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Polypharmacy

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101. Polypharmacy, defined as taking five or more drugs, is inadequate in the cardiovascular setting. Full Text available with Trip Pro

Polypharmacy, defined as taking five or more drugs, is inadequate in the cardiovascular setting. By how much polypharmacy (defined by number of drugs) differs from polyactive ingredient use (defined by the number of pharmacologically active ingredients) has not been assessed.To compare the extent of polypharmacy vs. polyactive ingredients among patients taking cardiovascular (CV) medicines.Prospective, 10-year follow-up study conducted among 880 participants of the CoLaus study taking CV drugs (...) at baseline. Polypharmacy was defined as the use of five or more CV medicines; polyactive ingredient use was defined as the use of five or more pharmacologically active CV ingredients.The prevalence of polypharmacy increased from 1.4% (0.7-2.4) (prevalence rate [95% confidence interval]) at baseline to 11.9% (9.9-14.3) at follow-up, and the prevalence of polyactive ingredients increased from 2.4% (1.5-3.6) at baseline to almost 17.6% (15.2-20.3) at follow-up. The prevalence of combination drugs increased

2018 Journal of Clinical Epidemiology

102. Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care. Full Text available with Trip Pro

Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care. To develop a core outcome set (COS) for use in effectiveness trials of interventions aiming to improve the appropriateness of polypharmacy in older people in primary care.Standard COS development methodology was followed, comprising identification of outcomes of studies from an update of a Cochrane systematic review and previously collected qualitative data and an online Delphi (...) the outcome as critical and 15% or fewer scoring the outcome as not important.Twenty-nine outcomes identified from the Cochrane review and existing qualitative data were included in the Delphi exercise. The final COS comprised 16 outcomes. The 7 highest-ranked outcomes were serious adverse drug reactions, medication appropriateness, falls, medication regimen complexity, quality of life, mortality, and medication side effects.A COS for interventions aiming to improve the appropriateness of polypharmacy

2018 Journal of the American Geriatrics Society

103. Polypharmacy in people with dementia: Associations with adverse health outcomes. Full Text available with Trip Pro

Polypharmacy in people with dementia: Associations with adverse health outcomes. Polypharmacy has been linked to higher risks of hospitalisation and death in community samples. It is commonly present in people with dementia but these risks have rarely been studied in this population. We aimed to investigate associations between polypharmacy and emergency department attendance, any and unplanned hospitalisation, and mortality in patients with dementia. Using a large mental health care database (...) of emergency department attendance (hazard ratio 1.20/1.35), hospitalisation (hazard ratio 1.12/1.32), unplanned hospital admission (hazard ratio 1.12/1.25), and death within two years (hazard ratio 1.29/1.39) after controlling for potential confounders. We found evidence of a dose response relationship with each additional drug at baseline increasing the risk of emergency department attendance and mortality by 5% and hospitalisation by 3%. In conclusion, polypharmacy at dementia diagnosis is associated

2018 Experimental Gerontology

104. Variation of polypharmacy in older primary care attenders occurs at prescriber level. Full Text available with Trip Pro

Variation of polypharmacy in older primary care attenders occurs at prescriber level. Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public (...) and private primary care clinics, and its association with patient, prescriber and practice characteristics.We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy

2018 BMC Geriatrics

105. Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. Full Text available with Trip Pro

Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status.Data on HIV+ and uninfected individuals in the US Veterans Affairs (...) Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication. We calculated average non-antiretroviral medication count for fiscal year 2009. As there is no established threshold for non-antiretroviral polypharmacy, we considered more than two and at least five medications. We followed for hospitalization and mortality (fiscal year 2010-2015), adjusting for age, sex, race/ethnicity and VACS Index.Among 9473

2018 AIDS

106. Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA). Full Text available with Trip Pro

Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA). While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5-9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England.Cross (...) -sectional study.The English Longitudinal Study of Ageing Wave 6 (2012-2013).7730 participants aged over 50 years.Two multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition.Lower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95% CI 1.04 to 1.69, P=0.02) and obesity

2018 BMJ open

107. Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery: A Population-based Cohort Study. (Abstract)

Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery: A Population-based Cohort Study. Polypharmacy is increasingly prevalent in older patients and is associated with adverse events among medical patients. The impact of polypharmacy on outcomes after elective surgery is poorly described. The authors' objective was to measure the association of polypharmacy with survival, complications, and resource use among older patients (...) undergoing elective surgery.After registration (NCT03133182), the authors identified all individuals older than 65 yr old having their first elective noncardiac surgery in Ontario, Canada, between 2002 and 2014. Using linked administrative data, the authors identified all prescriptions dispensed in the 90 days before surgery and classified people receiving five or more unique medications with polypharmacy. The associations of polypharmacy with 90-day survival (primary outcome), complications, length

2018 Anesthesiology

108. International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. Full Text available with Trip Pro

International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. Comparisons of clinical trial findings in systematic reviews can be hindered by the heterogeneity of the outcomes reported. Moreover, the outcomes that matter most to patients might be underreported. A core outcome set can address these issues, as it defines a minimum set of outcomes that should be reported in all clinical trials in a particular area of research (...) patients with polypharmacy.

2018 BMC Medicine

109. Characteristics of elderly patients with polypharmacy who refuse to participate in an in-hospital deprescribing intervention: a retrospective cross-sectional study. Full Text available with Trip Pro

Characteristics of elderly patients with polypharmacy who refuse to participate in an in-hospital deprescribing intervention: a retrospective cross-sectional study. Few studies have evaluated the characteristics of elderly patients with polypharmacy refusing deprescribing. The aim of this study was to evaluate the prevalence of potentially inappropriate medication (PIM) use in elderly patients accepting and refusing a deprescribing intervention and to investigate factors associated (...) with deprescribing refusal.We conducted a retrospective cross-sectional study by analyzing the electronic medical records from a single hospital. All consecutive patients aged 65 years or older who reported the use of five or more medications upon admission to the orthopedic ward from January 2015 to December 2016 and who were approached by a pharmacist for polypharmacy screening were included. Patients who had provided consent for the deprescribing intervention by the internal medicine physicians were defined

2018 BMC Geriatrics

110. Non antiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. (Abstract)

Non antiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals.

2018 AIDS

111. Narrative medicine-based intervention in primary care to reduce polypharmacy: results from the cluster-randomised controlled trial MultiCare AGENDA. Full Text available with Trip Pro

Narrative medicine-based intervention in primary care to reduce polypharmacy: results from the cluster-randomised controlled trial MultiCare AGENDA. To determine if patient-centred communication leads to a reduction of the number of medications taken without reducing health-related quality of life.Two-arm cluster-randomised controlled trial.55 primary care practices in Hamburg, Düsseldorf and Rostock, Germany.604 patients 65 to 84 years of age with at least three chronic conditions.Within

2018 BMJ open Controlled trial quality: predicted high

112. Inappropriate medication use and polypharmacy in end-stage cancer patients: Isn't it the family doctor's role to de-prescribe much earlier? (Abstract)

Inappropriate medication use and polypharmacy in end-stage cancer patients: Isn't it the family doctor's role to de-prescribe much earlier? Elderly patients are exposed to increased number of medications, often with no proof of a positive benefit/risk ratio. Unfortunately, this trend does not spare those with limited life expectancy, including end-stage cancer patients who require only palliative treatment. For many medications in this subpopulation, the risk of adverse drug events outweighs (...) the possible benefits and yet, many are still poly-medicated during their last year of life.To describe the extent of polypharmacy among end-stage cancer patients, at the time of admission to homecare hospice.A retrospective chart review of 202 patients admitted to Homecare Hospice of the Israel Cancer Association and died before January 2015.Average lifespan from admission until death was 39.2 ± 5.4 days. 63% died within the first month, 89% within 3 months. Excluding oncological treatments, 181 (90

2018 International journal of clinical practice

113. Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study. (Abstract)

Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study. Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe.We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices (...) for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (≥ 10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy.Polypharmacy was observed in 730 (39.0

