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Research in Social & Administrative... Aug 2023Explicit potentially inappropriate medications (PIM) criteria are commonly used to identify and deprescribe potentially inappropriate prescriptions among older patients.... (Review)
Review
BACKGROUND
Explicit potentially inappropriate medications (PIM) criteria are commonly used to identify and deprescribe potentially inappropriate prescriptions among older patients. Most of these criteria were developed specifically for the Western population, which might not be applicable in an Asian setting. The current study summarizes the methods and drug lists to identify PIM in older Asian people.
METHODS
A systematic review of published and unpublished studies were carried out. Included studies described the development of explicit criteria for PIM use in older adults and provided a list of medications that should be considered inappropriate. PubMed, Medline, EMBASE, Cochrane CENTRAL, CINAHL, PsycINFO, and Scopus searches were conducted. The PIMs were analyzed according to the general conditions, disease-specific conditions, and drug-drug interaction classes. The qualities of the included studies were assessed using a nine-point evaluation tool. The kappa agreement index was used to evaluate the level of agreement between the identified explicit PIM tools.
RESULTS
The search yielded 1206 articles, and 15 studies were included in our analysis. Thirteen criteria were identified in East Asia and two in South Asia. Twelve out of the 15 criteria were developed using the Delphi method. We identified 283 PIMs independent of medical conditions and 465 disease-specific PIMs. Antipsychotics were included in most of the criteria (14/15), followed by tricyclic antidepressants (TCAs) (13/15), antihistamines (13/15), sulfonylureas (12/15), benzodiazepines (11/15), and nonsteroidal anti-inflammatory drug (NSAIDs) (11/15). Only one study fulfilled all the quality components. There was a low kappa agreement (k = 0.230) between the included studies.
CONCLUSION
This review included 15 explicit PIM criteria, which most listed antipsychotics, antidepressants, and antihistamines as potentially inappropriate. Healthcare professionals should exercise more caution when dealing with these medications among older patients. These results may help healthcare professionals in Asian nations to create regional standards for the discontinuation of potentially harmful drugs for elderly patients.
Topics: Humans; Aged; Potentially Inappropriate Medication List; Antipsychotic Agents; Inappropriate Prescribing; Drug Interactions; Asia, Southern
PubMed: 37277240
DOI: 10.1016/j.sapharm.2023.05.017 -
BMJ Open May 2023This study aimed to identify determinants of inappropriate antibiotic prescription in primary care in developed countries and to construct a framework with the...
Determinants of inappropriate antibiotic prescription in primary care in developed countries with general practitioners as gatekeepers: a systematic review and construction of a framework.
OBJECTIVES
This study aimed to identify determinants of inappropriate antibiotic prescription in primary care in developed countries and to construct a framework with the determinants to help understand which actions can best be targeted to counteract development of antimicrobial resistance (AMR).
DESIGN
A systematic review of peer-reviewed studies reporting determinants of inappropriate antibiotic prescription published through 9 September 2021 in PubMed, Embase, Web of Science and the Cochrane Library was performed.
SETTING
All studies focusing on primary care in developed countries where general practitioners (GPs) act as gatekeepers for referral to medical specialists and hospital care were included.
RESULTS
Seventeen studies fulfilled the inclusion criteria and were used for the analysis which identified 45 determinants of inappropriate antibiotic prescription. Important determinants for inappropriate antibiotic prescription were comorbidity, primary care not considered to be responsible for development of AMR and GP perception of patient desire for antibiotics. A framework was constructed with the determinants and provides a broad overview of several domains. The framework can be used to identify several reasons for inappropriate antibiotic prescription in a specific primary care setting and from there, choose the most suitable intervention(s) and assist in implementing them for combatting AMR.
CONCLUSIONS
The type of infection, comorbidity and the GPs perception of a patient's desire for antibiotics are consistently identified as factors driving inappropriate antibiotic prescription in primary care. A framework with determinants of inappropriate antibiotic prescription may be useful after validation for effective implementation of interventions for decreasing these inappropriate prescriptions.
PROSPERO REGISTRATION NUMBER
CRD42023396225.
Topics: Humans; General Practitioners; Developed Countries; Anti-Bacterial Agents; Inappropriate Prescribing; Practice Patterns, Physicians'; Prescriptions; Primary Health Care
PubMed: 37197815
DOI: 10.1136/bmjopen-2022-065006 -
International Health Sep 2023Neonatal near miss (NNM) applies to cases where newborns almost died during the first 28 d of life but survived life-threatening conditions following birth. The most... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neonatal near miss (NNM) applies to cases where newborns almost died during the first 28 d of life but survived life-threatening conditions following birth. The most vulnerable time for infant survival is the neonatal stage, corresponding to almost 50% of deaths occurring at <5 y of age. No study indicates the overall pooled prevalence of NNM in Africa. Thus this review aimed to estimate the overall pooled prevalence of NNMs in Africa.
