Made available in DSpace on 2014-07-29T15:29:14Z (GMT). No. of bitstreams: 1 Dissertacao Thalyta Renata Araujo Santos.pdf: 792912 bytes, checksum: 67d105d6aad2c80ad2b6ca4a9fd13fca (MD5) Previous issue date: 2012-03-30 / Introduction: The fact of elderly people live in a greater amount with chronic diseases, make the elderly a great consumer of health services and, probably, the most medicated group in the society. In this context serious problems arise, such as the use of multiple medications simultaneously (polypharmacy) that can lead to serious consequences to the elderly health. Another problem is the self-medication, which may exacerbate the associated risks with prescript drugs, delaying a diagnosis and masking a disease. There is, still, the use of drugs considered inappropriate for elderly, either by reducing the therapeutic efficacy or an increased risk of adverse effects that increase the advantages in elderly usage. Objective: Analyzing the pattern of use of medications in aged people in the city of Goiânia-GO, and associate it with socioeconomic aspects and with the self-rated health. Methods: A population-based study and cross-section, that evaluated the health of elderly in the city of Goiânia-GO. The data collection was carried out in December/2009 to April/2010 from 934 elderly. The questionnaire had questions about medications, in addition to information about self-rated health and socioeconomic profile. The drugs groups were classified according to the Anatomical Therapeutic Chemical and Classification-ATC. The inappropriate drugs for elderly were identified according to Beers Criteria. Used Mann Whitney (U) and Chi-square test, it was considered significant p<0.05. Results: Among 934 elderly participants of the survey, 783 (83.8%) had answered completely to the questionnaire. These 738 elderly used 2846 drugs (3.63 drugs/elderly). Women consumed more medication than men (3.94 and 3.06 respectively, p <0.001). The most frequently consumed drugs act on the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and 35.7% of the elderly told to practise self-medication. The drugs most commonly used by self-medication were the painkillers (30.8%). According to Beers-Fick Criteria, 24.6% of the elderly used inappropriate drugs, 90.2% of these drugs came from a current prescription. The inappropriate drugs more consumed were benzodiazepines (34.2%). Women, widows, elderly with 80 years or more and those who had a worse self-rated health practiced more polypharmacy (p<0.05). Elderly people with lower education and with worse self-rated health practiced more self-medication (p<0.05). Conclusions: The results of this study showed that the pattern of drug use by elderly of Goiânia was similar to that found in elderly people from other regions of Brazil. Since the number of drugs used, the prevalence of polypharmacy and self-medication practices and the use of inappropriate drugs were within the national average. Women, widows, aged 80 years or more and those who consider their health as poor more often practiced polypharmacy, the largest self-medication was associated with a lower education and poorer self-rated health. / Introdução: A maior convivência com doenças crônicas faz dos idosos grandes usuários de serviços de saúde e possivelmente o grupo mais medicalizado da sociedade. Nesse contexto surgem sérios problemas, como o uso de vários medicamentos concomitantemente (polifarmácia) que pode levar a sérias consequencias à saúde do idoso. Pode ser citada também a prática da automedicação, que pode acentuar os riscos relacionados aos medicamentos prescritos, retardar um diagnóstico e mascarar uma doença. Além disso, têm-se o uso de medicamentos considerados impróprios para o idoso, seja por redução da eficácia terapêutica ou por um risco aumentado de efeitos adversos que superam seus benefícios. Objetivo: Analisar o padrão do uso de medicamentos em idosos no município de Goiânia, Goiás e associá-lo com aspectos socioeconômicos e com a autopercepção de saúde. Métodos: Estudo de base populacional e delineamento transversal, que avaliou o uso de medicamentos em idosos no município de Goiânia-GO. Foram coletados dados de 934 idosos no período entre dezembro/2009 e abril/2010. No questionário aplicado havia questões sobre medicamentos, além de informações sobre autopercepção de saúde e o perfil socioeconômico. Os medicamentos usados pelos idosos foram classificados segundo o Anatomical Therapeutic and Chemical Classification-ATC. Os medicamentos impróprios para idosos foram identificados segundo Critério de Beers-Fick. Utilizou-se Teste de Mann Whitney (U) e Qui-quadrado, considerando significativo p<0,05. Resultados: Dos 934 idosos participantes do inquérito, 783 (83,8%) responderam completamente ao questionário. Esses 783 idosos usavam 2.846 medicamentos (3,63 medicamentos/idoso). As mulheres usavam mais medicamentos que os homens (3,94 e 3,06 respectivamente, p<0,001). Os medicamentos mais usados atuam no aparelho cardiovascular (38,6%). A prevalência de polifarmácia foi de 26,4% e 35,7% dos idosos relatou praticar automedicação. Os medicamentos mais usados por automedicação foram os analgésicos (30,8%). Segundo os critérios de Beers-Fick, 24,6% dos idosos usava pelo menos um medicamento considerado impróprio, 90,2% desses medicamentos era proveniente de uma receita médica atual. Os medicamentos impróprios mais usados foram os benzodiazepínicos (34,2%). Mulheres, viúvos, idosos com 80 anos ou mais e os que apresentaram pior autopercepção de saúde praticavam mais a polifarmácia (p<0,05). Idosos com menor escolaridade e com pior autopercepção de saúde praticavam mais a automedicação (p<0,05). Conclusões: Os resultados desse estudo mostraram que o padrão do uso de medicamentos por idosos goianieneses foi semelhante ao encontrado em idosos de outras regiões do Brasil. Visto que o número de medicamentos usados, a prevalência das práticas da polifarmácia e automedicação e o uso de medicamentos impróprios estiveram dentro da média nacional. Mulheres, viúvos, idosos com 80 anos ou mais e aqueles que consideram sua saúde como ruim praticavam com maior frequência a polifarmácia; a maior prática da automedicação esteve associada com uma menor escolaridade e uma pior autopercepção de saúde.

No Brasil, poucos estudos investigaram a prevalência de medicamentos potencialmente inapropriados (MPIs) em idosos ambulatoriais. Este estudo visa determinar a prevalência de MPIs prescritos para estes pacientes, identificando os mais comumente envolvidos e verificando se a idade, o sexo e o número de medicamentos estão relacionados à prescrição de tais medicamentos. Foram coletadas prescrições de 3070 pacientes idosos (60 anos) em banco de dados, provenientes dos ambulatórios de Geriatria e Clínica Geral de um hospital universitário de atenção terciária em São Paulo-Brasil entre fevereiro e maio de 2008, que foram divididas de acordo com o sexo e faixa etária (60-69; 70-79 e 80). Os critérios de Beers versão 2003 foram utilizados para a avaliação de MPIs. A maior parte da casuística foi composta por mulheres em ambos os ambulatórios (66,6% na Clínica Geral e 77,7% na Geriatria). Os pacientes da Clínica Geral apresentaram média de idade de 71,3 anos e os da Geriatria, 80,1 anos. Na Clínica Geral a prevalência média de prescrição de MPIs foi de 37,6% e na Geriatria de 26,9%, sendo que em ambos as mulheres de 60-69 foram as que apresentaram a maior prevalência destes medicamentos. Os MPIs mais prescritos nos dois ambulatórios foram o carisoprodol, a fluoxetina e a amitriptilina, sendo que houve diferenças nos perfis de prescrições entre homens e mulheres. A chance de uso de MPI no sexo feminino é maior que no masculino (p<0,001); a chance de uso de MPI na faixa de 70-79 anos é menor que na faixa de 60-69 anos (p=0,030), assim como na faixa de 80 (p=0,024). Estas conclusões não dependem do ambulatório (p=0,164).O efeito de ambulatório depende do número de medicamentos (p=0,009). Se o número de medicamentos é < 9 a chance de uso de MPI na Clínica Geral é maior que na Geriatria (p=0,041). Quando o número de medicamentos é 7 ou 8, a chance de uso de MPI é maior do que quando são prescritos 1-4 medicamentos (p<0,001), nos dois ambulatórios (p=0,098). Quando são usados 9 medicamentos, a chance de uso de MPI depende do ambulatório (p=0,044). Na Geriatria, a chance de uso de um MPI é 8,2 vezes a RC na categoria 1-4 medicamentos; enquanto que na Clínica Geral a razão de chances é 4,6. As prevalências de MPIs encontradas foram semelhantes ao relatado na literatura e estão correlacionadas ao sexo feminino. A chance de prescrição de MPIs foi menor em pacientes com 70 anos; observou-se que se o número de medicamentos for <9, a chance de uso de MPI na Clínica Geral é maior que na Geriatria, porém, se o número de medicamentos for 9 não há diferença entre as chances de uso de MPI nos dois ambulatórios / In Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs) among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed to such patients, identify the medications most commonly involved and investigate whether age, sex and number of medications are related to the prescription of such medications. Prescriptions issued to 3,070 elderly patients (60 years) were gathered from a database. These patients were attended at the geriatric and general clinical outpatient services of a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. They were divided according to sex and age group (60- 69; 70-79; and 80 years). The Beers criteria (2003 version) were used to evaluate PIMs. The majority of the sample comprised women, at both outpatient services (66.6% in the general clinic and 77.7% in geriatrics). The mean age of the general clinical patients was 71.3 years and the mean for the geriatric patients was 80.1 years. At