2018 Drugs & Aging

114. Using Pharmacogenetics to Identify Patients With Polypharmacy at Risk of Medication Adverse Effects

Using Pharmacogenetics to Identify Patients With Polypharmacy at Risk of Medication Adverse Effects Using Pharmacogenetics to Identify Patients With Polypharmacy at Risk of Medication Adverse Effects - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please (...) remove one or more studies before adding more. Using Pharmacogenetics to Identify Patients With Polypharmacy at Risk of Medication Adverse Effects The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03748355 Recruitment Status : Enrolling by invitation First Posted : November 20, 2018 Last Update Posted

2018 Clinical Trials

115. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. Full Text available with Trip Pro

Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted (...) a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments

2018 Journal of internal medicine

116. Erdosteine: Drug exhibiting polypharmacy for the treatment of respiratory diseases. (Abstract)

Erdosteine: Drug exhibiting polypharmacy for the treatment of respiratory diseases. Mucoactive drugs are commonly used in the treatment of acute respiratory tract diseases, such as lower and acute respiratory infection and chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) in which an increased mucus secretion is one of main clinical features. Indeed these drugs are designed to promote secretion clearance and to specifically alter the viscoelastic properties of mucus

2018 Pulmonary Pharmacology & Therapeutics

117. Using an Integrated Care Pathway for Late-Life Schizophrenia Improves Monitoring of Adverse Effects of Antipsychotics and Reduces Antipsychotic Polypharmacy. (Abstract)

Using an Integrated Care Pathway for Late-Life Schizophrenia Improves Monitoring of Adverse Effects of Antipsychotics and Reduces Antipsychotic Polypharmacy. Antipsychotic use in older patients is associated with many adverse effects, including tardive dyskinesia and extrapyramidal symptoms, which, in turn, increase the risk of falling. Antipsychotics are also associated with metabolic syndrome and cognitive impairment in older patients. Integrated care pathways (ICPs) are designed to manage (...) conditions.Monitoring rates were significantly higher in the ICP group than in the TAU group for all assessments: extrapyramidal symptoms (94% versus 5%), metabolic disturbances (91% versus 25%), fall risk (82% versus 35%), and cognitive impairment (72% versus 28%). Rates of antipsychotic polypharmacy were also six times higher in the TAU group.Older patients with schizophrenia treated with antipsychotics within an ICP experience higher rates of monitoring and less psychotropic polypharmacy than older patients

2018 The American Journal of Geriatric Psychiatry Controlled trial quality: uncertain

118. Conceptualising multiple drug use in patients with comorbidity and multimorbidity: proposal for standard definitions beyond the term polypharmacy. Full Text available with Trip Pro

Conceptualising multiple drug use in patients with comorbidity and multimorbidity: proposal for standard definitions beyond the term polypharmacy. With older and aging populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Although the term "polypharmacy" has been applied (...) to the use of multiple medications, there is no consistent definition, and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used, which reclassifies the term "polypharmacy" into distinct phenotypes relating to the index chronic disease, additional conditions to the index (comorbidity), or the experience of multiple chronic conditions at the same time (multimorbidity). Using three exemplar index conditions

2018 Journal of Clinical Epidemiology

119. How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study. Full Text available with Trip Pro

How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study. Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population.GPs took an online survey that presented case-vignettes of a frail oldest-old patient

2018 BMC Family Practice

120. Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study. Full Text available with Trip Pro

Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study. To investigate longitudinal associations between polypharmacy and cognitive and physical capability and to determine whether these associations differ with cumulative exposure to polypharmacy.Prospective birth cohort study.England, Scotland, and Wales.An eligible sample of men and women from the Medical Research Council National Survey of Health and Development with medication data at age 69 (...) (N=2,122, 79%).Cognitive capability was assessed using a word learning test, visual search speed task, and the Addenbrooke's Cognitive Examination, Third Edition (ACE-III). Physical capability was measured using chair rise speed, standing balance time, walking speed, and grip strength.Polypharmacy (5-8 prescribed medications) was present in 18.2% of participants at age 69 and excessive polypharmacy (≥9 prescribed medications) in 4.7%. Both were associated with poorer cognitive and physical

2018 Journal of the American Geriatrics Society

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