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Polypharmacy

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21. Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation. (Abstract)

Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation. Polypharmacy and potentially inappropriate medications (PIMs) are increasingly common and associated with adverse health effects. However, post-graduate education in polypharmacy and complex medication management for older adults remain limited.The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE (...) ) polypharmacy clinic was created to provide a platform for teaching internal medicine (IM) and nurse practitioner (NP) residents about outpatient medication management and deprescribing for older adults. We aimed to assess residents' knowledge of polypharmacy and perceptions of this interprofessional education intervention.A prospective cohort study with an internal comparison group.IM residents and NP residents; Veterans ≥ 65 years and taking ≥ 10 medications.IMPROVE consists of a pre-clinic conference

2019 Journal of General Internal Medicine

22. Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study. Full Text available with Trip Pro

Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study. The use of unnecessary or excessive medications (inappropriate polypharmacy) is a major health challenge among older adults which is driven by several factors. This study aims to provide in-depth descriptions of the physician's role in the development of inappropriate polypharmacy among older adults in Iran.Qualitative content analysis of interviews, field notes and other relevant (...) perspectives which highlight the role of physicians in the development of inappropriate polypharmacy among older adults in Iran under the main concept of poor medical practice.This study provides valuable insight on the role of physicians in the development of inappropriate polypharmacy among the elderly in the healthcare setting in Iran by exploring the viewpoints of physicians, patients, caregivers and pharmacists. Physicians can be an influential factor in tackling this challenge through proper

2019 BMJ open

23. How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. Full Text available with Trip Pro

How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. To test whether the use of potentially inappropriate central nervous system acting medications, proton pump inhibitors (PPIs) or polypharmacy are associated with mortality in cognitively impaired older adults and whether frailer people are at greater risk of harm.A cohort study nested within the Cognitive Function and Ageing Study II (...) , a population representative cohort study of the older population in Cambridgeshire, Nottingham and Newcastle, UK.A total of 1154 cognitively impaired participants, aged 65 years or older.Any use of antipsychotics, antidepressants, other anticholinergic medication, benzodiazepines or PPIs, polypharmacy (5-9) and hyperpolypharmacy (≥10 reported medications) were ascertained at baseline. Frailty was assessed using the Fried criteria.Mortality up to 8 years follow-up. HRs associated with potentially

2019 BMJ open

24. Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland. Full Text available with Trip Pro

Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland. Polypharmacy is an increasing problem, leading to increased morbidity and mortality, especially in older, multimorbid patients. Consequently, there is a need for reduction of polypharmacy. The aim of this study was to explore attitudes, beliefs, and concerns towards deprescribing among older, multimorbid patients with polypharmacy who chose not to pursue at least (...) one of their GP's offers to deprescribe.Exploratory study using telephone interviews among patients of a cluster-randomized study in Northern Switzerland. The interview included a qualitative part consisting of questions in five pre-defined key areas of attitudes, beliefs, and concerns about deprescribing and an open explorative question. The quantitative part consisted of a rating of pre-defined statements in these areas.Twenty-two of 87 older, multimorbid patients with polypharmacy, to whom

2019 BMC Family Practice Controlled trial quality: uncertain

25. Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada. Full Text available with Trip Pro

Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada. Elders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently complex care needs. While many medications could be problematic, this project targets medications that should

2019 Implementation Science Controlled trial quality: predicted high

26. Polypharmacy among older Australians, 2006-2017: a population-based study. Full Text available with Trip Pro

Polypharmacy among older Australians, 2006-2017: a population-based study. To estimate the prevalence of polypharmacy among Australians aged 70 years or more, 2006-2017.Analysis of a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for people aged 70 or more who were dispensed PBS-listed medicines between 1 January 2006 and 31 December 2017.Prevalence of continuous polypharmacy (five or more unique medicines dispensed during both 1 April - 30 June and 1 October - 31 December (...) in a calendar year) among older Australians, and the estimated number of people affected in 2017; changes in prevalence of continuous polypharmacy among older concessional beneficiaries, 2006-2017.In 2017, 36.1% of older Australians were affected by continuous polypharmacy, or an estimated 935 240 people. Rates of polypharmacy were higher among women than men (36.6% v 35.4%) and were highest among those aged 80-84 years (43.9%) or 85-89 years (46.0%). The prevalence of polypharmacy among PBS concessional

2019 Medical Journal of Australia

27. Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study. (Abstract)

Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study. Polypharmacy carries the risk of adverse events, especially in people with multimorbidity.To investigate the prevalence of polypharmacy in community-dwelling adults, the association of multimorbidity with polypharmacy and the use of medications for primary prevention.Cross-sectional analysis of the follow-up data from the Program of Research on the Evolution of a Cohort (...) Investigating Health System Effects (PRECISE) in Quebec, Canada. Multimorbidity was defined as the presence of three or more chronic diseases and polypharmacy as self-reported concurrent use of five or more medications. Primary prevention was conceptualized as the use of statin or low-dose antiplatelets without a reported diagnostic of cardiovascular disease.Mean age 56.7 ± 11.6, 62.5% female, 30.3% had multimorbidity, 31.9% had polypharmacy (n = 971). The most common drugs used were statins, renin

2019 Family Practice

28. [Management of Polypharmacy and Drug-Drug Interactions in HIV Patients: A 2-year Experience of a Multidisciplinary Outpatient Clinic]. (Abstract)

[Management of Polypharmacy and Drug-Drug Interactions in HIV Patients: A 2-year Experience of a Multidisciplinary Outpatient Clinic]. HIV-positive patients are treated with various antiretroviral-containing drug combinations to control their underlying disease, which may also be combined with drugs aimed to manage independent or secondary comorbidities. This can expose patients to drug-drug interactions (DDIs) that may lead to suboptimal drug exposure, an increased risk of therapeutic failure (...) clinic in September 2016 to manage polypharmacy in HIV-infected patients. The main aims of the GAP clinic are to check whether patients are treated with drug combinations that are contraindicated due to known or predictable DDIs; assess the clinical and/or pharmacokinetic relevance of the DDIs; and provide written advice as to how the treatments should be modified if possible. We here describe the results of our 2-year experience in various clinical scenarios.Copyright: © 2019 Permanyer.

2019 AIDS reviews

29. Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors. (Abstract)

Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors. To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe.Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study.NHs in Europe and Israel.1843 NH residents on polypharmacy.Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction (...) (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing.Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed

2019 Journal of the American Medical Directors Association

30. A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial. Full Text available with Trip Pro

A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial. Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial is to determine if a patient-centered deprescribing intervention initiated in the hospital and continued in the PAC setting reduces the total number (...) of this trial will quantify the health outcomes associated with reducing medications for hospitalized older adults with polypharmacy who are discharged to post-acute care facilities.This trial was prospectively registered at clinicaltrials.gov ( NCT02979353 ). The trial was first registered on 12/1/2016, with an update on 09/28/17 and 10/12/2018.

2019 BMC health services research Controlled trial quality: predicted high

31. Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. (Abstract)

Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases. Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified (...) by statin discontinuation.Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using

2019 American Journal of Hospice and Palliative Medicine

32. Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study. Full Text available with Trip Pro

Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study. Information on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function.Our study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis

2019 Journal of the American Medical Directors Association

33. A qualitative exploration of the experiences of community dwelling older adults with sensory impairment/s receiving polypharmacy on their pharmaceutical care journey. Full Text available with Trip Pro

A qualitative exploration of the experiences of community dwelling older adults with sensory impairment/s receiving polypharmacy on their pharmaceutical care journey. Most developed countries have increasing numbers of community dwelling older people with both multi-morbidity and sensory impairment that includes visual, hearing or dual impairment. Older people with sensory impairment are more likely to have chronic health conditions and to be in receipt of polypharmacy (>4 medicines (...) ). It is important to understand their experience of pharmaceutical care provision to facilitate a safe, appropriate and person centred approach.this study explored the pharmaceutical care experiences and perspectives of older people with sensory impairment receiving polypharmacy.exploratory qualitative study with semi-structured telephone or face-to-face interviews with community dwelling older adults with sensory impairment receiving polypharmacy in Scotland in 2016.in total, 23 interviews were conducted

2019 Age and ageing

34. Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care. Full Text available with Trip Pro

Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care. Polypharmacy is on the rise. It is burdensome for patients and is a common source of error and adverse drug reactions, especially among older adults. Health policy advises clinicians to practice medicines optimisation-a person-centred approach to safe, effective medicines use. There has been little research exploring older patients (...) of observations in the home and clinical settings; interviews with patients and professionals; cultural probe activities; video recordings of clinical consultations and interprofessional talk; documents. Our analysis will illuminate the everyday practices of polypharmacy from a range of lay and professional perspectives; the institutional contexts within which these practices play out and the sense-making work that sustains-or challenges-these practices. Our research will adopt a 'practice theory' lens

2019 BMJ open

35. Confronting Medicine's Dichotomies: Older Adults' Use of Interpretative Repertoires in Negotiating the Paradoxes of Polypharmacy and Deprescribing. (Abstract)

