs that individual residents (...) = 0.36-0.80) and selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (OR = 0.52, 95% CI = 0.37-0.75).Polypharmacy, defined quantitatively according to number of drugs, was not associated with mortality in these NH residents.© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

2016 Journal of the American Geriatrics Society

292. Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care. Full Text available with Trip Pro

Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care. For older patients with polypharmacy, medication management is a process of careful deliberation that needs periodic adjustment based on treatment effects and changing conditions. Because of the heterogeneity of the patient group, and limited applicability of current guidelines, it is difficult for GPs to build up a routine.To gain insight into GPs (...) ' medication management strategies for patients with polypharmacy, and to explore the GPs' perspectives and needs on decision-making support to facilitate this medication management.Two focus group meetings with Dutch GPs, discussing four clinical vignettes of patients with multimorbidity and polypharmacy.Questions about medication management of the vignettes were answered individually; the strategy chosen in each case was discussed in plenary. Analysis followed a Framework approach.In total, 12 GPs

2016 British Journal of General Practice

293. Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies. (Abstract)

Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies. Polypharmacy, common in elderly multimorbid adults, leads to increased iatrogenic health risks. Yet, no consistent approach to stopping medicines exists in primary healthcare.Our objective was to synthesize qualitative studies exploring the perspectives and experiences of general practitioners (GPs) and older patients in reducing polypharmacy and to discover approaches (...) already being practiced.We conducted a search in the PubMed, Cochrane Library, Web of Science Core Collection, and Scopus databases to identify qualitative studies in the primary care setting addressing multimorbid older patients and polypharmacy reduction. The seven-step model of meta-ethnography allowed for cross-interpretation between studies considering their original context and developing theories.A total of 14 studies from the perspectives of patients (n = 6) and providers (n = 8) were included

2016 Drugs & Aging

294. Epidemiology of Polypharmacy and Potential Drug-Drug Interactions Among Pediatric Patients in ICUs of U.S. Children's Hospitals. Full Text available with Trip Pro

Epidemiology of Polypharmacy and Potential Drug-Drug Interactions Among Pediatric Patients in ICUs of U.S. Children's Hospitals. Polypharmacy is common in hospitalized children in the United States and has been identified as a major risk factor for exposure to potential drug-drug interactions. Little is known about the characteristics and prevalence of exposure of pediatric patients to polypharmacy and potential drug-drug interactions in PICUs.Retrospective cohort study using the Pediatric (...) distinct drugs used (p < 0.001), increasing length of stay in PICU (p < 0.001), and white race (p < 0.001).Many PICU patients are exposed to substantial polypharmacy and potential drug-drug interactions. Future research should identify the risk of adverse drug events following specific potential drug-drug interaction exposures, especially the risk of adverse drug events due to multiple potential drug-drug interaction exposures, and determine the probability and magnitude of the actual harm (if any

2016 Pediatric Critical Care Medicine

295. Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy - a prospective randomised controlled trial. Full Text available with Trip Pro

Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy - a prospective randomised controlled trial. In 2010 the 'Polymedication Check' (PMC), a pharmacist-led medication review, was newly introduced to be delivered independently from the prescriber and reimbursed by the Swiss health insurances. This study aimed at evaluating the impact of this new cognitive service focusing on medicines use and patients' adherence in everyday life.This randomised (...) controlled trial was conducted in 54 Swiss community pharmacies. Eligible patients used ≥4 prescribed medicines over >3 months. The intervention group received a PMC at study start (T-0) and after 28 weeks (T-28) while the control group received only a PMC at T-28. Primary outcome measure was change in patients' objective adherence, calculated as Medication Possession Ratio (MPR) and Daily Polypharmacy Possession Ratio (DPPR), using refill data from the pharmacies and patient information of dosing

2016 BMC health services research Controlled trial quality: uncertain

296. Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit? (Abstract)

Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit? This study aimed at verifying the role of polypharmacy as an independent risk factor for adverse health outcomes in older emergency department (ED) patients. This was a large (n = 2057) sample of older ED patients (≥65 years) participating in an observational cohort study. Polypharmacy and excessive polypharmacy were defined as having 6-9 drug prescriptions and 10 or more drug prescriptions (...) in the last 3 months, respectively. The total number of medication prescriptions was also available. Outcome measures were in-hospital mortality; 30-day ED return; ED revisit, hospital admission, and mortality at 6 months. Logistic and Cox regression models as well as receiver operating characteristic curves using the Youden index and the area under the curve were calculated. Polypharmacy and excessive polypharmacy were present in 624 (30.3 %) and 367 (17.8 %) subjects, respectively. The mean number

2016 Internal and emergency medicine

297. Factors associated with appropriate knowledge of the indications for prescribed drugs among community-dwelling older patients with polypharmacy. Full Text available with Trip Pro

Factors associated with appropriate knowledge of the indications for prescribed drugs among community-dwelling older patients with polypharmacy. polypharmacy contributes to patients' non-adherence with physicians' prescriptions. Patients' knowledge about the indications for their medicines is one of the factors influencing adherence.to identify factors associated with appropriate knowledge about the indications for drugs prescribed to older patients with polypharmacy.in a primary care setting

2016 Age and ageing

298. Adverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients. Full Text available with Trip Pro

Adverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients. To explore the relationship between polypharmacy and adverse outcomes among older hospital inpatients stratified according to their frailty status.A prospective study of 1418 patients, aged 70 and older, admitted to 11 hospitals across Australia.The interRAI Acute Care (AC) assessment tool was used for all data collection, including the derivation of a frailty index calculated using the deficit (...) accumulation method. Polypharmacy was categorized into 3 groups based on the number of regular drugs prescribed. Recorded adverse health outcomes were falls, delirium, functional and cognitive decline, discharge to a higher level of care and in-hospital mortality.Patients had a mean (SD) age of 81 (6.8) years and 55% were women. Polypharmacy (5-9 drugs per day) was observed in 48.2% (n = 684) and hyper-polypharmacy (≥10 drugs) in 35.0% (n = 497). Severe cognitive impairment was significantly associated

2016 Journal of the American Medical Directors Association

299. Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series. Full Text available with Trip Pro

Older age, chronic medical conditions and polypharmacy in Himalayan trekkers in Nepal: an epidemiologic survey and case series. The number of tourists in Nepal doubled between 2003 and 2013 is nearly 800 000. With the increased popularity of trekking, the number of those with pre-existing medical conditions requiring access to healthcare is likely to increase. We therefore sought to characterize the demographics and health status of trekkers on the Everest Base Camp route in the Solukhumbu (...) represented. Excluding acetazolamide, older trekkers (age >50 years) were more likely than younger ones to take medications (OR = 2.17; 95% CI 1.57-3.00; P <0.05). Acetazolamide use was not related to age.Our findings illustrate a wide variety of medical conditions present in trekkers in Nepal with wide-ranging potential complications that could pose difficulties in areas where medical care is scarce and evacuation difficult. Our cases illustrate the potential problems polypharmacy poses in trekkers

2016 Journal of Travel Medicine

300. Predictors of long-term (≥6months) antipsychotic polypharmacy prescribing in secondary mental healthcare. Full Text available with Trip Pro

Predictors of long-term (≥6months) antipsychotic polypharmacy prescribing in secondary mental healthcare. The predictors of long-term antipsychotic polypharmacy (APP) initiation are poorly understood. Existing research has been hampered by residual confounding, failure to exclude cross-titration, and difficulties in separating the timing of predictors and APP administration.Using data from the South London and Maudsley (SLaM) case register, we identified all adult patients with serious mental

2016 Schizophrenia Research

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