METHODS
Articles were retrieved through a comprehensive search strategy using PubMed/MEDLINE, Embase, Health InterNetwork Access to Research Initiative, Cochrane Library and Google Search. Data extraction was done independently by all authors. Forest plots and tables were used to represent the original data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore the authors used a meta-analysis of random effects to estimate the aggregate pooled prevalence of NNM in Africa. Funnel plot and Egger regression test methods were used to assess possible publication bias. R software version 3.5.3 and R studio version 1.2.5003 were used to analyse the data. The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to publish this article. The review was registered on the International Prospective Register of Systematic Reviews (registration ID: CRD42021290223).
RESULTS
Through an exhaustive search, we found 835 articles. However, we considered only eight full-text articles to be included in this meta-analysis. The analysis of included studies showed that the overall pooled prevalence of NNM in Africa was 30% (95% confidence interval [CI] 16 to 44). The subgroup analysis by study year showed that the prevalence of NNM from 2012-2015 and 2018-2019 was 36% (95% CI 23 to 49) and 20% (95% CI 1 to 39), respectively.
CONCLUSION
This finding suggests that the pooled prevalence of NNM is high in Africa as compared with other studies. Therefore the government and other stakeholders working on maternal and child health should assist in the design of interventions and strategies for improving the quality of neonatal care.
Topics: Infant; Child; Infant, Newborn; Humans; Prevalence; Near Miss, Healthcare; Africa; Family; Osteochondrodysplasias
PubMed: 37161974
DOI: 10.1093/inthealth/ihad034 -
Research in Social & Administrative... Jul 2023Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents... (Review)
Review
BACKGROUND
Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents have reported facing challenges with unlicensed medicines at the points of transfer of care between settings, a key time when medication errors may occur. There is little known about the patient journey as a whole, or the factors affecting patient care when receiving an unlicensed medicine.
OBJECTIVE
A systematic review of UK literature to better understand factors that affect the entire patient journey from the decision to initiate treatment with an unlicensed medicine to the point at which treatment is supplied through a community pharmacy or ends.
METHODS
Scopus, OVID EMCARE, EMBASE, OVID Medline ALL, CINAHL, Web of Science and Joanna Briggs Institute were searched from 1968 (introduction of the Medicines Act) until November 2020, using the PRISMA guidelines. Narrative synthesis of UK studies was employed to analyse descriptive and qualitative data on any reported findings that would impact the patient journey or care related to the use of unlicensed medicines, and any described barriers or enablers.
RESULTS
Forty-five studies met criteria for final inclusion, with high levels of heterogeneity in terms of designs and methods. Specific challenges that were seen to impact the continuity of care across care settings, patient safety and provision of patient-centred care included diversity of clinical needs and impact of patient population age; healthcare professional awareness and acceptability of the use of unlicensed medicines; the hierarchical structure of the NHS; inconsistent doses and formulations with varying bioequivalence; patient/parent/carer/public awareness of unlicensed medicines use and perceived acceptability.
CONCLUSIONS
This review identified a clear need for consistent information to be provided to healthcare professional and patients alike to support the safe and effective use of unlicensed medicines across care settings.
Topics: Humans; Patient Care; Health Personnel; Caregivers; Medicine; Medication Errors
PubMed: 37121796
DOI: 10.1016/j.sapharm.2023.04.120 -
The Turkish Journal of Pediatrics 2023The concept of Near Miss, has been used in the field of obstetrics as a tool for assessing and improving the quality of care. However, there is no standardized... (Review)
Review
BACKGROUND
The concept of Near Miss, has been used in the field of obstetrics as a tool for assessing and improving the quality of care. However, there is no standardized definition or international criteria for identifying neonatal near misses. The current review aims to investigate the development of the neonatal near miss concept based on the results of studies conducted so far on neonatal near misses and their identification criteria.
RESULTS
Sixty-two articles were retrieved by the electronic search, and after examination of different abstracts and reading of full texts, 17 articles were considered eligible meeting our inclusion criteria. All selected articles varied in terms of concept definition and criteria used. Neonatal Near Miss was defined as any newborn with pragmatic and/or management criteria who survived the first 27 days of life. All studies reviewed showed a Neonatal Near Miss rate that was 2.6 to 10 times higher than the neonatal mortality rate.
