Polypharmacy, or the concurrent use of multiple medications, is associated with detrimental outcomes for patients and has gathered increasing attention within the scientific clinical literature. Pediatric populations warrant special consideration for the practice of polypharmacy, as medication effects are more pronounced in youth and adverse effects may have a lasting impact on development. This dissertation study examined psychotropic prescribing practices in a sample of adolescents who have engaged in sexually abusive behaviors, a subset of justice-involved youth who are at risk for polypharmacy. General prescribing trends were examined, and a principle components analysis involving variables associated with risk of polypharmacy was conducted. Results indicated that polypharmacy was common, with many youth being prescribed medications at a young age. Use of risky medications such as antipsychotics was also prevalent, even for individuals without psychosis. Analyses suggested that behavioral issues, trauma and residential instability, and complex psychological concerns were significantly associated with polypharmacy outcomes. Clinical implications of findings are discussed.

Bakgrund: Utvecklingen av olika läkemedel och behandlingar har tillfört bättre behandlingsmöjligheter för äldre som har lett till ett längre liv. Eftersom äldre lider ofta av olika sjukdomar konsumerar de flera läkemedel än andra åldersgrupper. Samtidigt, kan förekomst av olika läkemedelsbehandlingar, som definieras som polyfarmaci, medföra en ökad risk för negativa effekter som kan påverka patientens välbefinnande och livskvalitet. Det är därför viktigt att belysa vilka omvårdnadsproblem som kan uppstå i samband med polyfarmaci. Genom identifiering av omvårdnadsproblem kan sjuksköterskan sedan prioritera och leda omvårdnadsåtgärder som gynnar den äldres trygghet och välbefinnande. Syfte: Att belysa omvårdnadsproblem relaterade till polyfarmaci hos äldre. Metod: Arbetet har utförts som en litteraturöversikt. Innehållet anskaffades genom sammanställning av tillgängliga studier inom det valda problemområdet. Valt material omfattar artiklar skrivna på engelska och inkluderar personer i åldersgruppen 65 år eller äldre som behandlas med polyfarmaci. Resultat: Resultatet baseras på 12 granskade artiklar som belyser omvårdnadsproblem i samband med polyfarmaci. Framträdande omvårdnadsproblem i denna litteraturöversikt inbegriper risk för fall, malnutrition, funktionsnedsättning, förvirring och bristande följsamhet. Diskussion: Sambandet mellan polyfarmaci och omvårdnadsproblem kan vara komplicerat att fastställa. Svårigheten beror på att polyfarmaci saknar en entydig definition. Dessutom ses polyfarmaci i många fall endast som en riskfaktor i mängden, snarare än unik orsak till olika problem. / Background: The development of various medicines and treatments has resulted in better treatment for the elderly that has led to a longer life. Because the elderly often suffer from various diseases, they consume more drugs than other age groups. At the same time, the presence of different drug therapies, defined as polypharmacy, increases the risk of adverse effects that can affect the patient's well-being and quality of life. It is therefore important to illuminate the nursing problems that may arise associated with polypharmacy. Through the identification of these problems, the nurse can be able to prioritize and manage nursing actions that benefit the elderly security and wellbeing. Aim: Illuminate nursing problems related to polypharmacy in the elderly. Methods: This paper has been carried out as a literature review. The content acquired through the compilation of available studies in the chosen problem area. The choice of material included articles written in english and included people aged 65 years and older treated with polypharmacy. Results: The result is based on 12 reviewed articles that illustrate associations between polypharmacy and nursing problems. Nursing problems that have emerged in this study include risk of falls, malnutrition, function disability, confusion and lack of adherence. Discussion: The relationship between polypharmacy and nursing problems can be complicated to determine. The difficulty is due to the fact that polypharmacy lacks a clear definition. In addition, polypharmacy is seen in many cases only as a risk factor in the crowd, rather than a unique cause of various problems.