the general clinic, the mean prevalence of prescriptions of PIMs was 37.6%, and it was 26.9% at the geriatric clinic. At both outpatient services, women aged 60-69 years presented the highest prevalence of such medications. The PIMs most prescribed at the two outpatient services were carisoprodol, fluoxetine and amitriptyline, and there were differences in the prescription profiles between the men and women. The chances of using PIMs were greater for the women than for the men (p < 0.001). The chances of using PIMs in the 70-79 years group were lower than in the 60-69 years group (p = 0.030), and likewise for the group 80 years (p = 0.024). These conclusions were independent of the outpatient service (p = 0.164). The outpatient effect depended on the number of medications (p = 0.009). If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic (p = 0.041). When the number of medications was 7 or 8, the chances of using PIMs were greater than when prescribed 1-4 medications (p < 0.001), at both outpatient services (p = 0.098). When 9 medications were used, the chances of using PIMs depended on the outpatient service (p = 0.044). At the geriatric clinic, the chances of using PIMs were 8.2 times greater than the chances in the category of 1-4 medications; while at the general clinic, the odds ratio was 4.6. The prevalence of PIMs encountered was similar to what has been reported in the literature, and it correlated with female sex. The chances of being prescribed PIMs were lower among patients 70 years. If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic. However, if the number of medications was 9, there was no difference in the chances of using PIMs between the two outpatient services

Le syndrome de fragilité est devenu le concept le plus étudié ces dix dernières années par les gériatres, de par le vieillissement rapide de la population Française et mondiale et pour l'intérêt en terme de prévention globale que ce syndrome pourrait représenter. L’ intérêt qu’ apporte ce nouveau concept de plus en plus consensuel est en effet sa capacité à définir une personne âgée comme étant une entité fonctionnelle et multidimensionnelle (cognitive, thymique et sociale) pouvant être réversible. A partir de la, l’élaboration d'une stratégie par les médecins, afin de dépister les patients les plus fragiles pourrait permettre d’éviter les stades irréversibles de la perte d’autonomie, l’institutionnalisation et la surmortalité. Cela aurait probablement des conséquence s possibles en matière de santé publique. Un des facteurs de risque possible de la fragilité est la douleur chronique qui a toujours été considérée à tord comme un simple symptôme prévalent chez les personnes âgées et non pas comme une maladie soit une entité clinico - pathologique complexe pouvant interagir avec la fragilité. Dans ce travail, nous avons étudié les mécanismes physiopathologiques communs qui lient le syndrome de fragilité à la douleur chronique , leur interaction et l’ intérêt que peut susciter l’optimisation du dépistage de la douleur chronique chez les personnes âgées dans l’évaluation des personnes les plus fragiles. Nous proposons à travers de nouveaux projets de recherche clinique prospectifs , de démontrer au - delà d e la relation possible entre la fragilité et la douleur persistante, le rôle que pourrait jouer les médicaments essentiellement analgésiques dans la réversibilité de ce syndrome / The frailty concept has become the most studied one over the past decade , by the rapid aging of French and the world population and for the interest in terms of overall prevention that this syndrome could represent. The advantage brought by this ne w concept increasingly consensual relies on its ability to define elderly as a m ultidimensional functional entity (cognitive, social and mood) being reversible. Caregivers have to start before to tailor a care plan by screening for the frailest patients in order to avoid irreversible stages of frailty, ( institutionalization and mortal ity ) . This probably would have possible consequences for public health. One of the possible risk factors for fragility is persistent pain which has always been wrongly considered as a mere prevalent symptom in o lder people and not as a clinical and patholo gical entity that can interact with the complex fragility syndrome. In this work, we studied the common pathophysiological mechanisms that link frailty to pain, their interaction and the interest that may lead to optimize screening of pain in older adults within frailty evaluation. We offer through new clinical research projects looking to demonstrate beyond the possible relationship between fragility and persistent pain, the potential role of analgesic drugs mainly in the reversibility of this syndrome

