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Marengoni A.,University of Brescia | Marengoni A.,Italian Medicines Agency | Nobili A.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Onder G.,Italian Medicines Agency | Onder G.,Catholic University of the Sacred Heart
Drugs and Aging | Year: 2015

Achievement of a good quality of prescribing is one of the major challenges for physicians caring for older persons, because of aging-related changes in pharmacokinetics and pharmacodynamics of drugs, the large number of co-occurring chronic diseases affecting older adults and consequent polypharmacy. Several approaches are available and have been used to tackle over-prescription of drugs, such as medication review, application of appropriateness criteria and computerized prescription support systems, but, one by one, they have shown limited effectiveness with respect to patient-centred outcomes. We propose to test a multicomponent intervention with the goal of achieving the best-tailored pharmacotherapy for each patient at a specific point in time. The intervention should start with identification of patients at risk of drug-related problems and identification of their priorities, followed by medication review over time, supported by the use of inappropriateness criteria and computerized systems, and also necessarily embedded in the Comprehensive Geriatric Assessment. © 2015, Springer International Publishing Switzerland. Source


Monesi L.,Laboratory of General Practice Research | Tettamanti M.,Laboratory of Geriatric Neuropsychiatry | Cortesi L.,Laboratory of General Practice Research | Baviera M.,Laboratory of General Practice Research | And 11 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2014

Aims: To investigate the incidence of major cardiovascular complications and mortality in the first years of follow-up in patients with newly diagnosed diabetes. Methods and results: We examined incidence rates of hospitalization for cardiovascular reasons and death among new patients with diabetes using the administrative health database of the nine million inhabitants of Lombardy followed from 2002 to 2007. Age and sex-adjusted rates were calculated and hazard ratios (HR) were estimated with a matched population without diabetes of the same sex, age (±1 year) and general practitioner.There were 158,426 patients with newly diagnosed diabetes and 314,115 subjects without diabetes. Mean follow-up was 33.0 months (SD ± 17.5). 9.7% of patients with diabetes were hospitalized for cardiovascular events vs. 5.4% of subjects without diabetes; mortality rate was higher in patients with diabetes (7.7% vs. 4.4%). The estimated probability of hospitalization during the follow up was higher in patients with diabetes than in subjects without for coronary heart disease (HR 1.4, 95% CI 1.3-1.4), cerebrovascular disease (HR 1.3.95% CI 1.2-1.3), heart failure (HR 1.4, 95% CI 1.3-1.4) as was mortality (HR 1.4, 95% CI 1.4-1.4).Younger patients with diabetes had a risk of death or hospital admission for cardio-cerebrovascular events similar to subjects without diabetes ten years older. Conclusions: The elevated morbidity and mortality risks were clear since the onset of diabetes and rose over time. These data highlight the importance of prompt and comprehensive patients care in addition to anti-diabetic therapy in patients with newly diagnosed diabetes. © 2013 Elsevier B.V. Source


Onder G.,Catholic University of the Sacred Heart | Vetrano D.L.,Catholic University of the Sacred Heart | Cherubini A.,Italian National Research Center on Aging | Fini M.,Scientific Direction | And 8 more authors.
Journal of the American Medical Directors Association | Year: 2014

In Italy, prescription drug costs represent approximately 17% of total public health expenditures. Older adults commonly use multiple drugs and, for this reason, this population is responsible for a large portion of drug-related costs. In 2012, public expenditure for pharmaceuticals in primary care exceeded 11 billion Euros (approximately 15.2 billion US $), and older adults aged 65 or older accounted for more than 60% of these costs. Recently, increased attention has been focused on studies aimed at monitoring drug use and evaluating the appropriateness of drug prescribing in older adults. In this article, we examined studies that assessed these issues in different settings at a national level. Specifically, results of surveys of prescription drug use in primary care (OsMED), hospital (GIFA, CRIME, and REPOSI) and long-term care (ULISSE and SHELTER) settings are reviewed. Overall, these studies showed that the quality of drug prescribing in older patients is far from optimal. This leads to an increased risk of negative health outcomes and increased health care costs. Data from these studies are valuable, not only to monitor drug use, but also to target interventions aimed at improving the quality of prescribing. Translating the findings of clinical research and monitoring programs will be challenging, but it will lead to quantifiable improvements in the quality of drug prescribing at a national level. © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Source