Confronting Medicine's Dichotomies: Older Adults' Use of Interpretative Repertoires in Negotiating the Paradoxes of Polypharmacy and Deprescribing. To address the risks associated with polypharmacy, health care providers are investigating the feasibility of deprescribing programs as part of routine medical care to reduce medication burden to older adults. As older adults are enrolled in these programs, they are confronted with two dominant and legitimate accounts of medications, labeled

2019 Qualitative Health Research

36. Polypharmacy among Older Individuals with COPD: Trends between 2000 and 2015 in Quebec, Canada. (Abstract)

Polypharmacy among Older Individuals with COPD: Trends between 2000 and 2015 in Quebec, Canada. The treatment of chronic obstructive pulmonary disease (COPD) and concomitant diseases requires several medications. Yet there is little data on how the pharmacological burden progressed over time among older individuals with COPD. We aimed to: 1) describe the proportion of older adults with COPD in Quebec, Canada, that were exposed to polypharmacy (≥10, ≥15 or ≥20 medications/year) between 2000 (...) between the years. The average number of drugs used increased from 12.0 in 2000 to 14.8 in 2015. The proportion of individuals exposed to polypharmacy increased (≥10 drugs: 62.0% to 74.6%;≥15 drugs: 31.2% to 45.4%; ≥20 drugs: 12.3% to 22.4%). The proportion of individuals receiving long-acting bronchodilators increased from 18.7% in 2000 to 69.6% in 2015. The use of short-acting bronchodilators decreased from 81.5% to 67.9%, and that of inhaled corticosteroids from 60.6% to 26.0%. The proportion

2019 COPD

37. Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. (Abstract)

Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP.We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing

2019 Journal of Affective Disorders

38. Polypharmacy and drug-drug interactions in HIV-infected subjects in the region of Madrid, Spain: a population-based study. Full Text available with Trip Pro

Polypharmacy and drug-drug interactions in HIV-infected subjects in the region of Madrid, Spain: a population-based study. Drug-drug interactions (DDIs) involving antiretrovirals (ARVs) tend to cause harm if unrecognized, especially in the context of multiple co-morbidity and polypharmacy.A database linkage was established between the regional drug dispensing registry of Madrid and the Liverpool HIV DDI database (January-June 2017). Polypharmacy was defined as the use of ≥5 non-HIV medications (...) , and DDIs were classified by a traffic-light ranking for severity. HIV-uninfected controls were also included.A total of 22,945 patients living with HIV (PLWH) and 6,613,506 uninfected individuals had received medications. Antiretroviral therapy regimens were predominantly based on integrase inhibitors (51.96%). Polypharmacy was significantly higher in PLWH (32.94%) than uninfected individuals (22.16%; P<0.001), and this difference was consistently observed across all age strata except for individuals

2019 Clinical Infectious Diseases

39. Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. Full Text available with Trip Pro

Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. The effectiveness of antipsychotic polypharmacy in schizophrenia relapse prevention is controversial, and use of multiple agents is generally believed to impair physical well-being.To study the association of specific antipsychotic combinations with psychiatric rehospitalization.In this nationwide cohort study, the risk of psychiatric rehospitalization was used (...) as a marker for relapse among 62 250 patients with schizophrenia during the use of 29 different antipsychotic monotherapy and polypharmacy types between January 1, 1996, and December 31, 2015, in a comprehensive, nationwide cohort in Finland. We conducted analysis of the data from April 24 to June 15, 2018. Rehospitalization risks were investigated by using within-individual analyses to minimize selection bias.Hazard ratio (HR) for psychiatric rehospitalization during use of polypharmacy vs during

2019 JAMA psychiatry (Chicago, Ill.)

40. Clinical Utility of Pharmacogenetic Testing and a Clinical Decision Support Tool to Enhance the Identification of Drug Therapy Problems Through Medication Therapy Management in Polypharmacy Patients. (Abstract)

Clinical Utility of Pharmacogenetic Testing and a Clinical Decision Support Tool to Enhance the Identification of Drug Therapy Problems Through Medication Therapy Management in Polypharmacy Patients. In polypharmacy patients, medication therapy management (MTM) services provide a comprehensive review of current medications and future treatment goals. Pharmacogenetics (PGx) may further optimize the identification of potential drug therapy problems (DTPs); however, the clinical utility of PGx (...) information with a clinical decision support tool (CDST) in an MTM setting in identifying DTPs has not been systematically assessed.To assess the clinical utility of an MTM service enhanced by pharmacogenetic test results and a clinical decision support tool.This study was a post hoc analysis of the data obtained from an open-label, randomized, observational trial. Polypharmacy patients eligible for MTM service were randomly assigned to 3 intervention arms: standard MTM (SMTM), MTM incorporating CDST

2019 Journal of managed care & specialty pharmacy Controlled trial quality: uncertain

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