American Journal Geriatric Pharmacotherapy最新文献

{"title":"Differences in Lithium Use Patterns in the Netherlands: Comparing Middle-Aged and Older Patients in a Database Study","authors":"Els Jacoba Maria van Melick MD ,&nbsp;Ingeborg Wilting PhD ,&nbsp;Patrick Cyriel Souverein PhD ,&nbsp;Toine Cornelus Gerardus Egberts PhD","doi":"10.1016/j.amjopharm.2012.02.001","DOIUrl":"10.1016/j.amjopharm.2012.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Age-dependent changes in lithium pharmacokinetic<span> and pharmacodynamic<span> properties can influence lithium use in an aging population, especially as newer treatment options are available.</span></span></p></div><div><h3>Objective</h3><p>We compared lithium use patterns between middle-aged and elderly outpatients in the Netherlands.</p></div><div><h3>Methods</h3><p>Data for this study were obtained from the Dutch PHARMO Record Linkage System. Incident lithium users 40 years or older were identified in the period 1996–2008. The following lithium use patterns were defined: continuation, add on, switch, and discontinuation. Differences were assessed for the following age groups: 40 to 49 years, 50 to 59 years, 60 to 69 years, and 70 years or older. The youngest group was the reference group. Patient baseline characteristics and potential determinants of changes in lithium use patterns were assessed.</p></div><div><h3>Results</h3><p><span>We identified 2081 incident lithium users. Use of antidepressants was not different at baseline between age groups, but elderly patients starting lithium treatment used baseline antipsychotics less frequently (</span><em>P</em><span> &lt; 0.05). Older patients were less likely to receive psychotropic drugs as add on to ongoing lithium therapy (</span><em>P</em> &lt; 0.05). Frequency of discontinuation and switch events did not differ between the age groups. In the whole study group, age was associated with any change in lithium use patterns.</p></div><div><h3>Conclusions</h3><p>Older patients are less likely to receive psychotropic drugs as add on to ongoing lithium therapy. Despite pharmacokinetic and pharmacodynamic changes in the elderly, lithium is not more often discontinued and not more often switched in older patients.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 193-200"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40164865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Greater Sensitivity of Elderly APOE ε4 Carriers to Anticholinergic Medications is Independent of Cerebrovascular Disease Risk","authors":"Robert D. Nebes PhD ,&nbsp;Bruce G. Pollock MD, PhD ,&nbsp;Subashan Perera PhD ,&nbsp;Edythe M. Halligan MA ,&nbsp;Judith A. Saxton PhD","doi":"10.1016/j.amjopharm.2012.03.003","DOIUrl":"10.1016/j.amjopharm.2012.03.003","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Recent studies found use of anticholinergic medications to be associated with greater performance decrements in older persons who carry an ε4 allele of the </span>apolipoprotein E (</span><em>APOE</em>) gene than in those carrying only ε2 or ε3 alleles.</p></div><div><h3>Objectives</h3><p><span>The present study examined whether the apparently greater behavioral toxicity of anticholinergic </span>drugs<span> in ε4 carriers may result from an increased risk of cerebrovascular disease, which is more common in ε4 carriers.</span></p></div><div><h3>Methods</h3><p>Cross-sectional data were available from 240 elderly community volunteers who had participated in 2 different studies of the cognitive and motor effects of normal aging. As part of these studies, information was gathered on subjects' use of anticholinergic medications (based on an inventory of medications taken within 24 hours of testing), risk of cerebrovascular disease (Framingham Stroke Risk Profile), and <em>APOE</em> genotype. Performance data were also available from measures of general cognitive status (Mini-Mental State Examination), executive function (Trail Making Test), mood (Geriatric Depression Scale), sleep (Pittsburgh Sleep Quality Index), and walking speed. Logistic and linear regression models were used to examine how outcomes differed between genotypes and drug use, independent of the risk of cerebrovascular disease.</p></div><div><h3>Results</h3><p>In persons with a non-ε4 genotype, anticholinergic medication use did not significantly affect any of the behavioral measures. By contrast, among ε4 carriers, those taking anticholinergic drugs performed significantly worse than did those not taking such drugs on tests of general cognitive status, executive function, mood, and sleep. Adjusting for participants' stroke risk had a minimal effect on these results.