Franchi C.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Tettamanti M.,Laboratory of Geriatric Neuropsychiatry | Pasina L.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Djignefa C.D.,Laboratory for Quality Assessment of Geriatric Therapies and Services | And 4 more authors.
European Journal of Clinical Pharmacology | Year: 2014

Purpose: To investigate the changes in the last decade (2000-2010) in drug prescribing among community-dwelling elderly people aged 65-94 years, in relation to age and sex. Methods: We analyzed the data of nearly two million subjects ranging in age from 65 to 94 years recorded in the Drug Administrative Database of the Lombardy Region (Italy) from 2000 to 2010. Associations between drug use (at least one drug, one chronic drug, polypharmacy or chronic polypharmacy) and age, sex, and year of prescription were analyzed by logistic regression analysis. We also analyzed differences in changes linked to sex and age. Results: Between 2000 and 2010, the prescriptions of at least one drug or one chronic drug increased by 2 % (from 88.0 to 90.3 %; p<0.0001) and 8 % (from 73.8 to 82.0 %; p<0.0001), respectively, while the mean number of packages/person/year rose from 34.6 [standard deviation (SD) 32.4] to 48.5 (SD 42.2). During this same period, there was a 10 % increase in the prevalence of elderly people exposed to polypharmacy (≥5 different active substances) (from 42.8 to 52.7 %; p<0.0001), and the prevalence of those exposed to chronic polypharmacy (≥5 different chronic drugs) doubled (from 14.9 to 28.5 %; p<0.0001). Males were less frequently treated than females, except for chronic polypharmacy. People aged ≥80 years showed the largest increase in all prescribing patterns. Drug consumption in ATC groups A, H, and N (women) and in B and C (men) increased most, with the greatest absolute differences occurring in the consumption of proton pump inhibitors (31.1 %), platelet aggregation inhibitors (30.1 %), and statins (23.8 %). Conclusion: Prescriptions to community-dwelling elderly people have increased substantially during the last 10 years. Although this might indicate an improvement in care, the large increase in the number of elderly people exposed to polypharmacy and chronic polypharmacy should be carefully analyzed in terms of quality of care, patient safety, and costs. © 2014 Springer-Verlag. Source


Pasina L.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Djade C.D.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Nobili A.,Laboratory for Quality Assessment of Geriatric Therapies and Services | Tettamanti M.,Laboratory for Quality Assessment of Geriatric Therapies and Services | And 7 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2013

Purpose: The aim of this study is to assess the prevalence of patients exposed to potentially severe drug-drug interactions (DDIs) at hospital admission and discharge and the related risk of in-hospital mortality and adverse clinical events, readmission, and all-cause mortality at 3months. Methods: This cross-sectional, prospective study was held in 70 Italian internal medicine and geriatric wards. Potentially severe DDIs at hospital admission and discharge; risk of in-hospital mortality and of adverse clinical events, readmission, and all-cause mortality at 3-month follow-up. Results: Among 2712 patients aged 65years or older recruited at hospital admission, 1642 (60.5%) were exposed to at least one potential DDI and 512 (18.9%) to at least one potentially severe DDI. Among 2314 patients discharged, 1598 (69.1%) were exposed to at least one potential DDI and 1561 (24.2%) to at least one potentially severe DDI. Multivariate analysis found a significant association with an increased risk of mortality at 3months in patients exposed to at least two potentially severe DDIs (Odds ratio 2.62; 95% confidence interval, 1.00-6.68; p=0.05). Adverse clinical events were potentially related to severe DDIs in two patients who died in the hospital, in five readmitted, and one who died at 3months after discharge. Conclusions: Hospitalization was associated with an increase in potentially severe DDIs. A significant association was found for mortality at 3months after discharge in patients with at least two potentially severe DDIs. Careful monitoring for potentially severe DDIs, especially those created at discharge or recently generated, is important to minimize the risk of harm. © 2013 John Wiley & Sons, Ltd. Source

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