Purpose: To show the necessity of distinguishing several patterns of drug prescribing that may lead to co-medication. It is demonstrated how these different patterns can be investigated using large databases containing pharmacy data or reimbursement data. Methods: Two examples illustrate how the particular pattern of co-medication studied will influence the reported proportion of patients having co-medication, the use of antidepressants among people using anticonvulsants, and the use of antihistamines among people receiving penicittines. Results: Depending on definition and period considered, the percentage of anticonvulsant users co-medicated with antidepressants ranged from 5.8% (95%CI 5.0%, 6.8%) to 14.5% (95%CI 13.2%, 15.9%) in 2000. Comparing 2002 with 2000, the ratio of proportions ranged from 1.3 to 2.1. The percentage of people who received penicillines and were co-medicated with antihistamines ranged from 0.5% (95%CI 0.4%, 0.6%) to 9.7% (95%CI 9.3%,10.2%) in 2000. Comparing 2002 with 2000, the ratio of proportions ranged from 1.2 to 1.6. Conclusion: The co-medication patterns investigated yielded clinical as well as statistically significant different estimates. The estimates differed up to a factor 2.5 for the drugs usually prescribed for long periods, and a factor 12 for drugs prescribed for short periods. Hence, we propose to distinguish the patterns 'co-prescribing', 'concomitant medication,' and 'possibly concurrent medication.' The research question determines the co-medication pattern of interest, and the drug and disease under study determine the time window.

Background. Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Methods. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were written during a 17-month period of study. Forty-two psychoactive medications were rank ordered in terms of prescription frequency. Results. Fifty-two per cent (52%) of all prescriptions written during the study period were for psychoactive medications. Anticonvulsant, antipsychotic and antidepressant medications were the most commonly filled prescriptions among psychoactive medications. Sixty per cent (62%) of the study population was given prescriptions for more than one psychoactive medication and 36% received three or more psychoactive medications. During the study period there was a statistically significant increase in prescriptions filled for olanzapine, risperidone, valproic acid, and clonazepam whereas prescriptions filled for thioridazine, haloperidol, and benzotropine showed a significant decline (P < 0.05-0.001). Distribution of psychoactive drug class by age showed that the majority of prescriptions were filled for individuals between 20 and 50 years with the exception of prescriptions for psychostimulants which peaked for individuals prior to 20 years. Conclusions. (1) Analysis of pharmacy billing records provides a method for assessing prescribing patterns of psychoactive medications in community-based individuals with IDDD. (2) Polypharmacy for psychoactive medications is prevalent in this setting. (3) The second-generation antipsychotic medications are prominently represented by an increasing number of filled prescriptions during the study period.

No description available.

Under de senaste 20 åren har läkemedelsanvändning hos äldre fördubblats. Sverige har relativt hög medellivslängd internationellt sett. Idag finns det cirka en halv miljon svenskar som är över 80 år. Allt fler blir äldre bl.a. tack vare läkemedel och behandlingar som räddar många liv. Andelen äldre människor har de senaste åren ökat och denna ökning fortsätter i hela världen. Den äldre gruppens ökade medellivslängd beror till stor del på utvecklingen inom läkemedelsbranschen. Idag har nya läkemedel tagits fram och fortsätter att tas fram, vilket gör att fler och allvarligare sjukdomar är behandlingsbara. Åldersförändringarna gällande läkemedelspåverkan beror på ett flertal olika faktorer. Det finns ett samband mellan polyfarmaci och en ökad risk för läkemedelsbiverkningar, interaktioner och bristande följsamhet vilket kan leda till onödiga läkarbesök och sjukhus inläggningar.