Background: Statins have questionable benefits among older adults with life-limiting illness. Statin use is widespread among U.S. older adults, but little is known about use in nursing homes. This dissertation was designed to identify the prevalence and predictors of statin pharmacotherapy use and discontinuation in U.S. nursing homes. Methods: Data sources (2011-2016) included: Minimum Data Set 3.0, Medicare administrative claims data, Provider of Service files, and Dartmouth Atlas files. Analyses included: descriptive statistics, multilevel modeling, and proportional change in cluster variations with adjustments to reduce confounding and model misspecification. Results: Approximately 36% of older adults admitted to U.S. nursing homes between 2015 – 2016 were actively using statins at the time of admission. Among long-stay residents with life-limiting illness, 34% were on statins at one time (2016; aged 65-75 years: 44%, >75 years: 31%). Statin use varied significantly by hospital referral regions, with most variation in the >75 age group. Limiting the sample to statin users, 20% discontinued statins within 30 days of nursing home admission. While discontinuation was positively associated with severity of life-limiting condition, the majority of residents remained on statins 30 days post-admission, including those with a < 6-month prognosis. Conclusion: Statin use is pervasive across US nursing homes and persists with life-limiting illness. Geographic variation appeared to coincide with clinical uncertainty, especially among adults >75 with few national guidelines. More needs to be done to prioritize statin deprescribing in nursing homes with research that identifies ways to facilitate improved patient-provider awareness and engagement in the discontinuation process.

Objective: Drugs increase fall risk and decrease performance on balance and mobility tests. Conversely, whether biofeedback training to reduce fall risk also decreases scores on a published drug-based fall risk index has not been documented. Forty-eight community-dwelling older adults underwent either treadmill gait training plus visual feedback (+VFB), or walked on a treadmill without feedback. The Quantitative Drug Index (QDI) was derived from each participant's drug list and is based upon all cause drug-associated fall risk. Analysis of covariance assessed changes in the QDI during the study, and data is presented as mean ± standard error of the mean. Results: The QDI scores decreased significantly (p = 0.031) for participants receiving treadmill gait training +VFB (- 0.259 ± 0.207), compared to participants who walked on the treadmill without VFB (0.463 ± 0.246). Changes in participants QDI scores were dependent in part upon their age, which was a significant covariate (p = 0.007). These preliminary results demonstrate that rehabilitation to reduce fall risk may also decrease use of drugs associated with falls. Determination of which drugs or drug classes that contribute to the reduction in QDI scores for participants receiving treadmill gait training +VFB, compared to treadmill walking only, will require a larger participant investigation. Trial Registration ISRNCT01690611, ClinicalTrials.gov #366151-1, initial 9/24/2012, completed 4/21/2016

Bakgrund: Andelen äldre ökar och för äldre är läkemedelsbiverkningar ett vanligt problem som ger ökad sjuklighet, ohälsa och dödlighet. Ofta är de läkemedel som orsakar allvarlig läkemedelsrelaterad ohälsa vanligt förekommande, biverkningarna är välkända och går att förebygga. Distriktssköterskan är en viktig del i det förebyggande arbetet genom läkemedelsgenomgångar, utbildning och kunskap som ger goda förutsättningar för att effektivt förebygga läkemedelsrelaterad ohälsa och öka patientsäkerheten. Syfte: var att beskriva läkemedelsförskrivningen hos den äldre befolkningen i Blekinge under perioden 2001–2015. Metod: Studien gjordes i samarbete med Swedish National Study on Aging and Care – Blekinge (SNAC-B). Den hade kvantitativ design med tre tvärsnitt mellan 2001–2015 och inkluderade äldre personer 65 år eller äldre. Analysen gjordes deskriptivt och för att se signifikant skillnad i medelantal förskrivna läkemedel genomfördes t-test. Resultat: Den äldre befolkningen hade i snitt lika många förskrivna läkemedel 2001–2015, äldre utan läkemedel ökade procentuellt från 2001–2015 och för äldre med läkemedel syntes en ökad förskrivning. Mellan åldersgrupperna fanns en statistiskt signifikant skillnad i medelvärdet av förskrivningar vid alla tre tidpunkterna, detta fanns mellan könen vid första tvärsnittets tidpunkt, 2001–2003, men kunde inte påvisas vid de två andra tvärsnitten. De fem mest förskrivna läkemedelsgrupperna var samma vid alla tre tidpunkterna. Slutsats: Antal förskrivningar visade sig vara konstant, men andelen äldre utan läkemedel ökade och hos äldre med läkemedel ökade förskrivningarna. Äldre äldre visade sig ha en ökad förskrivning jämfört med yngre äldre, det fanns även en skillnad i förskrivningar mellan könen 2001–2003, för att sedan jämnas ut.