</p></div><div><h3>Conclusions</h3><p>Anticholinergic medication use was associated with poorer performance on measures of cognition, sleep, and mood only in older persons who carried 1 or more ε4 alleles of the <em>APOE</em> gene; this effect did not appear to be the result of an increased risk of cerebrovascular disease.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 185-192"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40184167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Chronic Obstructive Pulmonary Disease Maintenance Medication Adherence With All-Cause Hospitalization and Spending in a Medicare Population","authors":"Linda Simoni-Wastila PhD ,&nbsp;Yu-Jung Wei PhD ,&nbsp;Jingjing Qian PhD ,&nbsp;Ilene H. Zuckerman PharmD, PhD ,&nbsp;Bruce Stuart PhD ,&nbsp;Thomas Shaffer MHS ,&nbsp;Anand A. Dalal PhD ,&nbsp;Lynda Bryant-Comstock MPH, MA","doi":"10.1016/j.amjopharm.2012.04.002","DOIUrl":"10.1016/j.amjopharm.2012.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Although maintenance medications are a cornerstone of chronic obstructive pulmonary disease (COPD) management, adherence remains suboptimal. Poor medication adherence is implicated in poor outcomes with other chronic conditions; however, little is understood regarding links between adherence and outcomes in COPD patients.</p></div><div><h3>Objective</h3><p>This study investigates the association of COPD maintenance medication adherence with hospitalization and health care spending.</p></div><div><h3>Methods</h3><p>Using the 2006 to 2007 Chronic Condition Warehouse administrative data, this retrospective cross-sectional study included 33,816 Medicare beneficiaries diagnosed with COPD who received at least 2 prescriptions for ≥1 COPD maintenance medications. After a 6-month baseline period (January 1, 2006 to June 30, 2006), beneficiaries were followed through to December 31, 2007 or death. Two medication adherence measures were assessed: medication continuity and proportion of days covered (PDC). PDC values ranged from 0 to 1 and were calculated as the number of days with any COPD maintenance medication divided by duration of therapy with these agents. The association of adherence with all-cause hospital events and Medicare spending were estimated using negative binomial and γ generalized linear models, respectively, adjusting for sociodemographics, Social Security disability insurance status, low-income subsidy status, comorbidities, and proxy measures of disease severity.</p></div><div><h3>Results</h3><p>Improved adherence using both measures was significantly associated with reduced rate of all-cause hospitalization and lower Medicare spending. Patients who continued with their medications had lower hospitalization rates (relative rate [RR] = 0.88) and lower Medicare spending (–$3764), compared with patients who discontinued medications. Similarly, patients with PDC ≥0.80 exhibited lower hospitalization rates (RR = 0.90) and decreased spending (–$2185), compared with patients with PDC &lt;0.80.</p></div><div><h3>Conclusions</h3><p>COPD patients with higher adherence to prescribed regimens experienced fewer hospitalizations and lower Medicare costs than those who exhibited lower adherence behaviors. Findings suggested the clinical and economic importance of medication adherence in the management of COPD patients in the Medicare population.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 201-210"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40172098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Patient Age and Comorbid Burden on Clinician Attitudes Toward Heart Failure Guidelines","authors":"Michael A. Steinman MD ,&nbsp;Rebecca L. Sudore MD ,&nbsp;Carolyn A. Peterson MA ,&nbsp;John B. Harlow BA ,&nbsp;Terri R. Fried MD","doi":"10.1016/j.amjopharm.2012.04.003","DOIUrl":"10.1016/j.amjopharm.2012.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Clinical practice guidelines have been criticized for insufficient attention to the unique needs of patients of advanced age and with multiple comorbid conditions. However, little empiric research is available to inform this topic.