Polypharmacy is broadly defined as the administration of more than one medication in a single patient, with the most commonly used definition indicating the concurrent use of five or more medications. Polypharmacy occurs in most clinical settings, particularly inpatient settings and treatment settings for persons with chronic illness and the elderly. Reasons for receiving more than one medication include ineffective treatment with monotherapy, targeting specific but varied symptoms, treating two distinct but co-morbid illnesses, addressing unremitting symptoms, and treating extrapyramidal side effects. Research indicates that each medication added to the patient’s regimen increases the likelihood of an adverse outcome, as well as the risk of adverse drug reactions, drug-to-drug interactions, cumulative toxicity, medication errors, patient non-compliance, patient morbidity, and patient mortality. The current study seeks to investigate the rates of polypharmacy and related characteristics predictive of polypharmacy within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101), African American (40.1%, n=73), and Hispanic (2.2%, n=4), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). Of those currently taking medications, 99.2% have been prescribed more than one type of medication, with 93.1% of those individuals being prescribed four or more. Polypharmacy was observed in 91% of participants. Of those diagnosed with a mood or psychotic disorder, an average of 3.6 different types of psychotropic medications were prescribed. Co-morbidity of mental illness was predictive of polypharmacy trends, F(1,181)=5.28, p<.05. Additionally, individuals with at least one chronic illness also were subjected to polypharmacy practices, with rates increasing for those with more than one chronic illness. As a measure of onset and severity of symptoms, age at first hospitalization and age of onset of aggressive behaviors were measured, and, interestingly, both measures were predictive of polypharmacy within these patients, F(1, 181)=13.45, p<.01. Results indicate that perceived severity of symptomology, aggression, and complex health problems all contribute to polypharmacy practices among prescribing physicians. The high rates of polypharmacy observed are concerning because of the potential for increased aversive health outcomes. Understanding the predictive factors, rates, and trends of polypharmacy has valuable implications for the future treatment and rehabilitation of individuals residing in a forensic psychiatric setting.

Yes / There is an increased evidence for treating hypertension by a combination of two or more drugs. Increasing the number of daily intake of tablets has been reported to negatively affect the compliance of patients. Therefore, numerous fixed dose combinations (FDCs) have been introduced to the market. However, the inherent rigid nature of FDCs does not allow the titration of the dose of each single component for an individual patient's needs. In this work, flexible dose combinations of two anti-hypertensive drugs in a single bilayer tablet with a range of doses were fabricated using dual fused deposition modelling (FDM) 3D printer. Enalapril maleate (EM) and hydrochlorothiazide (HCT) loaded filaments were produced via hot-melt extrusion (HME). Computer software was utilised to design sets of oval bi-layer tablets of individualised doses. Thermal analysis and x-ray diffractometer (XRD) indicated that HCT remained crystalline in the polymeric matrix whilst EM appeared to be in an amorphous form. The interaction between anionic EM and cationic methacrylate polymer may have contributed to a drop in the glass transition temperature (Tg) of the filament and obviated the need for a plasticiser. Across all tablet sets, the methacrylate polymeric matrix provided immediate drug release profiles. This dynamic dosing system maintained the advantages of FDCs while providing a superior flexibility of dosing range, hence offering an optimal clinical solution to hypertension therapy in a patient-centric healthcare service.

Yes / Background: In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalisation. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. Objective: To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. Design: Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A ‘trigger film’ showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritised and appropriate solutions were developed. Review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. Setting and participants: Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. Results: The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. Conclusions: Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. / National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)

Background: In older age polypharmacy is common due to a higher rate of chronic diseases. Taking multiple medications can result in drug related problems resulting in higher health care costs. OptiMEDs is an information and communications technology (ICT) guided medication review program that was created to improve the quality of the prescription of medicines in elderly. A pilot study of OptiMEDs was performed in 3 nursing homes in Belgium during 2019-2020.  Aim: To update the explicit criteria behind OptiMEDs and to make the tool more specific.  Method: Through a literature search of explicit criteria of potentially inappropriate prescribing (PIM-lists), newer versions published between 1st of January 2018 – 31st of October 2022 were sought. Redundancy of alerts was reduced by removing all the double alerts of PIMs. To minimize the number of alerts issued by the tool, several approaches to exemptions from and exclusion to PIMs were tested. To evaluate the improvement, results from the previous and new rule base were compared using the same dataset from the OptiMEDs feasibility trial.  Results:OnlyonePIM-list(Beer’scriteria)hadanewversion,resultingin45PIMsbeingadded to the database and 33 PIMs were removed. Removal of the duplicates resulted in a database with 594 PIMs. With the OptiMEDs data set; The amount of patients having a PIM decreased with 25.1 % when removing EU(7)-list as a source. The amount of patient having at least one candidate for deprescribing decreased with 10.4 % when only keeping the deprescribing.org and RTCs as a source.  Conclusion: The update probably made OptiMEDs more user-friendly as the number of PIMs decreased and the number of medications candidated for deprescribing decreased. However, an important further update is still needed, which is to include the clinical-based PIMs.