The prediction of polypharmacy side effects is crucial to reduce the mortality and morbidity of patients suffering from complex diseases. However, its experimental prediction is unfeasible due to the many possible drug combinations, leaving in silico tools as the most promising way of addressing this problem. This thesis improves the performance and robustness of a state-of-the-art graph convolutional network designed to predict polypharmacy side effects, by feeding it with complexity properties of the drug-protein network. The modifications also involve the creation of a direct pipeline to reproduce the results and test it with different datasets. / För att minska dödligheten och sjukligheten hos patienter som lider av komplexa sjukdomar är det avgörande att kunna förutsäga biverkningar från polyfarmaci. Att experimentellt förutsäga biverkningarna är dock ogenomförbart på grund av det stora antalet möjliga läkemedelskombinationer, vilket lämnar in silico-verktyg som det mest lovande sättet att lösa detta problem. Detta arbete förbättrar prestandan och robustheten av ett av det senaste grafiska faltningsnätverken som är utformat för att förutsäga biverkningar från polyfarmaci, genom att mata det med läkemedel-protein-nätverkets komplexitetsegenskaper. Ändringarna involverar också skapandet av en direkt pipeline för att återge resultaten och testa den med olika dataset.

O envelhecimento da população implica em aumento da prevalência de doenças crônicas não transmissíveis (DCNT) e uso de polifarmácia (uso de 5 ou mais medicamentos concomitantemente). Porém, o uso de medicamentos pode ter um efeito negativo em pacientes com multimorbidade. Entende-se como competição terapêutica (CT) a interação medicamento-doença em que o tratamento recomendado para certa condição pode alterar negativamente (competir com) outra condição coexistente. Neste âmbito, o objetivo principal deste trabalho foi estimar a prevalência de CT e avaliar características associadas à CT em idosos da comunidade. O presente estudo usou como base o estudo populacional de idosos do município de São Paulo: Estudo Saúde, Bem-estar e Envelhecimento, onda 2015. As CTs foram definidas a partir de guias de prática clínica (GPCs) com alta qualidade, selecionados a partir de revisão sistemática e avaliação da qualidade. Somente cerca de um quarto dos GPC apresentaram alta qualidade e foram usados para extração das CTs. A média de idade dos 1.224 idosos do SABE foi 70,8, 56,2% eram mulheres, 84% viviam acompanhados, 27,5% estudaram 9 anos e mais, quase 50% declararam renda insuficiente para cobrir com as despesas diárias, metade autoavaliaram a saúde como regular ou ruim, cerca de 40% relataram polifarmácia. Estatinas, inibidores da enzima de recaptação de angiotensina e inibidores da bomba de próton foram as classes de medicamentos mais relatadas. Multimorbidade foi reportada por 61,7% dos idosos. A prevalência de CT foi de 13,2%. Entre idosos com multimorbidade, a prevalência de CT foi de 21,4%. No modelo final de regressão logística, CT foi associada com polifarmácia (OR: 4,70; IC 95% 3,00 7,36), hospitalização no último ano (OR: 1,75; IC 95% 1,07 2,87), queda no último ano (OR: 1,57; IC 95% 1,04 2,36) e pior autoavaliação de saúde (OR: 1,92; IC 95% 1,23 2,99). Profissionais de saúde devem ter cautela ao selecionar GPC e ao prescrever medicamentos a idosos com multimorbidade. / Aging implies in an increasing prevalence of noncommunicable diseases (NCDs) and polypharmacy use (use of 5 or more medications concomitantly). However, medications may have a negative effect on patients with multimorbidity. Therapeutic competition (TC) is known as a drug-disease interaction in which the treatment recommended for a certain condition can negatively alter (compete with) another coexisting condition. In this context, the main objective of this study was to estimate the prevalence of TC and evaluate characteristics associated with TC in community dwelling older adults. The present study used the population-based study of older adults living in the city of São Paulo (SABE study, 2015 survey). TCs were identified by using clinical practice guidelines (CPGs) with high quality. A systematic review and critical appraisal of CPGs were conducted to identify high-quality CPGs. Only about a quarter of CPGs were of high quality and were used for CT extraction. A total of 80 CTs were identified from the high-quality CPGs. The mean age of the 1,224 SABE participants was 70.8, 56.2% were women, 84% did not live alone, 27.5% studied 9 years and over, almost 50% declared insufficient income to cover daily expenses, half self-assessed health, such as regular or poor, about 40% reported polypharmacy. Statins, angiotensin-reuptake enzyme inhibitors and proton pump inhibitors were the most commonly reported drug classes. Multimorbidity was reported by 61.7% seniors. The prevalence of TC was 13.2%. Among seniors with multimorbidity, the prevalence of TC was 21.4%. In the final logistic regression model, TC was associated with polypharmacy (OR: 4.70, 95% CI 3.00 - 7.36), hospitalization in the last year (OR: 1.75, 95% CI 1.07-2 , 95% CI 1.04 - 2.36) and worse health self - assessment (OR: 1.92, 95% CI 1.23 - 2.99), a decrease in the last year (OR: 1.57; Health professionals should be careful when selecting CPGs and prescribing medications to older adults with multimorbidity.