</p></div><div><h3>Methods</h3><p>We conducted telephone interviews with staff physicians and nurse practitioners in 4 VA health care systems. Respondents were asked to rate the usefulness of national heart failure guidelines for patients of different ages and levels of comorbid burden on a 5-point scale and to comment on the reasons for their ratings.</p></div><div><h3>Results</h3><p>Of 139 clinicians contacted, 65 (47%) completed the interview. Almost half (49%) were women, and 48 (74%) were general internists or family practitioners. On a 5-point scale assessing the usefulness of clinical practice guidelines for heart failure, the mean (SD) response ranged from 4.4 (0.7) for patients younger than 65 years with few comorbid conditions to 3.5 (1.2) for patients older than 80 years with multiple comorbid conditions (<em>P</em> <!-->&lt;<!--> <!-->0.001). The difference in perceived usefulness varied more by patient age than by degree of comorbidity (<em>P</em><span> = 0.02). Four major concepts underlay the perceived usefulness of guidelines across different patient types: (1) harm of treatment and complexity of the patient's clinical condition and pharmacologic needs, (2) expected benefits of treatment, (3) patient preferences and abilities, and (4) confidence in the validity of guideline recommendations.</span></p></div><div><h3>Conclusion</h3><p>Clinicians perceive heart failure guidelines to be substantially less useful in patients of older age and with greater comorbid burden. Concerns about the clinical and pharmacologic complexity of these patients and the expected benefits of drug therapy were commonly invoked as reasons for this skepticism.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 211-218"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30613194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Oral Bisphosphonate Therapy on Serum Calcium in Elderly Veterans With Poor Kidney Function","authors":"Scott Martin Vouri PharmD ,&nbsp;Carlos A. Alvarez PharmD, MSc, BCPS ,&nbsp;Amie Taggart Blaszczyk PharmD, CGP, BCPS, FASCP","doi":"10.1016/j.amjopharm.2012.04.001","DOIUrl":"10.1016/j.amjopharm.2012.04.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Limited data exist on the use of bisphosphonates </span>in patients with poor kidney function due to a contraindication derived from inadequate experience among patients with kidney failure, accounting for as much as 25% of nonprescribing when otherwise appropriate.</p></div><div><h3>Objectives</h3><p>To determine whether bisphosphonate use in patients with decreased renal function, as outlined in the package insert (estimated creatinine clearance<span> [eCrCl] &lt;35 mL/min), would result in higher rates of hypocalcemia, as suggested in previous studies.</span></p></div><div><h3>Methods</h3><p><span>This was a retrospective cohort study of elderly veterans 65 years of age and older at the </span>Veterans Affairs<span> North Texas Health Care System in Dallas, Texas. We identified 3089 patients who started oral bisphosphonate therapy between August 1, 2003 and July 12, 2010. Of the 252 patients meeting the inclusion criteria, 25 and 227 patients had an eCrCl &lt;35 mL/min and eCrCl ≥35 mL/min, respectively. Analyses of changes in serum calcium from baseline to the 1-year study end point were performed within and between each renal function group.</span></p></div><div><h3>Results</h3><p>Among the veterans with an eCrCl &lt;35 mL/min and eCrCl ≥35 mL/min, there were decreases in median serum calcium levels from baseline to study end point from 9.8 mg/dL (interquartile range [IQR], 9.4–10.2 mg/dL) to 9.3 mg/dL (IQR, 9.0–10.0 mg/dL; <em>P =</em> 0.028) and 9.6 mg/dL (IQR, 9.3–9.9 mg/dL) to 9.4 mg/dL (IQR, 9.1–9.8 mg/dL; <em>P</em> &lt; 0.001), respectively. However, there was no difference in Δcalcium: −0.2 mg/dL (IQR, 0–0.6 mg/dL) and 0.2 mg/dL (IQR, −0.2 to 0.5 mg/dL; <em>P</em> = 0.547), respectively.</p></div><div><h3>Conclusions</h3><p>This exploratory assessment may suggest that, in elderly veterans, the initiation of oral bisphosphonate therapy contributed to a statistically significant decrease in serum calcium levels regardless of baseline renal function; however, the clinical impact of this change does not appear to be significant. Future studies should assess serum calcium in a larger population of patients to confirm the safety of oral bisphosphonates in poor kidney function.