Medication-related problems in geriatric psychiatry-a retrospective cohort study.
adverse drug reactions
drug-drug interactions
geriatric psychiatry
medication-related problems
pharmacotherapy safety
Journal
International journal of geriatric psychiatry
ISSN: 1099-1166
Titre abrégé: Int J Geriatr Psychiatry
Pays: England
ID NLM: 8710629
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
27
04
2022
accepted:
12
08
2022
pubmed:
26
8
2022
medline:
27
8
2022
entrez:
25
8
2022
Statut:
ppublish
Résumé
Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60 years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. 230 patients (63.0% female, mean age 73.7 ± 8.4 years, median length of stay 18 days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180). The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy. The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
Références
European Medicines Agency. ICH Guideline E7 Studies in Support of Special Populations: Geriatrics; 1994.
Marengoni A, Onder G. Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ. 2015;350(mar11 4):h1059. https://doi.org/10.1136/bmj.h1059
Davies EA, O'Mahony MS. Adverse drug reactions in special populations-the elderly. Br J Clin Pharmacol. 2015;80(4):796-807. https://doi.org/10.1111/bcp.12596
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6-14. https://doi.org/10.1046/j.1365-2125.2003.02007.x
van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859-867. https://doi.org/10.1345/aph.1d182
Ates Bulut E, Isik AT. Abuse/misuse of prescription medications in older adults. Clin Geriatr Med. 2022;38(1):85-97. https://doi.org/10.1016/j.cger.2021.07.004
Einarson TR. Drug-related hospital admissions. Ann Pharmacother. 1993;27(7-8):832-840. https://doi.org/10.1177/106002809302700702
Mosshammer D, Haumann H, Morike K, Joos S. Polypharmacy-an upward trend with unpredictable effects. Dtsch Arztebl Int. 2016;113(38):627-633.
Schneider F, Erhart M, Hewer W, Loeffler LA, Jacobi F. Mortality and medical comorbidity in the severely mentally Ill. Dtsch Arztebl Int. 2019;116(23-24):405-411.
Kratz T, Diefenbacher A. Psychopharmacological treatment in older people: avoiding drug interactions and polypharmacy. Dtsch Arztebl Int. 2019;116(29-30):508-518.
Gerbel S, Laser H, Schoenfeld N, Rassmann T. The Hannover Medical School Enterprise Clinical Research Data Warehouse: 5 Years of Experience. In: Data Integration in the Life Sciences. 13th International Conference, DILS 2018, Hannover, Germany, November 20-21, 2018, Proceedings. Springer International Publishing; 2019:182-194.
Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007;63(2):187-195. https://doi.org/10.1111/j.1365-2125.2006.02744.x
Watson LC, Esserman DA, Ivey JL, et al. Enhancing quality in psychiatry with psychiatrists (EQUIPP)-results from a pilot study. Am J Geriatr Psychiatry. 2014;22(9):884-888. https://doi.org/10.1016/j.jagp.2013.01.075
GKV Spitzenverband. Statutory Health Insurance; 2019. Accessed 25 Jan 2022. https://www.gkv-spitzenverband.de/english/statutory_health_insurance/statutory_health_insurance.jsp
Holt S, Schmiedl S, Thuermann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31-32):543-551.
Heck J, Krichevsky B, Stichtenoth DO, Zu Siederdissen CH, Krause O. Duplicate prescriptions-proposal of a clinically oriented categorisation. Eur J Clin Pharmacol. 2021;77(10):1589-1591. https://doi.org/10.1007/s00228-021-03143-8
Schneider A, Hommel G, Blettner M. Linear regression analysis. Dtsch Arztebl International. 2010:776-782.
Egger SS, Drewe J, Schlienger RG. Potential drug-drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol. 2003;58(11):773-778. https://doi.org/10.1007/s00228-002-0557-z
Heilmann KE, Wagner M, Riedel-Heller S, Maier W, Jessen F. Treating late life depression with antidepressants-a summary of recommendations in international guidelines. Fortschr Neurol Psychiatr. 2015;83(7):381-391. https://doi.org/10.1055/s-0035-1553315
Boettiger Y, Laine K, Andersson ML, et al. SFINX-a drug-drug interaction database designed for clinical decision support systems. Eur J Clin Pharmacol. 2009;65(6):627-633. https://doi.org/10.1007/s00228-008-0612-5
van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inf Assoc. 2006;13(2):138-147. https://doi.org/10.1197/jamia.m1809
Kirilochev OO, Dorfman IP, Umerova AR, Bataeva SE. Potential drug-drug interactions in the psychiatric hospital: frequency analysis. Re Results in Pharmacol. 2019;5(4):1-6. https://doi.org/10.3897/rrpharmacology.5.39681
Nobili A, Pasina L, Tettamanti M, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Therapeut. 2009;34(4):377-386. https://doi.org/10.1111/j.1365-2710.2009.01021.x
Solmi M, Murru A, Pacchiarotti I, et al. Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review. Therapeut Clin Risk Manag. 2017;13:757-777. https://doi.org/10.2147/tcrm.s117321
Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012;5(4):219-232. https://doi.org/10.1177/1756283x12437358
Soennerstam E, Sjoelander M, Loevheim H, Gustafsson M. Clinically relevant drug-drug interactions among elderly people with dementia. Eur J Clin Pharmacol. 2018;74(10):1351-1360. https://doi.org/10.1007/s00228-018-2514-5
Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalised patients-frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005;61(9):675-681. https://doi.org/10.1007/s00228-005-0978-6
Doucet J, Chassagne P, Trivalle C, et al. Drug-drug interactions related to hospital admissions in older adults: a prospective study of 1000 patients. J Am Geriatr Soc. 1996;44(8):944-948. https://doi.org/10.1111/j.1532-5415.1996.tb01865.x
Kohler GI, Bode-Boger SM, Busse R, Hoopmann M, Welte T, Boger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther. 2000;38(11):504-513. https://doi.org/10.5414/cpp38504
Bjorkman IK, Fastbom J, Schmidt IK, et al. Pharmaceutical care of the elderly in Europe research (PEER) group. Drug-Drug interactions in the elderly. Ann Pharmacother. 2002;36(11):1675-1681. https://doi.org/10.1345/aph.1a484
Cool C, Cestac P, McCambridge C, et al. Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention. Br J Clin Pharmacol. 2018;84(7):1598-1610. https://doi.org/10.1111/bcp.13598
Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63(8):725-731. https://doi.org/10.1007/s00228-007-0324-2
Eshetie TC, Nguyen TA, Gillam MH, Kalisch Ellett LM. Potentially inappropriate prescribing in people with dementia: an Australian population-based study. Int J Geriatr Psychiatr. 2019;34(10):1498-1505. https://doi.org/10.1002/gps.5160
Idil E, Aydin AE, Ates Bulut E, Isik AT. Rationally decreasing the number of drugs seems to be a useful therapeutic approach in older adults: 6-month follow-up study. Arch Gerontol Geriatr. 2021;96:104472. https://doi.org/10.1016/j.archger.2021.104472
Ates Bulut E, Erken N, Kaya D, Dost FS, Isik AT. An increased anticholinergic drug burden index score negatively affect nutritional status in older patients without dementia. Front Nutr. 2022;9:789986. https://doi.org/10.3389/fnut.2022.789986
Heck J, Krause O, Schulze Westhoff M, et al. The interdisciplinary psychiatric ward round-evaluation of a pilot project. Psychopharmakotherapie. 2021;28:63-70.