ORCID Profile
0000-0001-9131-7465
Current Organisations
University of Tasmania
,
Tamil Nadu Dr MGR Medical University
,
University of Otago
,
JSS University
,
Swinburne University of Technology
,
Bharathiar University
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Publications
Comparison of anticholinergic risk scales and associations with adverse health outcomes in older people
Publisher: Wiley
Date: 2015
DOI: 10.1111/JGS.13206
Abstract: To investigate whether anticholinergic burden scores from nine published anticholinergic scales are associated with adverse health outcomes, including hospital admissions, hospitalizations for falls, hospital length of stay (LOS), and more visits to general practitioners (GPs). Pharmacoepidemiological population-based study. New Zealand. Population aged 65 and older (n = 537,387). Data were analyzed for 537,387 in iduals from the Pharmaceutical Claims Data Mart data set (2011). Anticholinergic medication exposure was calculated using nine published scales. Events information (2012) was extracted from the National Minimum Datasets using International Classification of Diseases, Tenth Revision, codes. Predictors of hospital admissions, hospitalizations for falls, LOS, and GP visits were examined using regression models adjusting for age, sex, ethnicity, comorbidities, and polypharmacy. Prevalence of exposure to anticholinergic medicines ranged from 22.8% to 55.9% according to the different scales. Multivariate regression analysis showed that anticholinergic burden scores quantified according to all nine scales were significantly associated with hospital admissions, hospitalizations for falls, LOS, and GP visits (P < .001). The strongest predictors of these outcomes were the Drug Burden Index-Anticholinergic component scores, aged 85 and older, female sex, and polypharmacy. There are substantial differences in the estimation of anticholinergic burden exposure between the nine scales. Anticholinergic burden scores obtained from each of the scales were associated with adverse clinical outcomes of interest.
A Systematic Review Evaluating the Use of the interRAI Home Care Instrument in Research for Older People
Publisher: Informa UK Limited
Date: 15-03-2019
THESEUS: A key space mission concept for Multi-Messenger Astrophysics
Publisher: Elsevier BV
Date: 08-2018
Residential medication management reviews of antithrombotic therapy in aged care residents with atrial fibrillation: assessment of stroke and bleeding risk
Publisher: Hindawi Limited
Date: 07-04-2016
DOI: 10.1111/JCPT.12385
Abstract: Antithrombotics reduce the risk of stroke in in iduals with atrial fibrillation (AF). However, optimal prescribing of antithrombotics in older people remains a challenge. The objective of this study was to assess the risk of stroke for aged care home residents with AF and to examine the pharmacist-led medication reviews on the utilization of antithrombotic therapy. This retrospective study included a random s le of de-identified residential medication management reviews (RMMRs) conducted by accredited pharmacists in aged care homes in Sydney, Australia, between August 2011 and December 2012. The study participants were 146 residents aged 65 years and older with AF living in low- and high-care residential aged care facilities. Antithrombotic therapy was examined among the residents, before and after medication review. CHADS2 , CHA2 DS2 -VASc, and HEMORR2 HAGES scoring tools were used to assess the risk of stroke and bleeding and indicate the appropriateness of antithrombotic therapy. The mean age (±SD) of in iduals was 88·4 (7·5) years, and 63·7% (n = 93) were female. The majority of residents (n = 99, 67·8%) were aged between 85 and 99 years. The mean (±SD) CHADS2 score was 3·1 (1·1), CHA2 DS2 -VASc was 4·6 (1·5), and HEMORR2 HAGES was 2·3 (1·0). All residents were classified as being at high risk of developing stroke. A total of 115 of 146 (78·8%) residents with AF were prescribed antithrombotics. There was a relatively low usage of anticoagulation (28·1%), and few recommendations from the medication review pharmacists to alter the thromboprophylactic therapy in AF. Application of the CHA2 DS2 -VASc risk tool indicated that 146 residents were eligible for antithrombotic treatments of these, 74 (50·7%) were prescribed antiplatelets and 41 (28·1%) were prescribed anticoagulants. Of the 31 (21·2%) residents with AF were not prescribed antithrombotics, 21 (67·7%) had relative contraindications for anticoagulant treatments. Although there was a high overall use of antithrombotic agents, the study found a reluctance to prescribe or recommend anticoagulants in eligible older people with AF, potentially due to associated contraindications and multimorbidity. The use of guideline-recommended stroke risk tools could assist medication review pharmacists in optimizing antithrombotic therapy in older adults with AF.
Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis
Publisher: BMJ
Date: 08-2022
DOI: 10.1136/EMERMED-2021-211660
Abstract: Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised. This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED. A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses. Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI −0.42 to −0.23, I 2 =51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I 2 =85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I 2 =95%) and quicker initiation of time-critical medications. The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams. CRD42020165234.
Incidence of Osteoporosis in Primary Care Patients with atrial fibrillation receiving different oral anticoagulants
Publisher: MDPI AG
Date: 30-10-2022
DOI: 10.3390/JCM11216438
Abstract: Background: Studies investigating the association between the use of oral anticoagulants (OACs) and osteoporosis are limited. We aimed to determine the risk of osteoporosis in patients with atrial fibrillation (AF) and receiving different OACs. Methods: We performed a population-based cohort study using a nationwide primary care dataset, MedicineInsight. Patients aged between 18 and 111 years with AF and newly recorded OAC prescriptions between 1 January 2013 and 31 December 2017 were included and followed until 31 December 2018. We applied propensity score matching to control for patients’ baseline characteristic differences before calculating adjusted hazard ratios (aHRs) for a new diagnosis of osteoporosis, using Cox proportional hazard models. Results: A total of 18,454 patients (1714 prescribed dabigatran, 5871 rivaroxaban, 5248 apixaban and 5621 warfarin) were included. Of these, 39.5% were females, and the overall mean age (standard deviation [SD] was 73.2(10.3) years. Over a mean follow-up of 841 days, 1627 patients (1028 receiving direct-acting oral anticoagulants (DOACs) and 599 warfarin) had a newly recorded diagnosis of osteoporosis. The weighted incidence rates (95% confidence interval CI) per 100 person-years of treatment were 5.0 (4.7–5.2) for warfarin, 4.3 (3.8–4.8) for dabigatran, 3.6 (3.3–3.8) for rivaroxaban, and 4.4 (4.0–4.7) for apixaban. Overall, DOAC use was associated with a significantly lower risk of a new diagnosis of osteoporosis than warfarin use (aHR, 0.79, 95% confidence interval (CI) 0.74–0.85 p 0.001). Use of each in idual DOAC was associated with a significantly lower risk of osteoporosis compared with warfarin (aHRs, 0.75, 95% CI 0.69–0.82 for rivaroxaban 0.78, 95% CI 0.71–0.86 for apixaban 0.88, 95% CI 0.77–0.99 for dabigatran). Conclusion: Compared with warfarin, the use of DOACs was associated with a significantly lower risk of developing osteoporosis in patients with AF. This association remained significant when in idual DOACs were compared with warfarin.
