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    Inappropriate prescribing and adverse drug events in older people.

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    Authors
    Hamilton, Hilary J
    Gallagher, Paul F
    O'Mahony, Denis
    Affiliation
    Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland. hilaryjaneh@yahoo.com
    Issue Date
    2009
    MeSH
    Aged
    Drug Prescriptions
    Drug Utilization
    Humans
    Medication Errors
    Pharmaceutical Preparations
    
    Metadata
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    Citation
    Inappropriate prescribing and adverse drug events in older people. 2009, 9:5 BMC Geriatr
    Journal
    BMC geriatrics
    URI
    http://hdl.handle.net/10147/201236
    DOI
    10.1186/1471-2318-9-5
    PubMed ID
    19175914
    Additional Links
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642820/pdf/1471-2318-9-5.pdf
    http://www.biomedcentral.com/content/pdf/1471-2318-9-5.pdf
    Abstract
    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.
    Item Type
    Article
    Language
    en
    ISSN
    1471-2318
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2318-9-5
    Scopus Count
    Collections
    Cork University Hospital

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