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 178-184"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40190677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of a Medication Therapy Management Program for Medicare Beneficiaries: Qualitative Findings From Patients and Physicians","authors":"Julie C. Lauffenburger PharmD ,&nbsp;Maihan B. Vu DrPH, MPH ,&nbsp;Jena Ivey Burkhart PharmD ,&nbsp;Morris Weinberger PhD ,&nbsp;Mary T. Roth PharmD, MHS","doi":"10.1016/j.amjopharm.2012.01.002","DOIUrl":"10.1016/j.amjopharm.2012.01.002","url":null,"abstract":"<div><h3>Background</h3><p>The quality of pharmacologic care provided to older adults is less than optimal. Medication therapy management (MTM) programs delivered to older adults in the ambulatory care setting may improve the quality of medication use for these individuals.</p></div><div><h3>Objectives</h3><p>We conducted focus groups with older adults and primary care physicians to explore (1) older adults' experiences working with a clinical pharmacist in managing medications, (2) physician perspectives on the role of clinical pharmacists in facilitating medication management, and (3) key attributes of an effective MTM program and potential barriers from patient and provider perspectives.</p></div><div><h3>Methods</h3><p>Five focus groups (4 with older adults, 1 with physicians) were conducted by a trained moderator using a semistructured interview guide. Each participant completed a demographic questionnaire. Sessions were recorded, transcribed verbatim, and analyzed using qualitative analysis software for theme identification.</p></div><div><h3>Results</h3><p>Twenty-eight older adults and 8 physicians participated. Older adults valued the professional, trusting nature of their interactions with the pharmacist. They found the clinical pharmacist to be a useful resource, thorough, personable, and a valuable team member. Physicians believe that the clinical pharmacist fills a unique role as a specialized practitioner, contributing meaningfully to patient care. Physicians emphasized the importance of effective communication, pharmacist access to the medical record, and a mutually trusting relationship as key attributes of a program. Potential barriers to an effective program include poor communication and lack of familiarity with the patient's history. The lack of a sustainable reimbursement model was cited as a barrier to widespread implementation of MTM.</p></div><div><h3>Conclusions</h3><p>This study provides information to assist pharmacists in designing MTM programs in the ambulatory setting. Key attributes of an effective program include being comprehensive and addressing all medication-related needs over time. The clinical pharmacist's ability to build trusting relationships with patients and providers is essential.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 2","pages":"Pages 129-138"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.01.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30418960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Falls and Fractures in Older Adults Using Atypical Antipsychotic Agents: A Propensity Score–Adjusted, Retrospective Cohort Study","authors":"Satabdi Chatterjee BPharm, MS,&nbsp;Hua Chen MD, PhD,&nbsp;Michael L. Johnson PhD,&nbsp;Rajender R. Aparasu MPharm, PhD","doi":"10.1016/j.amjopharm.2011.10.006","DOIUrl":"10.1016/j.amjopharm.2011.10.006","url":null,"abstract":"<div><h3>Background</h3><p>Atypical antipsychotic agents<span><span> are extensively prescribed in the elderly to treat various behavioral and psychiatric disorders. Past literature has documented an increased risk of falls and factures with the use of risperidone and </span>olanzapine compared with nonuse. However, none of the studies assessed the comparative safety profiles of atypical agents with respect to falls and fractures.</span></p></div><div><h3>Objective</h3><p>The goal of this study was to evaluate the risk of falls and fractures associated with the use of risperidone, olanzapine, and quetiapine in community-dwelling adults aged ≥50 years.</p></div><div><h3>Methods</h3><p>The study involved a propensity score–adjusted approach in new users of risperidone, olanzapine, or quetiapine anytime between July 1, 2000, and June 30, 2008, using data from the IMS LifeLink Health Plan Claims database. Patients were followed up until a hospitalization/emergency department visit for fall/fracture or the end of the study period, whichever occurred earlier. The Cox proportional hazards regression model was used to evaluate the comparative risk of falls/fractures. The covariates in the final model included propensity scores and their interaction terms.