Ten-Year Trends in the Use of Oral Anticoagulants in Australian General Practice Patients With Atrial Fibrillation
Publisher: Frontiers Media SA
Date: 23-03-2021
DOI: 10.3389/FPHAR.2021.586370
Abstract: Objective: Appropriate use of oral anticoagulants (OACs) reduces the risk of stroke in patients with atrial fibrillation (AF). The study characterized the prescribing of OACs in people with AF in the Australian primary care setting over 10 years. Design: Retrospective population study. Setting and Participants: We performed 10 sequential cross-sectional analyses of patients with a recorded diagnosis of AF between 2009 and 2018 using national general practice data. The proportion of patients with AF who were prescribed an OAC based on their stroke risk was examined. Primary and secondary outcomes: The primary outcome was the proportion of high stroke risk patients who were prescribed an OAC over a decade. The secondary outcome was variation in OAC prescribing among general practices. Results: The s le size of patients with AF ranged from 9,874 in 2009 to 41,751 in 2018. The proportion who were prescribed an OAC increased from 39.5% (95% CI 38.6–40.5%) in 2009 to 52.0% (95% CI 51.5–52.4%) in 2018 ( p for trend & 0.001). During this time, the proportion of patients with AF and high stroke risk who were prescribed an OAC rose from 41.7% (95% CI 40.7–42.8%) to 55.2% (95% CI 54.7–55.8% p for trend & 0.001) with the direct-acting oral anticoagulants accounting for over three-quarters of usage by 2018. There was substantial variation in OAC prescribing between general practices. In 2018, the proportion of moderate to high stroke risk patients who were prescribed an OAC was 38.6% (95% CI 37.2–40.1%) in the lowest practice site quintiles and 65.6% (95% CI 64.5–66.7%) in the highest practice site quintiles. Conclusions: Over the 10 years, OAC prescribing in high stroke risk patients with AF increased by one-third. There was considerable variation in OAC prescribing between general practices.
Oral anticoagulant treatment and the risk of dementia in patients with atrial fibrillation: a population-based cohort study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2022
Abstract: We compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large cohort of primary care patients with atrial fibrillation. We performed a retrospective study using an Australia‐wide primary care data set, MedicineInsight. Patients aged ≥18 years and newly diagnosed with atrial fibrillation between January 1, 2010, and December 31, 2017, and with no recorded history of dementia or stroke were included and followed until December 31, 2018. We applied a propensity score for 1:1 pair matching of baseline covariates and Cox regression for comparing the dementia incidence rates for OAC users and nonusers. Data were analyzed for 18 813 patients with atrial fibrillation (aged 71.9±12.6 years, 47.1% women) 11 419 had a recorded OAC prescription for at least 80% of their follow‐up time. During the mean follow‐up time of 3.7±2.0 years, 425 patients (2.3% 95% CI, 2.1%–2.5%) had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59 95% CI, 0.44–0.80 P .001) compared with nonusers. Direct‐acting oral anticoagulant users had a lower incidence of dementia than non‐OAC users (HR, 0.49 95% CI, 0.33–0.73 P .001) or warfarin users (HR, 0.46 95% CI, 0.28–0.74 P =0.002). No significant difference was seen between warfarin users and non‐OAC users (HR, 1.08 95% CI, 0.70–1.70 P =0.723). In patients with atrial fibrillation, direct‐acting oral anticoagulant use may result in a lower incidence of dementia compared with treatment with either warfarin or no anticoagulant.
Cognitive adverse effects and brain deterioration associated with use of anticholinergic activity medicines in older adults
Publisher: BMJ
Date: 04-11-2016
Actual drug-related harms in residential aged care facilities: a narrative review
Publisher: Informa UK Limited
Date: 02-06-2022
DOI: 10.1080/14740338.2022.2084071
Abstract: Older people in residential aged care facilities (RACFs) have a high risk of safety issues and concerns about the potential quality of care received. This narrative review investigates the types of actual drug-related harms, their prevalence, reporting of any standard definitions for these harms, and their identification methods. The authors conducted a systematic search on Ovid Embase, Ovid Medline, and PubMed from March 2001 to March 2021. This narrative review included all types of studies targeting aged care residents aged 65 years and above with actual drug-related harms. The prevalence of actual drug-related harms in residents ranged from 0.07% to 63.0%. Falls, drug-drug interactions, neuropsychiatric symptoms, anaphylaxis, urinary tract infection, hypoglycemia, hypokalaemia, and acute kidney injury are the most common drug-related harms in older residents. Psychotropic drugs are the most common drug class implicated in these harms. Evidence related to the association between in idual psychotropic drugs and injury, or harm is also lacking. Due to the variation in study duration, reported prevalence, identification methods, and absence of a definition for actual drug-related harms in most studies, further research is mandated to understand the prevalence and clinical implications of drug-related harms in older residents.
Anticholinergics: theoretical and clinical overview
Publisher: Informa Healthcare
Date: 30-03-2016
DOI: 10.1517/14740338.2016.1165664
Abstract: Anticholinergics are a class of medicines that block the neurotransmitter, acetylcholine, in the brain and peripheral tissues. Medicines with anticholinergic activity are widely prescribed for and used by older people for various medical conditions. One-third to one-half of the medicines commonly prescribed for older people have anticholinergic activity. Several studies have reported anticholinergic burden to be a predictor of cognitive and functional impairments in older people. This article exemplifies the theoretical and clinical aspects of medicines with anticholinergic activity, including pharmacology (definition of medicines that possess anticholinergic activity, antimuscarinic receptors, therapeutic and adverse effects), epidemiology, measures and effects of cumulative anticholinergic burden in older adults, and clinical recommendations. In addition, the gaps in the literature have been identified for future research. Many medicines that are commonly prescribed to older people have a degree of anticholinergic activity that can contribute to anticholinergic burden. Anticholinergic burden, measured in several ways that consider number, dose and/or degree of anticholinergic activity of medicines, has shown to be a predictor of adverse health and functional outcomes. The anticholinergic burden on older people should be minimised by avoiding, reducing dose and deprescribing medicines with anticholinergic activity where clinically possible.
A review of current evidence allied to step-up and top-down medication therapy in inflammatory bowel disease
Publisher: Portico
Date: 2019
DOI: 10.1358/DOT.2019.55.6.2969816
Abstract: Inflammatory bowel disease (IBD), classified as a global disease in the 21st century, comprises Crohn's disease (CD) and ulcerative colitis (UC), and is manifested by chronic inflammation of the gastrointestinal tract of unknown etiology. The step-up approach is effective for inducing remission and controlling inflammation, whereas the top-down therapy appears to be a better solution for the maintenance of remission with an improved bowel function. A systematic search was performed in Ovid MEDLINE and Embase (1946-December 2018) to identify relevant trials that support medication therapy in IBD. Thirty-nine potential trials were retrieved, of which 29 focused on CD, and 10 studied UC. There is mounting evidence on both benefits and disadvantages in the application of early initiation of top-down therapy in suitably selected patients. Nevertheless, there are uncertainties about the appropriateness of these approaches for the management of IBD and there are conflicting results in overall outcomes including mucosal healing and rehospitalization. The choice of either top-down or step-up therapy in the treatment of IBD should be an in idualized approach and cannot be recommended as a part of a generalized guideline. Further prospective studies are warranted to determine whether combination therapy or aggressive therapy is superior to monotherapy.
