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Potentially inappropriate prescribing in older adults with advanced chronic kidney disease.

ABSTRACT: BACKGROUND:Older adults with chronic kidney disease (CKD) are at heightened risk for polypharmacy. We examined potentially inappropriate prescribing in this population and whether introducing pharmacists into the ambulatory kidney care model was associated with improved prescribing practices. METHODS:Retrospective cohort study using linked administrative databases. We included patients with an eGFR ?30 mL/min/1.73 m2 ?66 years of age followed in multidisciplinary kidney clinics in Ontario, Canada (n = 25,016 from 28 centres). The primary outcome was the absence of a statin prescription or the receipt of a potentially inappropriate prescription defined by the American Geriatric Society Beers Criteria® and a modified Delphi panel that identified key drugs of concern in CKD. We calculated the crude cumulative incidence and incidence rate for the primary outcome and used change-point regression to determine if a change occurred following pharmacist introduction. RESULTS:There were 6,007 (24%) and 16,497 patients (66%) not prescribed a statin and with ?1 potentially inappropriate prescription, respectively. The rate of potentially inappropriate prescribing was 125.6 per 100 person-years and was higher in more recent years. The change-point regression analysis included 2,275 patients from two centres. No immediate change was detected at pharmacist introduction, but potentially inappropriate prescribing was increasing pre-pharmacist introduction, and this rising trend was reversed post-pharmacist introduction. The incidence of potentially inappropriate prescribing still remained high post-pharmacist introduction. CONCLUSIONS:Potentially inappropriate prescribing practices were common. Incorporating pharmacists into the kidney care model may improve prescribing practices. The role of pharmacists in the ambulatory kidney care team warrants further investigation in a randomized controlled trial.

SUBMITTER: Molnar AO

PROVIDER: S-EPMC7444541 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Potentially inappropriate prescribing in older adults with advanced chronic kidney disease.

Molnar Amber O AO Bota Sarah S Jeyakumar Nivethika N McArthur Eric E Battistella Marisa M Garg Amit X AX Sood Manish M MM Brimble K Scott KS

PloS one 20200820 8

<h4>Background</h4>Older adults with chronic kidney disease (CKD) are at heightened risk for polypharmacy. We examined potentially inappropriate prescribing in this population and whether introducing pharmacists into the ambulatory kidney care model was associated with improved prescribing practices.<h4>Methods</h4>Retrospective cohort study using linked administrative databases. We included patients with an eGFR ≤30 mL/min/1.73 m2 ≥66 years of age followed in multidisciplinary kidney clinics in ...[more]

PMID: 32818951

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Project description:Background and aimsA potentially inappropriate medication (PIM) is defined as a drug-carrying risks outweighing the expected clinical benefits. Elderly patients with chronic kidney disease (CKD) are particularly at higher risk of drug-related toxicities. In Lebanon, no studies have been conducted regarding the prescribing of PIMs in hospitalized CKD patients. This study aimed to check the prevalence of PIMs using the American Geriatrics Society (AGS) Beers criteria in elderly patients with advanced CKD stages including dialysis and to identify possible risk factors that may be associated with prescribing PIMs in this population.MethodsA retrospective cross-sectional study was conducted on patients with advanced CKD above the age of 65 years and admitted between January 2019 and June 2019 to two University Hospitals in Beirut, Lebanon. We used multiple logistic regression analysis to determine which factors were associated with prescription of PIMs according to AGS Beers criteria-2019.ResultsThe study sample included 199 patients with renal dysfunction, 75.9% were aged 70 years or more, 53.8% were females, and 61.8% were prescribed five drugs or more. Eighty-two patients were receiving hemodialysis (41.2%). PIMs prevalence was 34.1% (68/199 patients) according to Beers criteria in elderly patients with advanced CKD stages.The most frequently prescribed PIMs were ranitidine (39.1%), enoxaparin (25%), tramadol (9.8%), and ciprofloxacin (5.4%). Polypharmacy (OR 2.1, CI 95% 1.58-2.79), a higher number of comorbidities (OR 3.01, CI 95% 1.43-6.30), and coronary artery diseases (OR 3.14 CI 95% 1.44-6.85) were the factors associated with an increased risk of at least one PIM prescription.ConclusionOur study found that one out of three patients with advanced CKD had at least one PIM according to the latest Beers criteria. A large proportion of inappropriate prescribing is preventable by increasing awareness of prescribing physicians to the explicit lists of PIMs.

Project description:BackgroundMany medications pose greater health risks when prescribed for older adults, compared with available pharmacologic and nonpharmacologic alternatives. We sought to quantify the frequency and cost of potentially inappropriate prescribing for older women and men in Canada.MethodsUsing data for 2013 from the National Prescription Drug Utilization Information System database, which contains prescription claims from publicly financed drug plans in all provinces except for Quebec, we identified the frequency of prescribing and cost of potentially inappropriate medications dispensed to provincial drug plan enrollees aged 65 years or more. Potentially inappropriate prescriptions were defined with the use of the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults.ResultsFor the 6 provinces with relatively complete data coverage (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Prince Edward Island), 37% of older people filled 1 or more prescription meeting the Beers Criteria. A higher proportion of women (42%) than men (31%) filled potentially inappropriate prescriptions. The highest rates of prescribing of potentially inappropriate medications were among women aged 85 or more (47%). Benzodiazepines and other hypnotics were the leading contributors to the overall frequency of and sex differences in prescribing of potentially inappropriate drugs among older adults. We estimated that $75 per older Canadian, or $419 million in total, was spent on potentially inappropriate medications outside of hospital settings in 2013.InterpretationPrescribing of potentially inappropriate medications for older adults is common and costly in Canada, especially for women. Multipronged and well-coordinated strategies to reduce the use and cost of potentially inappropriate drugs would likely generate significant health system savings while simultaneously generating major benefits to patient health.

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Potentially inappropriate prescribing in older adults with advanced chronic kidney disease.

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Potentially inappropriate prescribing in older adults with advanced chronic kidney disease.

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