Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP : a cross-sectional study

Background Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria. Objective To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person’s Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. Results A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores.   Conclusions The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.Publisher PDFPeer reviewe

Pan‐European survey on medication adherence management by healthcare professionals /

Aims: While medication adherence (MA) is a key prerequisite for achieving optimalclinical and economic outcomes, nonadherence is highly prevalent. Assessing howhealthcare professionals (HCPs) in Europe manage MA, focusing on measurement,reporting and interventions, is the subject of this study.Methods: A cross-sectional study was conducted among 40 European countries andquantitative analysis was conducted via an online survey. The multi-language onlinesurvey was created using Webropol 3.0 survey and reporting tool. Descriptive statis-tics and chi-squared tests were applied.Results: In total, 2875 HCPs (pharmacists: 39.9%; physicians: 36.7%; nurses: 16.4%)from 37 European countries participated. The most used methods for MA assess-ment were direct communication with patients (86.4%) and referring to personalpatient records (56.7%) (P < 0.0001). Physicians (74.9%) and nurses (58.8%) weremore aware of problems related to MA in contrast to pharmacists (48.6%)(P < 0.001). Almost all HCPs (92.6%) indicated that MA-enhancing interventionsinvolved mainly direct communication with nonadherent patients (93.3%) and theircaregivers (55.7%). Medication review and related optimization of therapy weremainly performed in Western European countries (46.8%). Technological solutionswere ranked as one of the less applied approaches (10–15%) (P < 0.001).Conclusions: HCPs in all European regions recognize MA management as an integralelement of overall patient-centred care. More efforts are needed to ensure timely,adequate and relevant MA assessment, reporting and improvement and involvementof all HCPs, especially among pharmacists who were generally less aware of MA issues. Promotion and use of digital technological solutions should be the focus ofcurrent and future clinical practice to optimize MA management processes