Computer-based simulators in pharmacy practice education: a systematic narrative review
Publisher: MDPI AG
Date: 02-01-2023
Abstract: Computer-based simulations may represent an innovative, flexible, and cost-efficient training approach that has been underutilised in pharmacy practice education. This may need to change, with increasing pressure on clinical placement availability, COVID-19 restrictions, and economic pressures to improve teaching efficiency. This systematic narrative review summarises various computer-based simulations described in the pharmacy practice education literature, identifies the currently available products, and highlights key characteristics. Five major databases were searched (Medline, CINAHL, ERIC, Education Source and Embase). Authors also manually reviewed the publication section of major pharmacy simulator websites and performed a citation analysis. We identified 49 studies describing 29 unique simulators, which met the inclusion criteria. Only eight of these simulators were found to be currently available. The characteristics of these eight simulators were examined through the lens of eight main criteria (feedback type, grading, user play mode, cost, operational requirement, community/hospital setting, scenario sharing option, and interaction elements). Although a number of systems have been developed and trialled, relatively few are available on the market, and each comes with benefits and drawbacks. Educators are encouraged to consider their own institutional, professional and curriculum needs, and determine which product best aligns with their teaching goals.
A systematic review and meta-analysis on serum anticholinergic activity and adverse outcomes in older people
Publisher: Elsevier BV
Date: 09-2016
Deprescribing medications in older people: a narrative review
Publisher: Portico
Date: 2018
DOI: 10.1358/DOT.2018.54.8.2856495
Abstract: In the aging population, the process of medication prescribing and management is likely to be complex and challenging. Polypharmacy and inappropriate medication use are more prevalent among older people and are associated with geriatric syndromes, reduced cognitive and functional outcomes, and increased mortality. Deprescribing is the process of planned and supervised tapering or safe withdrawal of potentially inappropriate medication that can cause harm, or is no longer indicated or beneficial to the current therapy. The purpose of deprescribing is to reduce inappropriate polypharmacy, medication burden and harm, and to improve patient health-related outcomes. Deprescribing is best performed by reducing medicines one at a time, and the whole process requires careful assessment, effort, commitment and time. Deprescribing should be considered after careful assessment of the patient's overall health, therapeutic goals, medication adherence to current treatment regimen and willingness to deprescribe the medicine. Many medications can be safely removed to successfully achieve this, the process of deprescribing should follow an evidence-based, patient-centered and team-based approach involving both the healthcare professionals and the patient/caregivers to effectively reduce inappropriate medication use.
A study on drug–drug interactions through prescription analysis in a South Indian teaching hospital
Publisher: SAGE Publications
Date: 22-05-2013
Abstract: The objective of this study was to assess the drug–drug interactions (DDIs) through prescription analysis among the inpatients of a South Indian teaching hospital. The study was a prospective observational prescription analysis conducted for a period of 6 months, from October 2010 to March 2011. The prescriptions having two or more drugs and where a DDI was suspected were selected by the physician in charge of the ward. The drugs in the prescription were then entered into the drug interaction checker software. The DDIs were classified based on the mechanism of interactions, severity of interactions, relation to the number of drugs prescribed, and disease conditions were also determined. A total of 204 prescriptions were analyzed, of which 186 prescriptions had 856 DDIs. Most of the DDIs were pharmacokinetic drug interactions (42%) followed by unknown mechanisms (34%) and pharmacodynamic mechanisms (24%). The study findings showed that the prescriptions for cardiovascular with respiratory disease conditions had the greatest number of drug interactions on average. A severity assessment showed that majority of the DDIs were moderate (70%) followed by minor (28%). The study results showed that as the number of drugs increases in a prescription, the number of DDIs also increases. The interventions determined showed that dosage adjustment (12%) was to be followed in most of the DDIs. This study assists in understanding the factors associated with DDIs that can help in safe and effective use of drugs in the future.
Impact of Anticholinergic Discontinuation on Cognitive Outcomes in Older People: A Systematic Review
Publisher: Springer Science and Business Media LLC
Date: 14-02-2014
DOI: 10.1007/S40266-014-0158-4
Abstract: Medicines with anticholinergic properties increase the risks of functional and cognitive decline, morbidity and mortality, institutionalization and length of hospital stay in older people. It is postulated that minimizing anticholinergic burden should result in improved short-term memory, confusion and delirium, and may improve the quality of life and daily functioning of older people. The objective of this systematic review was to investigate the impact of discontinuing medicines with anticholinergic properties on cognitive outcomes in older people. A comprehensive systematic search was performed to identify relevant studies, using Medline, Embase, International Pharmaceutical Abstracts (IPA), PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials, from 1946 to July 2013. The critical appraisal was performed by two independent reviewers, and the data were extracted onto standardized forms. The primary outcome of interest was evaluation of cognitive changes in older people after anticholinergic discontinuation, measured using cognitive assessment scales. Meta-analysis was not conducted, because of the heterogeneity of the study designs, interventions and outcome measures. The primary electronic literature search identified a total of 475 records in the six different databases. On the basis of full-text analysis, only four studies met the inclusion criteria. The review found two randomized control trials and two prospective cohort studies that met the inclusion criteria. Only the cohort studies demonstrated improvement of cognitive performance after discontinuation of anticholinergic medicines. The impact of anticholinergic discontinuation on cognitive function remains poorly researched and poorly understood. A larger s le size, longer duration of follow-up and better methods of assessing anticholinergic-induced cognitive impairment are warranted.
Impact of Partnered Pharmacist Medication Charting (PPMC) on Medication Discrepancies and Errors: A Pragmatic Evaluation of an Emergency Department-Based Process Redesign
Publisher: MDPI AG
Date: 13-01-2023
Abstract: Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies’ clinical significance, with ‘unintentional’ discrepancies deemed ‘errors’. Fewer patients in the PPMC group had at least one error (3.5% 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4% 95% CI: 42.5% to 56.3%) and usual care group (61.4% 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.
Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review
Publisher: MDPI AG
Date: 28-01-2022
DOI: 10.3390/JCM11030714
Abstract: Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. Aims: This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. Results: We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. Conclusion: This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.
Study on the Classification, Causality, Preventability and Severity of Adverse Drug Reactions Found in a Tertiary Care Teaching Hospital
Publisher: MDPI AG
Date: 18-08-2018
DOI: 10.20944/PREPRINTS201808.0319.V1
Abstract: Hospital-based adverse drug reaction (ADR) monitoring and reporting programs intend to identify and quantify the risks associated with the use of drugs. To examine the causality, preventability and severity of ADR in a hospital setting a prospective cohort study on spontaneous ADR reporting was conducted from December 2015 to May 2016. Incidence of ADRs, causality, type, severity and preventability were assessed using necessary assessment scales. The study included 3157 hospitalized in iduals, in whom 51 ADRs were detected among 49 patients. The overall incidence of suspected ADRs was found to be 1.6%. According to the causality assessment, most of the ADRs reported were probable (n = 26, 51.0%), and type A (augmented harmacological) reactions (n = 39, 76%) were the most common type of ADR found. The majority of ADRs were moderate to severe (n = 35, 68.6%), of which 37.3% were found to be potentially preventable. Predictability was observed in 28 (54.9%) reported ADRs. The drugs most frequently associated with ADRs were antibiotics, antiepileptics and antihypertensives. This feasibility study was able to highlight the clinical pharmacist& rsquo s role in ADR monitoring service and create awareness about the way it could be done to promote safer drug use. Similar ADR reporting programs are necessary to educate and to improve awareness among the healthcare professionals in developing countries.