CONCLUSIONS
Neonatal Near Miss is a new concept that is currently being debated. There is a need for universal consensus on the definition and its identification criteria. Further efforts are needed to standardize the definition of this concept, including the development of criteria that can be assessed in a neonatal care setting. This is to improve the quality of neonatal care in every setting, regardless of the local level.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Near Miss, Healthcare; Infant Mortality; Pregnancy Complications
PubMed: 37114684
DOI: 10.24953/turkjped.2022.182 -
Drugs & Aging Jun 2023Worldwide, polypharmacy and medication appropriateness-related outcomes (MARO) are growing public health concerns associated with potentially inappropriate prescribing,...
INTRODUCTION
Worldwide, polypharmacy and medication appropriateness-related outcomes (MARO) are growing public health concerns associated with potentially inappropriate prescribing, adverse health effects, and avoidable costs to health systems. Continuity of care (COC) is a cornerstone of high-quality care that has been shown to improve patient-relevant outcomes. However, the relationship between COC and polypharmacy/MARO has not been systematically explored.
OBJECTIVE
The aim of this systematic review was to investigate the operationalization of COC, polypharmacy, and MARO as well as the relationship between COC and polypharmacy/MARO.
METHODS
We performed a systematic literature search in PubMed, Embase, and CINAHL. Quantitative observational studies investigating the associations between COC and polypharmacy and/or COC and MARO by applying multivariate regression analysis techniques were eligible. Qualitative or experimental studies were not included. Information on the definition and operationalization of COC, polypharmacy, and MARO and reported associations was extracted. COC measures were assigned to the relational, informational, or management dimension of COC and further classified as objective standard, objective non-standard, or subjective. Risk of bias was assessed by using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
RESULTS
Twenty-seven studies were included. Overall, substantial differences existed in terms of the COC dimensions and related COC measures. Relational COC was investigated in each study, while informational and management COC were only covered among three studies. The most frequent type of COC measure was objective non-standard (n = 16), followed by objective standard (n = 11) and subjective measures (n = 3). The majority of studies indicated that COC is strongly associated with both polypharmacy and MARO, such as potentially inappropriate medication (PIM), potentially inappropriate drug combination (PIDC), drug-drug interaction (DDI), adverse drug events (ADE), unnecessary drug use, duplicated medication, and overdose. More than half of the included studies (n = 15) had a low risk of bias, while five studies had an intermediate and seven studies a high risk of bias.
CONCLUSIONS
Differences regarding the methodological quality of included studies as well as the heterogeneity in terms of the operationalization and measurement of COC, polypharmacy, and MARO need to be considered when interpreting the results. Yet, our findings suggest that optimizing COC may be helpful in reducing polypharmacy and MARO. Therefore, COC should be acknowledged as an important risk factor for polypharmacy and MARO, and the importance of COC should be considered when designing future interventions targeting these outcomes.
Topics: Humans; Continuity of Patient Care; Cross-Sectional Studies; Drug-Related Side Effects and Adverse Reactions; Inappropriate Prescribing; Polypharmacy; Potentially Inappropriate Medication List; Observational Studies as Topic
PubMed: 36972012
DOI: 10.1007/s40266-023-01022-8 -
BMJ Open Mar 2023The aim of this study is to investigate the effect of artificial intelligence (AI) and/or algorithms on drug management in primary care settings comparing AI and/or...
OBJECTIVES
The aim of this study is to investigate the effect of artificial intelligence (AI) and/or algorithms on drug management in primary care settings comparing AI and/or algorithms with standard clinical practice. Second, we evaluated what is the most frequently reported type of medication error and the most used AI machine type.
METHODS
A systematic review of literature was conducted querying PubMed, Cochrane and ISI Web of Science until November 2021. The search strategy and the study selection were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Population, Intervention, Comparator, Outcome framework. Specifically, the Population chosen was general population of all ages (ie, including paediatric patients) in primary care settings (ie, home setting, ambulatory and nursery homes); the Intervention considered was the analysis AI and/or algorithms (ie, intelligent programs or software) application in primary care for reducing medications errors, the Comparator was the general practice and, lastly, the Outcome was the reduction of preventable medication errors (eg, overprescribing, inappropriate medication, drug interaction, risk of injury, dosing errors or in an increase in adherence to therapy). The methodological quality of included studies was appraised adopting the Quality Assessment of Controlled Intervention Studies of the National Institute of Health for randomised controlled trials.
RESULTS
Studies reported in different ways the effective reduction of medication error. Ten out of 14 included studies, corresponding to 71% of articles, reported a reduction of medication errors, supporting the hypothesis that AI is an important tool for patient safety.
CONCLUSION
This study highlights how a proper application of AI in primary care is possible, since it provides an important tool to support the physician with drug management in non-hospital environments.
Topics: Humans; Child; Artificial Intelligence; Medication Therapy Management; Medication Errors; Patient Safety; Primary Health Care
PubMed: 36958780
DOI: 10.1136/bmjopen-2022-065301 -
BMC Geriatrics Mar 2023Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status.
