Cargando…

Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months

Polypharmacy with “potentially inappropriate medications” (PIMs) and “potential prescribing omissions” (PPOs) are frequent among those 65 and older. We assessed PIMs and PPOs in a retrospective study of 82,935 patients ≥ 65 during their first admission in the period March 2013 through February 2018...

Descripción completa

Detalles Bibliográficos
Autores principales: Thomas, Roger E., Nguyen, Leonard T., Jackson, Dave, Naugler, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344435/
https://www.ncbi.nlm.nih.gov/pubmed/32545451
http://dx.doi.org/10.3390/geriatrics5020037
_version_ 1783555943010664448
author Thomas, Roger E.
Nguyen, Leonard T.
Jackson, Dave
Naugler, Christopher
author_facet Thomas, Roger E.
Nguyen, Leonard T.
Jackson, Dave
Naugler, Christopher
author_sort Thomas, Roger E.
collection PubMed
description Polypharmacy with “potentially inappropriate medications” (PIMs) and “potential prescribing omissions” (PPOs) are frequent among those 65 and older. We assessed PIMs and PPOs in a retrospective study of 82,935 patients ≥ 65 during their first admission in the period March 2013 through February 2018 to the four acute-care Calgary hospitals. We used the American Geriatric Society (AGS) and STOPP/START criteria to assess PIMs and PPOs. We computed odds ratios (ORs) for key outcomes of concern to patients, their families, and physicians, namely readmission and/or mortality within six months of discharge, and controlled for age, sex, numbers of medications, PIMs, and PPOs. For readmission, the adjusted OR for number of medications was 1.09 (1.09–1.09), for AGS PIMs 1.14 (1.13–1.14), for STOPP PIMs 1.15 (1.14–1.15), for START PPOs 1.04 (1.02–1.06), and for START PPOs correctly prescribed 1.16 (1.14–1.17). For mortality within 6 months of discharge, the adjusted OR for the number of medications was 1.02 (1.01–1.02), for STOPP PIMs 1.07 (1.06–1.08), for AGS PIMs 1.11 (1.10–1.12), for START PPOs 1.31 (1.27–1.34), and for START PPOs correctly prescribed 0.97 (0.94–0.99). Algorithm rule mining identified an 8.772 higher likelihood of mortality with the combination of STOPP medications of duplicate drugs from the same class, neuroleptics, and strong opioids compared to a random relationship, and a 2.358 higher likelihood of readmission for this same set of medications. Detailed discussions between patients, physicians, and pharmacists are needed to improve these outcomes.
format Online
Article
Text
id pubmed-7344435
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-73444352020-07-14 Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months Thomas, Roger E. Nguyen, Leonard T. Jackson, Dave Naugler, Christopher Geriatrics (Basel) Article Polypharmacy with “potentially inappropriate medications” (PIMs) and “potential prescribing omissions” (PPOs) are frequent among those 65 and older. We assessed PIMs and PPOs in a retrospective study of 82,935 patients ≥ 65 during their first admission in the period March 2013 through February 2018 to the four acute-care Calgary hospitals. We used the American Geriatric Society (AGS) and STOPP/START criteria to assess PIMs and PPOs. We computed odds ratios (ORs) for key outcomes of concern to patients, their families, and physicians, namely readmission and/or mortality within six months of discharge, and controlled for age, sex, numbers of medications, PIMs, and PPOs. For readmission, the adjusted OR for number of medications was 1.09 (1.09–1.09), for AGS PIMs 1.14 (1.13–1.14), for STOPP PIMs 1.15 (1.14–1.15), for START PPOs 1.04 (1.02–1.06), and for START PPOs correctly prescribed 1.16 (1.14–1.17). For mortality within 6 months of discharge, the adjusted OR for the number of medications was 1.02 (1.01–1.02), for STOPP PIMs 1.07 (1.06–1.08), for AGS PIMs 1.11 (1.10–1.12), for START PPOs 1.31 (1.27–1.34), and for START PPOs correctly prescribed 0.97 (0.94–0.99). Algorithm rule mining identified an 8.772 higher likelihood of mortality with the combination of STOPP medications of duplicate drugs from the same class, neuroleptics, and strong opioids compared to a random relationship, and a 2.358 higher likelihood of readmission for this same set of medications. Detailed discussions between patients, physicians, and pharmacists are needed to improve these outcomes. MDPI 2020-06-12 /pmc/articles/PMC7344435/ /pubmed/32545451 http://dx.doi.org/10.3390/geriatrics5020037 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Thomas, Roger E.
Nguyen, Leonard T.
Jackson, Dave
Naugler, Christopher
Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months
title Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months
title_full Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months
title_fullStr Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months
title_full_unstemmed Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months
title_short Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months
title_sort potentially inappropriate prescribing and potential prescribing omissions in 82,935 older hospitalised adults: association with hospital readmission and mortality within six months
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344435/
https://www.ncbi.nlm.nih.gov/pubmed/32545451
http://dx.doi.org/10.3390/geriatrics5020037
work_keys_str_mv AT thomasrogere potentiallyinappropriateprescribingandpotentialprescribingomissionsin82935olderhospitalisedadultsassociationwithhospitalreadmissionandmortalitywithinsixmonths
AT nguyenleonardt potentiallyinappropriateprescribingandpotentialprescribingomissionsin82935olderhospitalisedadultsassociationwithhospitalreadmissionandmortalitywithinsixmonths
AT jacksondave potentiallyinappropriateprescribingandpotentialprescribingomissionsin82935olderhospitalisedadultsassociationwithhospitalreadmissionandmortalitywithinsixmonths
AT nauglerchristopher potentiallyinappropriateprescribingandpotentialprescribingomissionsin82935olderhospitalisedadultsassociationwithhospitalreadmissionandmortalitywithinsixmonths