Five-Year Trends in Potential Drug Interactions with Direct-Acting Oral Anticoagulants in Patients with Atrial Fibrillation: An Australian-Wide Study
Publisher: MDPI AG
Date: 05-11-2020
DOI: 10.3390/JCM9113568
Abstract: Background: Co-prescribing medications that can interact with direct-acting oral anticoagulants (DOACs) may decrease their safety and efficacy. The aim of this study was to examine the co-prescribing of such medications with DOACs using the Australian national general practice dataset, MedicineInsight, over a five-year period. Methods: We performed five sequential cross-sectional analyses in patients with atrial fibrillation (AF) and a recorded DOAC prescription. Patients were defined as having a drug interaction if they had a recorded prescription of an interacting medication while they had had a recorded prescription of DOAC in the previous six months. The s le size for the cross-sectional analyses ranged from 5333 in 2014 to 19,196 in 2018. Results: The proportion of patients who had potential drug interactions with a DOAC decreased from 45.9% (95% confidence interval (CI) 44.6%–47.4%) in 2014 to 39.9% (95% CI 39.2%–40.6%) in 2018, p for trend 0.001. During this period, the most frequent interacting class of medication recorded as having been prescribed with DOACs was selective serotonin/serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) antidepressants, followed by non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs) and amiodarone. Conclusions: Overall, potential drug interactions with DOACs have decreased slightly over the last five years however, the rate of possible interaction with SSRIs/SNRIs has remained relatively unchanged and warrants awareness-raising amongst prescribers.
Association between anticholinergic drug burden and mortality in older people: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 12-12-2019
DOI: 10.1007/S00228-019-02795-X
Abstract: The purpose of the study is to conduct a systematic review of studies examining the association between anticholinergic burden and mortality in older in iduals. A literature search was performed to identify relevant studies, using MEDLINE, EMBASE, PsycINFO and CENTRAL, from January 1990 to December 2018. We included studies of patients with a mean age of 65 years or older where the anticholinergic burden was estimated using anticholinergic risk assessment tools, and associations between anticholinergic load and mortality were investigated. The primary outcome of interest was the association between anticholinergic burden and mortality. Twenty-seven studies were included. These were three cross-sectional, one nested case-control and 23 prospective or retrospective cohort studies. Most studies were determined to be of good quality. A total of 15 studies reported a positive correlation between anticholinergic burden and mortality, while the remaining 10 studies did not report a significant association. Eighteen out of 27 studies (80%) had a short follow-up period of 1 year or less. Among the five high-quality studies that met all the domains of the quality assessment criteria, four showed a positive association. The variation in results could relate to the quality of the studies, follow-up period, anticholinergic risk assessment tool used and the study setting. Sixty-three percent (n = 17) of all the included studies, but almost all of the high-quality studies with an extended follow-up, reported a positive correlation between anticholinergic burden and mortality. Further high-quality research, using standardized measures and with adequate follow-up periods, is required to confirm the relationship between anticholinergic burden and mortality.
Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation
Publisher: Wiley
Date: 03-12-2020
DOI: 10.1111/ECI.13457
Abstract: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF. Using an Australian nationally representative general practice dataset, MedicineInsight, we identified patients newly diagnosed with AF between January 2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice. A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) were identified. Nearly two‐thirds of these patients (40 854 [64.6%]) were initiated on an OAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2% in 2019 ( P .001). High risk of stroke (CHA 2 DS 2 ‐VASc, adjusted odds ratio (AOR), 4.39 [95% CI, 3.99‐4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72‐2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65‐1.98]) and male sex (AOR, 1.29 [95% CI, 1.22‐1.35]) were independently associated with OAC initiation. Direct‐acting oral anticoagulant (DOAC) use increased from 11.9% in 2011 to 94.0% of all OAC initiations in April 2019 ( P .001). The proportion of newly diagnosed patients with AF initiated on OAC increased markedly following the introduction of the DOACs. Of those initiated, 9 in 10 were receiving a DOAC at the end of the study period. There is potential underuse in women and in iduals with dementia.
Pharmacists as a Source of Advice on Medication Use for Athletes
Publisher: MDPI AG
Date: 15-01-2020
Abstract: Background: The World Anti-Doping Agency (WADA) specifies substances that competitive sportspersons are not allowed to take. Some of these substances are contained in common medicines used in everyday medical practice and could be used by athletes by accident. Objectives: This study aimed to explore pharmacists’ knowledge and confidence in guiding athletes about the use of medicines in professional sport. Methods: Registered pharmacists in Australia were invited to participate in an online survey. The survey had five domains and aimed to identify pharmacists’ demographic information, interest in sport, familiarity with WADA guidelines, knowledge on prohibited drug classes, and their opinion about the role of pharmacists in educating athletes on medication use. Descriptive statistics were provided and where appropriate, Chi-square, Mann–Whitney and independent t-test were used to identify potential associations and difference between means. Results: One hundred and thirty-five pharmacists (response rate of 10.6%) completed the survey, with the majority indicating that they were not confident in advising athletes on medication use. Although most respondents believed that pharmacists have a role in the education of athletes to help avoid unintentional doping, only about a quarter indicated that they had sufficient knowledge to advise athletes. About one-half of the respondents could provide fully correct answers when asked to identify the WADA status of some commonly used drugs. Conclusions: The results of the survey indicate that upskilling is required to enable pharmacists in Australia to provide accurate medication advice to professional athletes.
Examination and Estimation of Anticholinergic Burden: Current Trends and Implications for Future Research
Publisher: Springer Science and Business Media LLC
Date: 04-2016
DOI: 10.1007/S40266-016-0362-5
Abstract: It is postulated that minimizing anticholinergic burden in older people may result in improved short-term memory and behavior, reduced confusion and delirium, and enhanced quality of life and daily functioning. The purpose of this opinion article was to investigate the current trends and future implications relating to the examination and estimation of anticholinergic burden in older people. Current evidence linking medicines with anticholinergic activity and cognitive impairment is derived mostly from observational data. Further research with larger trials or cohort studies with adequate power and appropriate follow-up periods is required to confirm associations between anticholinergic burden and adverse outcomes. This article provides insights into different approaches for the estimation of anticholinergic burden. Network-based systems pharmacology models could be an effective way of understanding anticholinergic drug-induced adverse effects. The emphasis on mechanistic models may open new opportunities for researchers to understand adverse drug effects in clinical practice. In the interim, medicines with high anticholinergic activity should be avoided in older people, unless considered clinically essential. In this instance, they should be used at a low/titrated dose and for the shortest duration possible. It is therefore important to reinforce the clinical significance of reviewing anticholinergic medicines in older people.
Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 25-03-2015
Ten-year trends in the use of oral anticoagulants in Australian general practice patients with atrial fibrillation
Publisher: Authorea, Inc.
Date: 22-05-2020
Potential Barriers to the Implementation of Computer-Based Simulation in Pharmacy Education: A Systematic Review
Publisher: MDPI AG
Date: 17-05-2023
Abstract: Computer-based simulation (CBS) is an interactive pedagogical training method that has seen increased interest, especially in recent years. There is some evidence that CBS in pharmacy education is not as widely adopted compared to other healthcare disciplines. Pharmacy education literature to date has not specifically discussed the potential barriers which may cause this uptake challenge. In this systematic narrative review, we attempted to explore and discuss potential barriers that may impact the integration of CBS in pharmacy practice education and provide our suggestions to overcome them. We searched five major databases and used the AACODS checklist for grey literature assessment. We identified 42 studies and four grey literature reports, published between 1 January 2000 and 31 August 2022, which met the inclusion criteria. Then, the specific approach of Braun and Clarke for thematic analysis was followed. The majority of the included articles were from Europe, North America, and Australasia. Although none of the included articles had a specific focus on barriers to implementation, thematic analysis was used to extract and discuss several potential barriers, such as resistance to change, cost, time, usability of software, meeting accreditation standards, motivating and engaging students, faculty experience, and curriculum constraints. Ad- dressing academic, process, and cultural barriers can be considered the first step in providing guidance for future implementation research for CBS in pharmacy education. The analysis suggests that to effectively overcome any possible barriers to implementing CBS, different stakeholders must engage in careful planning, collaboration, and investment in resources and training. The review indicates that additional research is required to offer evidence-based approach and strategies to prevent overwhelming or disengaging users from either learning or teaching process. It also guides further research into exploring potential barriers in different institutional cultures and regions.
Credentials for a PharmD graduate: The voyage never ends
Publisher: SAGE Publications
Date: 07-05-2015
Drug-associated hyperthermia: A longitudinal analysis of hospital presentations
Publisher: Hindawi Limited
Date: 02-12-2020
DOI: 10.1111/JCPT.13090
Abstract: Hyperthermia occurs when heat accumulation surpasses the body's ability for heat dissipation. Many drugs can affect thermoregulation through mechanisms including altering the neurotransmitters that cause increased heat production or decreased heat loss and may, therefore, be associated with hyperthermia. This study aimed to examine hospitalizations and emergency department (ED) presentations due to hyperthermia and to investigate the potential association with drug therapy. A retrospective analysis of ED presentations and hospitalizations due to hyperthermia in all four major hospitals in Tasmania, Australia, between July 2010 and December 2018 was performed. Data of patients aged ≥18 years were extracted from the hospital digital medical records and analysed for the prevalence, trends and various potential risk factors for hyperthermia, such as age, environmental temperature and drug therapy. This study included 224 patients. The data illustrated a trend with time, albeit not statistically significant, towards increasing hospital presentations due to hyperthermia. Antiepileptics (P = .03) and furosemide (P = .04) were the most frequently used drugs in patients with primary hyperthermia. The high use of levothyroxine in the study population (6.7%) stood out compared with the estimated national average (2.1%). Various drug classes associated with hyperthermia were used significantly more in the age group ≥60 years, suggesting polypharmacy in the elderly as a contributing factor for hyperthermia. This study reports a possible association of some drugs, particularly diuretics (furosemide), antiepileptics and levothyroxine, with hyperthermia. Healthcare professionals should be aware of the increasing prevalence of hyperthermia and the possible involvement of drugs.
Serum Anticholinergic Activity and Cognitive and Functional Adverse Outcomes in Older People: A Systematic Review and Meta-Analysis of the Literature
Publisher: Public Library of Science (PLoS)
Date: 21-03-2016
Study on the Classification, Causality, Preventability and Severity of Adverse Drug Reaction Using Spontaneous Reporting System in Hospitalized Patients
Publisher: MDPI AG
Date: 29-09-2018
Abstract: Hospital-based adverse drug reaction (ADR) monitoring and reporting programs intend to identify and quantify the risks associated with the use of medicines. To examine the causality, preventability and severity of ADR in a hospital setting a prospective cohort study on spontaneous ADR reporting was conducted from December 2015 to May 2016. Incidence of ADRs, causality, type, severity and preventability were assessed using necessary assessment scales. The study included 3157 hospitalized in iduals, in whom 51 ADRs were detected among 49 patients. The overall incidence of suspected ADRs was found to be 1.6%. According to the causality assessment, most of the ADRs reported were probable (n = 26, 51.0%), and type A (augmented harmacological) reactions (n = 39, 76%) were the most common type of ADR found. The majority of ADRs were moderate to severe (n = 35, 68.6%), of which 37.3% were found to be potentially preventable. Predictability was observed in 28 (54.9%) reported ADRs. The prescribed medicines most frequently associated with ADRs were antibiotics, antiepileptics and antihypertensives. This feasibility study was able to highlight the clinical pharmacist’s role in ADR monitoring service and create awareness about the way it could be done to promote safer medication use. Similar ADR reporting programs are necessary to educate and to improve awareness among healthcare professionals in some countries.
Exploring Australian pharmacists' views toward reducing the risk of medicines‐related harm in aged care residents
Publisher: Wiley
Date: 24-05-2023
DOI: 10.1002/PRP2.1104
Abstract: Medicines‐related harm is common in older people living in residential aged care facilities (RACFs). Pharmacists offering services in the aged care sector may play a key role in reducing medicines‐related injury. This study aimed to explore Australian pharmacists' views toward reducing the risk of medicines‐related harm in older residents. Qualitative, semi‐structured interviews were conducted with 15 Pharmacists across Australia providing services (e.g., through the provision of medication reviews, supplying medications, or being an embedded pharmacist) to RACFs identified via convenience s ling. Data were analyzed by thematic analysis using an inductive approach. Medicines‐related harm was thought to occur due to polypharmacy, inappropriate medicines, anticholinergic activity, sedative load, and lack of reconciliation of medicines. Pharmacists reported that strong relationships, education of all stakeholders, and funding for pharmacists were facilitators in reducing medicines‐related harm. Pharmacists stated that renal impairment, frailty, staff non‐engagement, staff burnout, family pressure, and underfunding were barriers to reducing medicines‐related harm. Additionally, the participants suggested pharmacist education, experience, and mentoring improve aged care interactions. Pharmacists believed that the irrational use of medicines increases harm in aged care residents, and medicines‐specific (e.g., sedative load) and patient‐specific risk factors (e.g., renal impairment) are associated with injuries in residents. To reduce medicines‐related harm, the participants highlighted the need for increased funding for pharmacists, improving all stakeholders' awareness about medicines‐associated harms through education, and ensuring collaboration between healthcare professionals caring for older residents.
Comparing the renal outcomes in patients with atrial fibrillation receiving different oral anticoagulants
Publisher: Informa UK Limited
Date: 04-03-2022
DOI: 10.1080/17512433.2022.2070151
Abstract: We aimed to compare renal function changes in patients with atrial fibrillation (AF) prescribed different oral anticoagulants (OACs). We performed a retrospective analysis of Australian national primary care data. A total of 12,562 patients with AF and initiated OAC between 1 January 2013 and 31 December 2017 were included. Inverse probability of treatment weighting was used for balancing baseline characteristics and the risks of decline in estimated glomerular filtration rate (eGFR) in patients prescribed each OAC were compared. Compared with warfarin, prescribing of direct-acting oral anticoagulants (DOACs) was associated with a lower risk of renal function decline per 1000 person-years: hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.68-0.81, p < 0.001 for ≥30% decline in eGFR HR 0.28, 95% CI 0.20-0.41, p < 0.001 for eGFR decline to ≤30 mL/min/1.73 m The risk of renal function decline appeared to be lower in patients prescribed DOACs versus warfarin.
An overview of pharmacodynamic modelling, ligand-binding approach and its application in clinical practice
Publisher: Elsevier BV
Date: 02-2017
The Influence of Patient Characteristics on Anticholinergic Events in Older People
Publisher: S. Karger AG
Date: 06-01-2016
DOI: 10.1159/000441718
Abstract: b i Aims: /i /b To examine patient characteristics that predict adverse anticholinergic-type events in older people. b i Methods: /i /b This retrospective population-level study included 2,248 hospitalised patients. In idual data on medicines that are commonly associated with anticholinergic events (delirium, constipation and urinary retention) were identified. Patient characteristics examined were medicines with anticholinergic effects (ACh burden), age, sex, non-anticholinergic medicines (non-ACM), Charlson comorbidity index scores and ethnicity. The Akaike information criterion was used for model selection. The data were analysed using logistic regression models for anticholinergic events using the software NONMEM. b i Results: /i /b ACh burden was found to be a significant independent predictor for developing an anticholinergic event [adjusted odds ratio (aOR): 3.21, 95% CI: 1.23-5.81] for those taking an average of 5 anticholinergic medicines compared to those taking 1. Both non-ACM and age were also independent risk factors (aOR: 1.41, 95% CI: 1.31-1.51 and aOR: 1.08, 95% CI: 1.05-1.10, respectively). b i Conclusion: /i /b To our knowledge, this is the first study that has examined population-level data in a nonlinear model framework to predict anticholinergic-type adverse events. This study evaluated the relationship between important patient characteristics and the occurrence of anticholinergic-type events. These findings reinforce the clinical significance of reviewing anticholinergic medicines in older people.
Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis
Publisher: SAGE Publications
Date: 10-08-2020
Abstract: To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36 95%CI=0.79-2.35) or hospitalization (OR=1.02 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. In iduals with cognitive impairment or dementia are at increased risk of medication misadventure based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.
Ten-Year Trends in Psychotropic Prescribing and Polypharmacy in Australian General Practice Patients with and without Dementia
Publisher: MDPI AG
Date: 10-05-2023
DOI: 10.3390/JCM12103389
Abstract: Objective: Little research has evaluated trends in psychotropic prescribing and polypharmacy in primary care patients, especially those with dementia. We sought to examine this in Australia from 2011 to 2020 using the primary care dataset, MedicineInsight. Methods: Ten consecutive serial cross-sectional analyses were performed to evaluate the proportion of patients aged 65 years or more, with a recorded diagnosis of dementia, who were prescribed psychotropic medications within the first six months of each year from 2011 to 2020. This proportion was compared with propensity score-matched control patients without dementia. Results: Before matching, 24,701 patients (59.2% females) with, and 72,105 patients (59.2% females) without, a recorded diagnosis of dementia were included. In 2011, 42% (95% confidence interval [CI] 40.5–43.5%) of patients in the dementia group had at least one recorded prescription of a psychotropic medication, which declined to 34.2% (95% CI 33.3–35.1% p for trend 0.001) by 2020. However, it remained unchanged for matched controls (36% [95% CI 34.6–37.5%] in 2011 and 36.7% [95% CI 35.7–37.6%] in 2020). The greatest decline in the dementia groups by medication class was for antipsychotics (from 15.9% [95% CI 14.8–17.0%] to 8.8% [95% CI 8.2–9.4%] p for trend 0.001). During this period, the prevalence of psychotropic polypharmacy (use of two or more in idual psychotropics) also decreased from 21.7% (95% CI 20.5–22.9%) to 18.1% (95% CI 17.4–18.9%) in the dementia groups, and slightly increased from 15.2% (95% CI 14.1–16.3%) to 16.6% (95% CI 15.9–17.3%) in the matched controls. Conclusions: The decline in psychotropic prescribing, particularly antipsychotics, in Australian primary care patients with dementia is encouraging. However, psychotropic polypharmacy still occurred in almost one in five patients with dementia at the end of the study period. Programs focused on encouraging further reductions in the use of multiple psychotropic drugs in patients with dementia are recommended, particularly in rural and remote regions.
Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: a ten-year follow-up
Publisher: Wiley
Date: 22-01-2021
DOI: 10.1111/ECI.13489
Abstract: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA 2 DS 2 ‐VASc (CHA 2 DS 2 ‐VA) score. Overall, the CHA 2 DS 2 ‐VA score increased by a mean of 1.34 (95% confidence interval, 1.29‐1.39) points over the study period. Nearly two‐thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. Nearly one‐third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.
Australian community pharmacists’ experiences during the COVID-19 pandemic
Publisher: Oxford University Press (OUP)
Date: 22-06-2023
DOI: 10.1093/IJPP/RIAD038
Abstract: Community pharmacists have played an important role in providing services for their community during the COVID-19 pandemic. In this study, the purpose is to present the attitudes and experiences of Australian pharmacists regarding the COVID-19 pandemic. A qualitative semi-structured interview explored community pharmacist experiences during the initial COVID-19 lockdown. Thematic analysis of transcribed interviews was conducted to investigate the experiences of pharmacists. Interviews were conducted with 15 pharmacists from different regional areas and states of Australia. In the study, five main themes were developed: COVID-19 practice complications pharmacy practice changes difficult patient interactions worsened mental well-being and coping strategies and career dissatisfaction. Pharmacists stated that an increase in workload, shortage of supplies and frequent COVID-19 management updates increased pressure on their duties. The negative customer interactions during COVID-19 lockdown adversely affected some pharmacists’ mental health and career satisfaction. Community pharmacists are subject to multiple factors affecting their practice, impairing their mental well-being and triggering them to reconsider their career choice. It is important to provide support to community pharmacists to help improve their well-being and workplace satisfaction.
Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013
Publisher: S. Karger AG
Date: 26-11-2015
DOI: 10.1159/000368191
Abstract: b i Background: /i /b Polypharmacy and hyperpolypharmacy are proxy indicators for inappropriate medicine use. Inappropriate medicine use in older people leads to adverse clinical outcomes. b i Objective: /i /b The objectives of this study were to investigate the prevalence and trends of polypharmacy and hyperpolypharmacy in older people in New Zealand from 2005 to 2013, analyzing the pharmaceutical collections maintained by the Ministry of Health. b i Methods: /i /b A repeated cross-sectional analysis of population-level dispensing data was conducted from January 1, 2005 to December 31, 2013. Polypharmacy and hyperpolypharmacy in in iduals were defined as the use of 5-9 medicines and ≥10 medicines, respectively, dispensed concurrently for a period of ≥90 days. Differences in polypharmacy and hyperpolypharmacy between 2005 and 2013 were examined. A multinomial regression model was used to predict sociodemographic characteristics associated with polypharmacy and hyperpolypharmacy. b i Results: /i /b Polypharmacy and hyperpolypharmacy were found to be higher in 2013 compared to 2005 (polypharmacy: 29.5 vs. 23.4%, p 0.001 hyperpolypharmacy: 2.1 vs. 1.3%, p 0.001). The risk of polypharmacy and hyperpolypharmacy was higher in females, in those aged 80-84 years, in the Māori population (for polypharmacy) and the Middle Eastern, Latin American, or African population (for hyperpolypharmacy), in people living in the Southern-district health board, and in in iduals with increasing deprivation. b i Conclusion: /i /b The population of New Zealand is aging and the number of older people with multiple chronic conditions is increasing. The proportion of older people exposed to polypharmacy and hyperpolypharmacy has increased in 2013 compared to 2005. Our study provides important information to alert health policy makers, researchers, and clinicians about the dire need to reduce the medication burden in older New Zealanders.
Ten-year trends in adverse drug reaction-related hospitalizations among people with dementia
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/20420986221080796
Abstract: Trends in the incidence of adverse drug reaction (ADR)–related hospitalizations have been studied in the general population, but not specifically in people with dementia. This study aimed to investigate trends in the incidence of ADR-related hospitalizations among people with dementia, and identify the most commonly implicated drugs and diagnoses in these admissions. This study utilized the administrative data of all adults admitted to the four major public hospitals of Tasmania, Australia, with a primary or secondary diagnosis of dementia from July 2010 to December 2019. ADR-related hospitalizations were identified by using diagnosis-based and external cause codes. The Cochran–Armitage test was used to examine trends in the incidence of ADR-related hospitalizations. Of the 7552 people with dementia admitted to the hospital at least once within the study period, 1775 (23.5%) experienced at least one ADR-related hospitalization. The estimated annual incidence of ADR-related hospitalizations increased 18% (1484–1760 per 100,000 population with dementia, p for trend .05) from 2010 to 2019. For those ADR-related admissions with a drug code recorded, 19.3% were due to antithrombotics and 11.5% to antihypertensives. The most frequent ADR-related admission diagnoses were renal diseases (72.9%). Length of hospital stay and in-hospital mortality were both significantly greater for ADR-related, relative to non-ADR-related, admissions (median 7 versus 5 days and 11% versus 6.7%, respectively p 0.001). The annual incidence of ADR-related hospitalizations in people with dementia increased between 2010 and 2019. Antithrombotics were the most commonly implicated drug class. The ADR-related hospitalizations were associated with increased length of stay and greater mortality. Adverse drug reaction–related hospitalizations among people with dementia This study aimed to investigate trends in hospitalizations associated with medication problems among people with dementia, and identify the most commonly implicated drugs and diagnoses in these admissions. This study utilized the administrative data of all adults admitted to the four major public hospitals of Tasmania, Australia, with dementia from July 2010 to December 2019. The annual incidence of hospitalizations associated with medication problems among people with dementia increased nearly 20% over 10 years. The length of hospital stay and in-hospital mortality were significantly greater for hospitalizations related to medication problems. The incidence of hospitalizations associated with medication problems in people with dementia increased between 2010 and 2019.
Ten-year trends in prescribing of antiarrhythmic drugs in Australian primary care patients with atrial fibrillation
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/IMJ.15514
Abstract: Despite changes in antiarrhythmic drug (AAD) choice in patients with atrial fibrillation (AF), trends in AAD prescribing remain not investigated. We aimed to examine these changes using a nationwide Australian general practice data from 2009 to 2018. Over the 10 years, AAD prescribing in patients with AF decreased, which was mainly due to a reduction in the use of amiodarone, sotalol and digoxin. In contrast, the use of beta‐blockers and flecainide increased.
Eight-Year Trends in Direct-Acting Oral Anticoagulant Dosing, Based on Age and Kidney Function, in Patients With Atrial Fibrillation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-10-2021
Esketamine: new hope for the treatment of treatment-resistant depression? A narrative review
Publisher: SAGE Publications
Date: 2020
Abstract: This narrative review aims to provide an overview of the current literature on the pharmacology, safety, efficacy and tolerability of intranasal esketamine, the S-enantiomer of ketamine, for the treatment of treatment-resistant depression (TRD). A literature search using Medline, Embase, PsycINFO and Cochrane Central was conducted (January 2000 to July 2019). Product information and www.clinicaltrials.gov were also reviewed. The literature search was limited to human studies published in English. Phase I, II, and III studies of intranasal esketamine for TRD were reviewed. About a third of patients with major depressive disorder fail to achieve remission despite treatment with multiple antidepressants. This article examines the trials that led to the approval of esketamine in the United States, as well as other recent studies of esketamine for TRD. The findings from limited phase III trials illustrate that intranasal esketamine is effective and safe in reducing depressive symptoms and achieving clinical response in patients with TRD. The optimum duration and frequency of use are not fully understood. Although the nasal spray is a convenient dosage form, its use in practice may be limited by cost and administrative regulation. While it may prove beneficial to many patients who suffer from TRD, further long-term data are required, along with comparative trials with the R-isomer (arketamine). In the interim, care and monitoring should be exercised in its use in clinical practice. Esketamine: new therapy for severe depression Intranasal esketamine, the S-enantiomer of ketamine, was recently approved in the United States for the treatment of treatment-resistant depression (TRD). The findings from limited clinical trials indicate that intranasal esketamine is effective and safe in patients with TRD, although the optimum dose, duration and frequency of use are not fully understood. Its use in practice may be limited by cost and administrative regulation, and further long-term data are required.
A study of the factors affecting time to onset of lactogenesis-II after parturition
Publisher: Elsevier BV
Date: 2013
Risk of osteoporosis in patients with atrial fibrillation with and without oral anticoagulant therapy
Publisher: Informa UK Limited
Date: 21-07-2022
DOI: 10.1080/17512433.2022.2103540
Abstract: We aimed to compare the risk of developing osteoporosis in patients prescribed warfarin or direct-acting oral anticoagulants (DOACs) with those with no therapy. We included 37,632 patients aged between 18 and 111 years with a recorded diagnosis of AF between 1 January 2013 and 31 December 2017. Patients were followed until the diagnosis of osteoporosis, switch or discontinuation of the OAC, last clinical visit, or end of the study period, whichever occurred first. The incidences of new-onset osteoporosis were calculated using the Cox proportional hazards model. Of total, 16,995 (45.2%) had no recorded OAC prescription, and 20,637 had a recorded prescription of warfarin (6,609) or DOAC (14,028). Compared with those not prescribed an OAC, the risk of being diagnosed with new-onset osteoporosis increased in patients prescribed warfarin (HR 2.22, 95% CI 2.00-2.47, p < 0.001) and DOACs (HR 1.42, 95% CI 1.29-1.58, p < 0.001). However, the effect of DOACs was not statistically significant (HR 1.07, 95% CI 0.86-1.33, p < 0.535) after excluding patients with at least one recorded prescription of systemic corticosteroids, antiepileptics, or proton pump inhibitors. Use of warfarin or DOACs was associated with a significantly increased risk of developing osteoporosis compared with no OAC treatment.
Development of Phylodynamic Methods for Bacterial Pathogens
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.TIM.2021.02.008
Abstract: Phylodynamic methods have been essential to understand the interplay between the evolution and epidemiology of infectious diseases. To date, the field has centered on viruses. Bacterial pathogens are seldom analyzed under such phylodynamic frameworks, due to their complex genome evolution and, until recently, a paucity of whole-genome sequence data sets with rich associated metadata. We posit that the increasing availability of bacterial genomes and epidemiological data means that the field is now ripe to lay the foundations for applying phylodynamics to bacterial pathogens. The development of new methods that integrate more complex genomic and ecological data will help to inform public heath surveillance and control strategies for bacterial pathogens that represent serious threats to human health.
Temporal trends in the use of antidiabetic medicines: a nationwide 9-year study in older people living in New Zealand
Publisher: SAGE Publications
Date: 31-07-2016
Abstract: The global burden of diabetes is increasing worldwide. The aim of the study was to investigate the trends in use of antidiabetic medicines among older New Zealanders between 2005 and 2013, and to perform a separate analysis by age, sex, ethnicity, district health board domicile and socioeconomic deprivation index. The study population included in iduals’ aged 65 years and older living in New Zealand (NZ) captured in the pharmaceutical collections. Repeated cross-sectional analysis of population-level dispensing data was conducted from 1 January 2005 to 31 December 2013. Linear regression model using a gamma link function was used to estimate prevalence ratios and trends between 2005 and 2013. The main outcome measure was the prevalence of antidiabetic medicines in older New Zealanders. The prevalence of antidiabetic medicines in older New Zealanders increased by 17.6% between 2005 and 2013. In iduals in the 70–74 age group had the highest utilization of each of the classes of antidiabetic medicines and those aged ⩾85 had the lowest utilization. Among the antidiabetic class of medicines, utilization of sulfonylureas was highest and alpha-glucosidase inhibitors the least. The utilization of thiazolidinediones increased over the study period. In 2013, insulin isophane and insulin glargine were the most common insulin analogues used. Insulin use was high in those aged ⩾85 years across the entire study period. The utilization of metformin increased gradually throughout the study period (by 43.9% in 2013 compared with 2005). This population-level study showed an increase in utilization of antidiabetic medicines in older people in NZ from 2005 to 2013 however, the increase does not seem to parallel the proportional increase in prevalence of diabetes for the study period. Improving access to newer antidiabetic medicines in line with emerging evidence should be a consideration for decision makers.
