The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease.

Autor:	Tesfaye WH; a Department of Pharmacy, School of Medicine, College of Health and Medicine , University of Tasmania , Tasmania , Australia., Wimmer BC; a Department of Pharmacy, School of Medicine, College of Health and Medicine , University of Tasmania , Tasmania , Australia., Peterson GM; a Department of Pharmacy, School of Medicine, College of Health and Medicine , University of Tasmania , Tasmania , Australia.; b Unit for Medication Outcomes Research and Education , University of Tasmania , Tasmania , Australia., Castelino RL; c Sydney Nursing School , The University of Sydney , Sydney , Australia., Jose MD; a Department of Pharmacy, School of Medicine, College of Health and Medicine , University of Tasmania , Tasmania , Australia.; d Menzies Institute for Medical Research , University of Tasmania , Tasmania , Australia.; e Royal Hobart Hospital , Tasmania , Australia., McKercher C; d Menzies Institute for Medical Research , University of Tasmania , Tasmania , Australia., Zaidi STR; a Department of Pharmacy, School of Medicine, College of Health and Medicine , University of Tasmania , Tasmania , Australia.; f School of Healthcare , University of Leeds , Leeds , UK.
Jazyk:	angličtina
Zdroj:	Current medical research and opinion [Curr Med Res Opin] 2019 Jun; Vol. 35 (6), pp. 1119-1126. Date of Electronic Publication: 2019 Jan 11.
DOI:	10.1080/03007995.2018.1560193
Abstrakt:	Objectives: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use. Methods: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76-87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3-12] to 5 [2-9]; p < .01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p < .01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56-0.88) and lower eGFR values (β - 0.11, 95% CI -0.18 to -0.04) had higher MAI scores after adjusting for age, sex and Charlson's comorbidity index. Conclusions: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu