A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older HIV-Positive Patients

被引：80

作者：

McNicholl, Ian R. ^{[1
]}

Gandhi, Monica ^{[2
]}

Hare, C. Bradley ^{[3
]}

Greene, Meredith ^{[4
]}

Pierluissi, Edgar ^{[5
,6
]}

机构：

[1] Gilead Sci Inc, HIV Med Affairs, 333 Lakeside Dr, Foster City, CA 94404 USA

[2] Univ Calif San Francisco, Dept Med, Div HIV Infect Dis & Global Med, San Francisco, CA USA

[3] Kaiser Permanente, Infect Dis, San Francisco, CA USA

[4] Univ Calif San Francisco, Dept Med, Div Geriatr, San Francisco, CA USA

[5] Univ Calif San Francisco, Div Geriatr, San Francisco, CA 94143 USA

[6] Univ Calif San Francisco, San Francisco Gen Hosp, Dept Med, Hosp Med, San Francisco, CA USA

来源：

PHARMACOTHERAPY | 2017年 / 37卷 / 12期

关键词：

potentially inappropriate prescribing; HIV; Beers; STOPP; older; aging; pharmacist; polypharmacy;

D O I：

10.1002/phar.2043

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

OBJECTIVE The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions. DESIGN Prospective randomized interventional trial. SETTING Large urban clinic providing interdisciplinary primary and HIV care for similar to 2700 HIV-positive publicly insured patients. DATA SOURCE A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months. PATIENTS After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed. MEASUREMENTS AND MAIN RESULTS Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm(3). Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 +/- 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist. CONCLUSIONS Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention.

引用

页码：1498 / 1506

页数：9

共 43 条

[1]

Holtzman C., Armon C., Tedaldi E., Et al., Polypharmacy and the risk of antiretroviral drug interactions among the aging HIV-infected population, J Gen Intern Med, 28, pp. 1302-1310, (2013)

[2]

Charlesworth C.J., Smit E., Lee D.S., Alramadhan F., Odden M.C., Polypharmacy among adults aged 65 years and older in the United States: 1988–2010, J Gerontol A Biol Sci Med Sci, 70, pp. 989-995, (2015)

[3]

Blanco-Reina E., Ariza-Zafra G., Ocana-Riola R., Leon-Ortiz M., Bellido-Estevez I., Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are these two concepts related?, Eur J Clin Pharmacol, 71, pp. 199-207, (2015)

[4]

Guthrie B., McCowan C., Davey P., Simpson C.R., Dreischulte T., Barnett K., High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice, BMJ, 342, pp. 1-12, (2011)

[5]

Gleason L.J., Luque A.E., Shah K., Polypharmacy in the HIV-infected older adult population, Clin Interv Aging, 8, pp. 749-763, (2013)

[6]

Edelman E.J., Gordon K.S., Glover J., McNicholl I.R., Fiellin D.A., Justice A.C., The next therapeutic challenge in HIV: Polypharmacy, Drugs Aging, 30, pp. 613-628, (2013)

[7]

Onen N.F., Overton E.T., Seyfried W., Et al., Aging and HIV infection: a comparison between older HIV-infected persons and the general population, HIV Clin Trials, 11, pp. 100-109, (2010)

[8]

Greene M.L., Steinman M.A., McNicholl I.R., Valcour V., Polypharmacy, drug–drug interactions and potentially inappropriate medications in older adults with human immunodeficiency virus infection, J Am Geriatr Soc, 62, pp. 447-453, (2014)

[9]

Edelman E.J., Gordon K., Akgun K., Et al., HIV+ individuals on ART are at risk of polypharmacy: more medication increases mortality [presentation 76]

[10]

Moore H.N., Mao L., Oramasionwu C.U., Factors associated with polypharmacy and the prescription of multiple medications among persons living with HIV (PLWH) compared to non-PLWH, AIDS Care, 27, pp. 1443-1448, (2015)

← 1 2 3 4 5 →