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  • 1
    Keywords: Germany ; TOOL ; TRIAL ; education ; ADULTS ; ERRORS ; COMMUNICATION ; ADHERENCE ; knowledge
    Abstract: We investigated the prevalence and quality of medication schedules of elderly ambulatory patients and assessed factors associated with the availability of a medication schedule. In particular, we evaluated whether sending out a blank medication schedule template would increase the chances to use such a document. Data originate from the ESTHER study, a cohort study conducted in Saarland, Germany, in which trained study physicians performed home visits. They scanned all medication schedules, recorded the participants' medication, and performed thorough geriatric assessments. As part of the intervention, a blank medication schedule template along with a brochure was mailed to half of the participants (intervention group) 4 weeks prior to the home visits. In total, 553 of 2470 participants (22.4 %) had a medication schedule. Almost two thirds of the schedules were issued by health care professionals (n = 353, 63.8 %). These schedules offered a higher quality, although important information such as over-the-counter (OTC) medication was regularly missing. Self-reported adherence was higher in participants who used self-issued medication schedules; however, self-reported medication adherence in patients with any medication schedule was poorer compared to those patients not using a schedule. Factors associated with the availability of a medication schedule were male sex, a higher number of medicines to take, and a more complex drug regimen. The intervention did not increase the number of patients having a medication schedule. Only a minority of elderly ambulatory patients had a medication schedule at home. Sending out a brochure along with a blank medication schedule template did not increase the prevalence of medication schedules.
    Type of Publication: Journal article published
    PubMed ID: 26105963
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  • 2
    Keywords: MORTALITY ; POPULATION ; prevention ; ELDERLY-PATIENTS ; CRITERIA ; ALL-CAUSE ; OLDER-PEOPLE ; SCREENING TOOL ; ALERT DOCTORS ; POLYPHARMACY
    Abstract: Background Cardiovascular disease is a leading cause of death in older people, and the impact of being exposed or not exposed to preventive cardiovascular medicines is accordingly high. Underutilization of beneficial drugs is common, but prevalence estimates differ across settings, knowledge on predictors is limited, and clinical consequences are rarely investigated. Methods Using data from a prospective population-based cohort study, we assessed the prevalence, determinants, and outcomes of medication underuse based on cardiovascular criteria from Screening Tool To Alert to Right Treatment (START). Results Medication underuse was present in 69.1% of 1454 included participants (mean age 71.1 +/- 6.1 years) and was significantly associated with frailty (odds ratio: 2.11 [95% confidence interval: 1.24-3.63]), body mass index (1.03 [1.01-1.07] per kg/m(2)), and inversely with the number of prescribed drugs (0.84 [0.79-0.88] per drug). Using this information for adjustment in a follow-up evaluation (mean follow-up time 2.24 years) on cardiovascular and competing outcomes, we found no association of medication underuse with cardiovascular events (fatal and non-fatal) (hazard ratio: 1.00 [0.65-1.56]), but observed a significant association of medication underuse with competing deaths from non-cardiovascular causes (2.52 [1.01-6.30]). Conclusion Medication underuse was associated with frailty and adverse non-cardiovascular clinical outcomes. This may suggest that cardiovascular drugs were withheld because of serious co-morbidity or that concurrent illness can preclude benefit from cardiovascular prevention. In the latter case, adapted prescribing criteria should be developed and evaluated in those patients.
    Type of Publication: Journal article published
    PubMed ID: 26288222
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  • 3
    Keywords: THERAPY ; PHARMACOKINETICS ; GASTROESOPHAGEAL-REFLUX DISEASE ; ACID SUPPRESSION
    Abstract: Purpose We investigated the association between conditions of proton pump inhibitor (PPI) treatment failure and food intake in an elderly ambulatory population. Methods Our data originate from a large population-based cohort study. During a home visit done by a trained study physician, patients were asked for each medication to state whether it was taken in relation to a meal (before, concurrently with, and after) or independent of a meal. This information was analyzed for all patients taking a PPI daily and correlated to markers of PPI failure. Results Out of 2717 patients participating in a home visit and taking at least one medication, 383 took a PPI daily (14.1%). A PPI intake independent of meals was defined as incorrect and was observed in 64 patients, whereas 319 patients took their PPI in relation to a meal, which was defined as the correct intake. Treatment failure was observed in 10 out of 64 (15.6%) PPI users with incorrect intake and in 18 out of 319 (5.6%) PPI users with correct intake. The risk of treatment failure was threefold higher in patients taking their PPI independent of meals (OR 3.35; 95% CI 1.44-7.76). Conclusion The higher risk for PPI failure in patients taking PPIs independent of meals suggests that synchronized PPI administration with meals is indeed essential, and better counseling of patients is needed.
    Type of Publication: Journal article published
    PubMed ID: 24723311
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  • 4
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  21. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie, 9. Deutscher Pharmakovigilanztag; 20141120-20141121; Bonn; DOC14gaa27 /20141118/
    Publication Date: 2014-11-19
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 5
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  20. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie; 20131205-20131206; Düsseldorf; DOC13gaa39 /20131125/
    Publication Date: 2013-11-26
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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