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Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences

Polypharmacy and prescribing of potentially inappropriate medications (PIMs) are the key elements of inappropriate medication use (IMU) in older multimorbid people. IMU is associated with a range of negative healthcare consequences including adverse drug events and unplanned hospitalizations. Furthe...

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Autores principales: Curtin, Denis, Gallagher, Paul F., O’Mahony, Denis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378636/
https://www.ncbi.nlm.nih.gov/pubmed/30800270
http://dx.doi.org/10.1177/2042098619829431
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author Curtin, Denis
Gallagher, Paul F.
O’Mahony, Denis
author_facet Curtin, Denis
Gallagher, Paul F.
O’Mahony, Denis
author_sort Curtin, Denis
collection PubMed
description Polypharmacy and prescribing of potentially inappropriate medications (PIMs) are the key elements of inappropriate medication use (IMU) in older multimorbid people. IMU is associated with a range of negative healthcare consequences including adverse drug events and unplanned hospitalizations. Furthermore, prescribing guidelines are commonly derived from randomized controlled clinical trials which have specifically excluded older adults with multimorbidity. Consequently, indiscriminate application of single disease pharmacotherapy guidelines to older multimorbid patients can lead to increased risk of drug–drug interactions, drug–disease interactions and poor drug adherence. Both polypharmacy and PIMs are highly prevalent in older people and strategies to improve the quality and safety of prescribing, largely through avoidance of IMU, are needed. In the last 30 years, numerous explicit PIM criteria-based tools have been developed to assist physicians with medication management in clinically complex multimorbid older people. Very few of these PIM criteria sets have been tested as an intervention compared with standard pharmaceutical care in well-designed clinical trials. In this review, we describe the most widely used sets of explicit PIM criteria to address inappropriate polypharmacy with particular focus on STOPP/START criteria and FORTA criteria which have been associated with positive patient-related outcomes when used as interventions in recent randomized controlled trials.
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spelling pubmed-63786362019-02-22 Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences Curtin, Denis Gallagher, Paul F. O’Mahony, Denis Ther Adv Drug Saf Review Polypharmacy and prescribing of potentially inappropriate medications (PIMs) are the key elements of inappropriate medication use (IMU) in older multimorbid people. IMU is associated with a range of negative healthcare consequences including adverse drug events and unplanned hospitalizations. Furthermore, prescribing guidelines are commonly derived from randomized controlled clinical trials which have specifically excluded older adults with multimorbidity. Consequently, indiscriminate application of single disease pharmacotherapy guidelines to older multimorbid patients can lead to increased risk of drug–drug interactions, drug–disease interactions and poor drug adherence. Both polypharmacy and PIMs are highly prevalent in older people and strategies to improve the quality and safety of prescribing, largely through avoidance of IMU, are needed. In the last 30 years, numerous explicit PIM criteria-based tools have been developed to assist physicians with medication management in clinically complex multimorbid older people. Very few of these PIM criteria sets have been tested as an intervention compared with standard pharmaceutical care in well-designed clinical trials. In this review, we describe the most widely used sets of explicit PIM criteria to address inappropriate polypharmacy with particular focus on STOPP/START criteria and FORTA criteria which have been associated with positive patient-related outcomes when used as interventions in recent randomized controlled trials. SAGE Publications 2019-02-13 /pmc/articles/PMC6378636/ /pubmed/30800270 http://dx.doi.org/10.1177/2042098619829431 Text en © The Author(s), 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Curtin, Denis
Gallagher, Paul F.
O’Mahony, Denis
Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
title Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
title_full Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
title_fullStr Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
title_full_unstemmed Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
title_short Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
title_sort explicit criteria as clinical tools to minimize inappropriate medication use and its consequences
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378636/
https://www.ncbi.nlm.nih.gov/pubmed/30800270
http://dx.doi.org/10.1177/2042098619829431
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