</p></div><div><h3>Results</h3><p><span>There were 12,145 new users of atypical agents in the study population (5083 risperidone, 4377 olanzapine, and 2685 quetiapine). A total of 417 cases of falls/fractures with at least 1 hospitalization/ emergency department visit after the use of the </span>antipsychotic agents were identified. The number of falls for risperidone, olanzapine, and quetiapine were 179 (3.56%), 123 (2.84%), and 115 (4.34%), respectively. After adjusting for propensity scores, the Cox proportional hazards model showed that there was no statistically significant difference with use of risperidone (hazard ratio = 1.10 [95% CI, 0.86–1.39]) or quetiapine (hazard ratio = 1.12 [95% CI, 0.86–1.46]) compared with olanzapine (reference group) in the risk of falls or fractures.</p></div><div><h3>Conclusions</h3><p>The study found no significant difference across the individual atypical agents in the risk of falls/fractures in community-dwelling older adults. Future studies are required to evaluate the overall safety profiles of the antipsychotic agents in this population.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 2","pages":"Pages 83-94"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30437165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Challenges in a Patient With Dabigatran-Induced Fatal Hemorrhage","authors":"Ennie L. Cano PharmD, BCPS,&nbsp;Marta A. Miyares PharmD, BCPS","doi":"10.1016/j.amjopharm.2012.02.004","DOIUrl":"10.1016/j.amjopharm.2012.02.004","url":null,"abstract":"<div><h3>Objective</h3><p>To report clinical challenges in managing dabigatran-induced bleeding.</p></div><div><h3>Methods</h3><p><span><span><span>A 78-year-old woman came to the hospital with severe coagulopathy, respiratory failure, hypotension, and bleeding secondary to </span>dabigatran therapy. At admission, </span>creatinine clearance<span><span> was 15 mL/min; prothrombin time, 147.5 seconds; activated </span>partial thromboplastin time<span>, &gt;200 seconds; and international normalized ratio, 12.42. Medications taken at home included dabigatran, 150 mg BID. During the hospitalization, multiple blood product transfusions were given, vitamin K and </span></span></span>prothrombin complex concentrate<span> were administered, and dialysis was initiated in an attempt to achieve hemostasis. Despite multiple interventions, coagulopathy persisted (prothrombin time, 70.8 seconds; activated partial thromboplastin time, &gt;200 seconds; and international normalized ratio, 6.05), with continued bleeding. On hospital day 5, the patient died.</span></p></div><div><h3>Conclusions</h3><p><span>According to the Naranjo probability scale, bleeding associated with dabigatran revealed a probable relationship. This fatal case illustrates our concern about the usefulness of currently recommended anticoagulation<span> laboratory tests and of the efficacy of blood transfusion, dialysis, and prothrombin complex concentrate in managing life-threatening bleeding secondary to dabigatran. In addition, clinicians should be cognizant of the renal recommendations for the newer </span></span>oral anticoagulant agents to prevent potentially catastrophic results.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 2","pages":"Pages 160-163"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.02.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30503396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complexity of Medication Use in Newly Diagnosed Chronic Obstructive Pulmonary Disease Patients","authors":"Caitlyn T. Solem PhD ,&nbsp;Todd A. Lee PhD ,&nbsp;Min J. Joo MD, MPH ,&nbsp;Bruce L. Lambert PhD ,&nbsp;Surrey M. Walton PhD ,&nbsp;A. Simon Pickard PhD","doi":"10.1016/j.amjopharm.2011.12.003","DOIUrl":"10.1016/j.amjopharm.2011.12.003","url":null,"abstract":"<div><h3>Background</h3><p>To better understand how medications have been used and the complexity of regimens used to treat patients, we characterized patterns of medication use and the degree to which patients used different classes of medications in combination and over time in a cohort of newly diagnosed chronic obstructive pulmonary disease (COPD) patients.</p></div><div><h3>Objective</h3><p>The objectives of this study were to characterize patterns of medication use, including the degree to which patients used different classes of medications in combination and over time within a cohort of newly diagnosed COPD patients and to identify the proportion of patients who had gaps in filling their prescriptions.