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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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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 |
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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 |
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