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jueves, 1 de diciembre de 2011

Inappropiate prescribing in older people


Inappropriate prescribing and adverse drug events in older people
Hilary J Hamilton, Paul F Gallagher and Denis O'Mahony
BMC Geriatrics 2009; 9:5 doi:10.1186/1471-2318-9-5

Abstract
Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training



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4 drugs accounted for two thirds of emergency
hospitalizations in US
Handful of drugs are responsible for most emergency room visits by patients in US, revealed by CDC researchers (US Centers for Disease Control and Prevention) in a recent study.
-->The study researchers pointed out four drugs and drug classes - warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents.
An estimated 100000 older Americans are hospitalized for adverse drug reactions yearly, and most of those emergencies stem from these four common drugs. The study used data collected between 2007 and 2009 from a nationally representative sample of 58 hospitals participating in CDC's National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. Four medications, used alone or together, accounted for two–thirds of the emergency hospitalizations:
- 33 percent, or 33,171 emergency hospitalizations, involved warfarin, a medication used to prevent blood clots.
- 14 percent involved insulins. Insulin injections are used to control blood sugar in people who have diabetes.
- 13 percent involved antiplatelet drugs, such as aspirin or clopidogrel, which prevent platelets, or pieces of blood cells from clumping together to start a clot.
- 11 percent involved diabetes medications that are taken by mouth, called oral hypoglycemic agents.
This study identified specific medication safety issues that provide the greatest opportunities for reducing patient harm and health care utilization today. Continued national monitoring of adverse drug events will be important as new medications are approved and become more commonly used.