There are widespread concerns about the increasing use of multiple medicines. The aims of this thesis were to identify older patients' and general practitioners' (GPs) attitudes to and experiences of multiple medicine use, as well as to describe patterns of multiple medicine use in different age groups in association with patient-related factors. An additional aim was to contribute to scientific methodological development by providing an empirical example of the application of the Lehoux, Poland, &amp; Daudelin template for the analysis of interaction in focus groups. Data were collected via qualitative focus group discussions and from a cross-sectional community-based population survey conducted during 2001-2005. The patients revealed co-existing accounts of both immediate gratitude that medicines exist and problems with using multiple medicines such as worrying whether multiple medicine use is 'good' for the body. The patient-doctor relationship coloured their attitudes towards their treatment and care. The GPs at times felt insecure, though surrounded by treatment guidelines. Lack of communication with hospital specialists was perceived to reduce treatment quality, while influence of patient pressure was thought to contribute to the development of multiple medicine use. An interaction analysis helped in appreciating and clarifying the contexts in which results from the content analysis were created. Further discussion is needed on how to best report these results. Different cut-offs are useful in defining multiple medicine use in different age groups. Vast majorities of users of multiple medicines were found to have unique medicine combinations. Multiple medicine use was found to be associated with morbidity and poor self-rated health across all age groups.

Older people admitted to hospital are at high risk of rehospitalization and medication errors. We have demonstrated, in a randomized controlled trial, that a clinical pharmacist intervention reduces the incidence of revisits to hospital for patients aged 80 years or older admitted to an acute internal medicine ward. The aims of this thesis were to further study the effects of the intervention and to investigate possibilities of targeting the intervention by identifying predictors of treatment response or adverse health outcomes. The effect of the pharmacist intervention on the appropriateness of prescribing was assessed, by using three validated tools. This study showed that the quality of prescribing was improved for the patients in the intervention group but not for those in the control group. However, no association between the appropriateness of prescribing at discharge and revisits to hospital was observed. Subgroup analyses explored whether the clinical pharmacist intervention was equally effective in preventing emergency department visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing on admission. The intervention appeared to be most effective in patients taking fewer drugs, but the treatment effect was not altered by appropriateness of prescribing. The most relevant risk factors for rehospitalization and mortality were identified for the same study population, and a score for risk-estimation was constructed and internally validated (the 80+ score). Seven variables were selected. Impaired renal function, pulmonary disease, malignant disease, living in a nursing home, being prescribed an opioid and being prescribed a drug for peptic ulcer or gastroesophageal reflux disease were associated with an increased risk, while being prescribed an antidepressant drug (tricyclic antidepressants not included) was linked with a lower risk. These variables made up the components of the 80+ score. Pending external validation, this score has potential to aid identification of high-risk patients. The last study investigated the occurrence of prescription errors when patients with multi-dose dispensed (MDD) drugs were discharged from hospital. Twenty-five percent of the MDD orders contained at least one medication prescription error. Almost half of the errors were of moderate or major severity, with potential to cause increased health-care utilization.