Exploring Australian pharmacists' perceptions and practices towards reducing the risk of medicines-related harm in aged care residents
Publisher: Frontiers Media SA
Date: 03-2023
DOI: 10.3389/FPHAR.2023.1131456
Abstract: Background: Older people living in residential aged care facilities frequently experience medicines-related harm. Evidence regarding the perception and practices towards reducing these harms may facilitate the development of customised educational programs for pharmacists providing services in RACFs. Objective: To explore Australian pharmacists’ opinions and practices towards reducing the risk of medicines-related harm in aged care residents. Methods: An online survey was developed based on a literature review, expert opinion, and feedback from pharmacists providing services in RACFs. A web link for the survey was shared via professional pharmacy organisations and social media groups with Australian pharmacists providing services in RACFs. Results: A total of 209 pharmacists participated in the survey. Of these, 76% ( n = 158) were residential medication management review embedded pharmacists, and 24% ( n = 51) were supply pharmacists for RACFs. Most pharmacists believed that medicines-related harm is common in residents ( n = 174, 83%), yet few agreed that pharmacists have enough time to participate in medicines-related harm reduction services ( n = 60, 28%). There was a high level of agreement regarding the key risk factors (e.g., inappropriate medicines, anticholinergic drug use, and transitions of care) and potential strategies (e.g., embedded pharmacists in RACFs, educating aged care staff, and collaborative pharmacist-led medication reviews) for reducing medicines-related harm in residents. Conclusion: Pharmacists agreed that older residents often experience medicines-related harm, but they did not frequently participate in medicines-related harm reduction services. Initiatives to engage pharmacists in team-based harm reduction services and educate aged care staff regarding safe medication management may improve residents’ safety and health outcomes.
Pharmacist-led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review
Publisher: Wiley
Date: 20-04-2021
DOI: 10.1111/BCP.14824
Abstract: We aimed to investigate the efficacy and effectiveness of pharmacist‐led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs). We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi‐experimental studies conducted in RACFs. We screened 3826 records and included 23 studies. We found seven single‐component and 16 multicomponent pharmacist‐led interventions to reduce ADEs in older people living in RACFs. The most frequent single‐component pharmacist‐led intervention was medication review. Medication review and education provision to healthcare professionals were the most common components in many pharmacist‐led multicomponent interventions. Thirteen studies (56%) showed no effect, whereas ten studies (43%) reported significant reductions in ADEs following pharmacist‐led interventions either as a sole intervention or as a part of a multi‐component intervention. Many interventions focused on reducing the incidence of falls (39%). This systematic review suggests that pharmacist‐led interventions have the potential to reduce the incidence of ADEs in older people living in RACFs. Medication review and educational programmes, particularly academic detailing, either as a single component or as part of multicomponent interventions were the most common approaches to reducing drug‐related harm in older people living in RACFs. The lack of a positive association between interventions and ADE in many studies suggests that targeted and tailored pharmacist‐led interventions are required to reduce ADEs in older people in RACFs.
Assessment of Knowledge, Attitude and Practices of the Hospital and Community Pharmacists in Saudi Arabia (Jeddah) towards Inappropriate Medication Use in Older Adults
Publisher: MDPI AG
Date: 16-01-2023
Abstract: In Saudi Arabia, the older adult population is growing and is projected to increase three-fold by 2030. Potentially inappropriate medications (PIMs) are harmful to older adults’ and have a direct impact on clinical, health and economic outcomes. Pharmacists have a vital role in medication tailoring for older adults as multidisciplinary team members. However, there is also a paucity of research regarding pharmacists’ participation in detecting and avoiding PIMs use among older adults in Saudi Arabia. A cross-sectional, self-administered survey was conducted to assess the knowledge, practices, and attitude of pharmacists from seven hospitals and ten community pharmacies in Jeddah, Saudi Arabia. The survey comprised three sections (i) identifying participants’ general characteristics, (ii) assessing their knowledge of PIMs use in older adults and (iii) examining the pharmacist’s attitude towards the procedures followed in dispensing for older adults. Inferential and descriptive statistics were used to analyse the survey data. A total of 157 community and hospital pharmacists participated in this study. Most of them dispensed medication weekly to older adults (85.4%), and 43.3% had relevant work experience of six to ten years. Though 44.6% of the participants were aware of PIMs that older adults should avoid, only 10.8% claimed adequate knowledge about PIMs. From the given three clinical case scenarios, a minority of pharmacists (21.7%) chose the correct answers, with a mean score of 2.38 ± 2.91 (95% CI 2.35–3.15). Participants who claimed to have knowledge of PIMs had a significantly higher mean score than those who did not, 4.59 ± 2.81 25 (95% CI 2.35–2.61). A minority of the pharmacists (14.7%) used screening tools such as STOPP, Beers criteria, or Medication Appropriateness Index (MAI) to detect PIMs in older adults. No statistically significant differences were detected when comparing the levels of knowledge of pharmacists with 1 to 5 years of practice to pharmacists with 6 to 15 and more years of experience (p = 0.431). Pharmacists’ knowledge, attitude and practices toward PIMs use in older adults in Saudi Arabia should be improved. The application of PIMs detection tools such as STOPP/START or Beers criteria currently has no place in day-to-day pharmacists’ roles in Saudi Arabia. Therefore, concerned stakeholders should develop educational programs to improve pharmacists’ knowledge of PIMs and promote the effective use of PIM screening tools such as Beers and STOPP criteria in their practice.
Drug-associated non-pyrogenic hyperthermia: a narrative review
Publisher: Springer Science and Business Media LLC
Date: 23-10-2019
DOI: 10.1007/S00228-019-02763-5
Abstract: Hyperthermia occurs when heat accumulation surpasses the body's ability for heat dissipation. Many drugs may affect thermoregulation. This narrative review aimed to provide an overview of the current literature concerning reports of drug-associated non-pyrogenic hyperthermia. A comprehensive search was performed across 5 databases covering the period of inception to March 2019, for publications that reported hyperthermia associated with drug use. Studies that reported potential drug association with hyperthermia due to altered thermoregulatory mechanisms were included. Case reports of less than 3 cases were excluded, as well as hyperthermia due to other causes, such as hypersensitivity, malignant hyperthermia and neuroleptic malignant syndrome. The primary outcomes of interest were hospitalisation and mortality. The literature search initially identified a total of 2609 records. Based on full-text analysis, 11 articles met the inclusion criteria, of which there were 5 case-control studies, 2 case series and 4 retrospective analyses. Studies reported heat-related hospitalisations or emergency department presentations associated with the use of psychotropics (antipsychotics, antidepressants and anxiolytics), anticholinergics, antihistamines, diuretics, cardiovascular agents, non-steroidal anti-inflammatory drugs and anticoagulants. Psychotropic drugs were reported to be associated with increased heat-related mortality, other than through neuroleptic malignant syndrome, but findings varied among the studies. Given the relative lack of publications, more research is necessary to study specific effects of drugs on body temperature and the likelihood of inducing non-pyrogenic hyperthermia. In particular, psychotropics, anticholinergics, diuretics and cardiovascular agents are of interest for future studies.
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