</p></div><div><h3>Methods</h3><p><span>We identified a cohort of patients from the Veterans Affairs<span> health care system with newly diagnosed COPD between 1999 and 2003. Using prescription fill information, we quantified the prevalence and incidence of exposure to short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), short-acting </span></span>anticholinergics<span> (eg, ipratropium [IPRA]), and inhaled corticosteroids (ICSs) over 1 year. We additionally characterized the sequencing of medication addition and discontinuation and gaps between prescription fills. The prevalence of multiple respiratory medication use was summarized at 90, 180, and 365 days of follow-up.</span></p></div><div><h3>Results</h3><p>Of 133,737 patients with newly diagnosed COPD, the majority (80.0%) used a SABA, followed by 40.0% using IPRA, 33.2% using an ICS and 16.0% using a LABA during the 1-year follow-up. Medication changes were frequent, with 57.7% of patients having a medication addition and 48.6% discontinuing medication. The sequence of medication changes varied greatly across patients. Multiple respiratory medication use was common, with 29% of patients dispensed 3 to 4 medication classes in 1 year.</p></div><div><h3>Conclusions</h3><p>Many COPD patients who are started on medication management undergo changes in prescribed pharmacotherapy and are taking multiple medications. Despite clinical practice guidelines, there is an ad hoc nature of COPD medication management, and such heterogeneity challenges the ability to estimate relationships between drug exposure and outcomes using real-world data.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 2","pages":"Pages 110-122.e1"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2011.12.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30416111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polypharmacy With Common Diseases in Hospitalized Elderly Patients","authors":"Fumihiro Mizokami BS ,&nbsp;Yumiko Koide BS ,&nbsp;Takeshi Noro BS ,&nbsp;Katsunori Furuta BS","doi":"10.1016/j.amjopharm.2012.02.003","DOIUrl":"10.1016/j.amjopharm.2012.02.003","url":null,"abstract":"<div><h3>Background</h3><p><span>Elderly persons are exposed to polypharmacy<span> because of multiple chronic conditions. Many risk factors for polypharmacy have been identified including age, race/ethnicity, sex, educational achievement level, health status, and number of chronic diseases. However, </span></span>drugs prescribed for individual diseases have not been analyzed.</p></div><div><h3>Objective</h3><p>The objective of this study was to analyze each common disease in the elderly with respect to prescribed drugs and polypharmacy.</p></div><div><h3>Methods</h3><p><span><span>A 1-year (January through December 2009) cross-sectional study was performed in which all drugs given to hospitalized elderly patients (age, &gt;65 years) were investigated. Common diseases of the elderly were separated into disease groups including hypertension, hyperlipidemia, </span>gastric ulcer, previous stroke, </span>reflux esophagitis<span><span>, diabetes mellitus, malignancy<span>, osteoporosis, </span></span>angina pectoris<span><span>, congestive heart failure, </span>chronic obstructive pulmonary disease, dementia, and depression.</span></span></p></div><div><h3>Results</h3><p>Among 1768 elderly patients, the mean (range) age of study patients was 78 (65 to 100) years. The mean (SD) number of diseases was 7.7 (3.4), and the number of drugs overall was 4.9 (3.6). The number of drugs and prevalence of polypharmacy were hypertension, 5.2 (3.9 [51%]); hyperlipidemia, 5.6 (3.8 [58%]); gastric ulcer, 5.4 (3.8 [53%]); previous stroke, 5.8 (3.2 [61%]); reflux esophagitis, 5.6 (3.8 [40%]), diabetes mellitus, 5.6 (3.1 [54%]); malignancy, 4.1 (3.1 [37%]); osteoporosis, 5.4 (3.4 [45%]); angina pectoris, 5.7 (3.6 [42%]); congestive heart failure, 6.1 (4.0 [60%]); chronic obstructive pulmonary disease, 5.0 (3.5 [53%]); dementia, 5.1 (3.2 [52%]); and depression, 7.0 (4.2 [73%]).</p></div><div><h3>Conclusions</h3><p>When assessing the risk of polypharmacy, physicians should carefully consider the type of any chronic disease. Elderly patients with multiple diseases may be subjected to further polypharmacy.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 2","pages":"Pages 123-128"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.02.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30503863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}