METHODS
A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study.
RESULTS
Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories.
CONCLUSIONS
There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
Topics: Humans; Aged; Social Class; Income; Educational Status; Occupations; Polypharmacy; Socioeconomic Factors
PubMed: 36934249
DOI: 10.1186/s12877-023-03835-z -
Applied Clinical Informatics Jan 2023Although electronic medication administration records (eMARs) and bar-coded medication administration (BCMA) have improved medication safety, poor usability of these...
BACKGROUND
Although electronic medication administration records (eMARs) and bar-coded medication administration (BCMA) have improved medication safety, poor usability of these technologies can increase patient safety risks.
OBJECTIVES
The objective of our systematic review was to identify the impact of eMAR and BCMA design on usability, operationalized as efficiency, effectiveness, and satisfaction.
METHODS
We retrieved peer-reviewed journal articles on BCMA and eMAR quantitative usability measures from PsycInfo and MEDLINE (1946-August 20, 2019), and EMBASE (1976-October 23, 2019). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we screened articles, extracted and categorized data into the usability categories of effectiveness, efficiency, and satisfaction, and evaluated article quality.
RESULTS
We identified 1,922 articles and extracted data from 41 articles. Twenty-four articles (58.5%) investigated BCMA only, 10 (24.4%) eMAR only, and seven (17.1%) both BCMA and eMAR. Twenty-four articles (58.5%) measured effectiveness, 8 (19.5%) efficiency, and 17 (41.5%) satisfaction. Study designs included randomized controlled trial ( = 1; 2.4%), interrupted time series ( = 1; 2.4%), pretest/posttest ( = 21; 51.2%), posttest only ( = 14; 34.1%), and pretest/posttest and posttest only for different dependent variables ( = 4; 9.8%). Data collection occurred through observations ( = 19, 46.3%), surveys ( = 17, 41.5%), patient safety event reports ( = 9, 22.0%), surveillance ( = 6, 14.6%), and audits ( = 3, 7.3%).
CONCLUSION
Of the 100 measures across the 41 articles, implementing BCMA and/or eMAR broadly resulted in an increase in measures of effectiveness ( = 23, 52.3%) and satisfaction ( = 28, 62.2%) compared to measures of efficiency ( = 3, 27.3%). Future research should focus on eMAR efficiency measures, utilize rigorous study designs, and generate specific design requirements.
Topics: Humans; Medication Errors; Medication Systems, Hospital; B-Cell Maturation Antigen; Pharmaceutical Preparations; Surveys and Questionnaires
PubMed: 36889339
DOI: 10.1055/s-0043-1761435 -
PloS One 2023Neonatal near miss is a condition of newborn infant characterized by severe morbidity (near miss), but survived these conditions within the first 27 days of life. It is... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Neonatal near miss is a condition of newborn infant characterized by severe morbidity (near miss), but survived these conditions within the first 27 days of life. It is considered as the first step to design management strategies that can contribute in reducing long term complication and mortality. The aim of this study was to assess prevalence and determinants of neonatal near miss in Ethiopia.
METHODS
The protocol of this systematic review and meta-analysis was registered at the Prospero with a registration number of (PROSPERO 2020: CRD42020206235). International online databases such as PubMed, CINAHL, Google scholar, Global Health, Directory of open Access journal and African Index Medicus were used to search articles. Data extraction was undertaken with Microsoft Excel and STATA11 was used to conduct the Meta-Analysis. Random effect model analysis was considered when there was evidence of heterogeneity between the studies.
RESULTS
The overall pooled prevalence of neonatal near miss was 35.51% (95%CI: 20.32-50.70, I2 = 97.0%, p = 0.000). Primiparity (OR = 2.52, 95%CI: 1.62, 3.42), referral linkage (OR = 3.92, 95%CI: 2.73, 5.12), premature rupture of membrane (OR = 5.05, 95%CI: 2.03, 8.08), Obstructed labor (OR = 4.27, 95%CI: 1.62, 6.91) and maternal medical complications during pregnancy (OR = 7.10, 95%CI: 1.23, 12.98) had shown significant statistical association with neonatal near miss.
CONCLUSION
The prevalence of neonatal near miss in Ethiopia is evidenced to be high. Primiparity, referral linkage, premature rupture of membrane, obstructed labor and maternal medical complications during pregnancy were found to be determinant factors of neonatal near miss.
Topics: Infant; Pregnancy; Infant, Newborn; Female; Humans; Prevalence; Ethiopia; Near Miss, Healthcare; Parity; Morbidity; Dystocia
PubMed: 36809252
DOI: 10.1371/journal.pone.0278741