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Improvement of inappropriate prescribing and adverse drug withdrawal events after admission to long‐term care facilities
Author(s) -
Mita Yumiko,
Akishita Masahiro,
Tanaka Katsuaki,
Yamada Shizuru,
Nakai Ryuhei,
Tanaka Eigo,
Nakamura Tetsuro,
Toba Kenji
Publication year - 2004
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/j.1447-0594.2004.00244.x
Subject(s) - medicine , discontinuation , adverse effect , emergency medicine , depression (economics) , medical prescription , hospital admission , drug , medical record , retrospective cohort study , pediatrics , deprescribing , drug withdrawal , polypharmacy , intensive care medicine , psychiatry , economics , pharmacology , macroeconomics
Background: The objectives of this study were to determine whether medications, particularly inappropriate prescribing, would be reduced after admission to long‐term care facilities, and whether adverse drug withdrawal events (ADWEs) would occur in relation to discontinuation of medications. Methods: The study consists of a retrospective survey using medical chart review in five health service facilities for the elderly in Japan. All the patients who were admitted to the facilities between January 2001 and December 2002 ( N = 627) were participants in the study. Medications taken on admission, at 1 month and 3 months after admission, and events (significant worsening of the disease status, accidents, new symptoms and signs, and other acute events) during a 3‐month period were recorded. Inappropriate prescribing was determined using Beers’ criteria with some modification. ADWEs were determined using the Naranjo causality algorithm. Results: On admission, the patients were taking 3.5 ± 2.5 (mean ± SD) drugs. One month later, the number of prescribed drugs was decreased by 17% ( P < 0.01 vs on admission), but did not show an additional reduction 3 months later. Inappropriate prescribing was found in 10% of the patients taking drugs on admission, but the number of inappropriately prescribed medications was reduced by 33% after 1 month. Of 105 events recorded, only five (2% of the patients with drug reduction) were considered ADWEs; three cases of confusion, a case of depression, and a case of hyperglycemia, following discontinuation of psychotropic drugs, antidepressants and a sulfonylurea, respectively. Conclusion: Adverse drug withdrawal events were not frequent despite the significant reduction of medications after admission to long‐term care facilities. This might be because the rate of reduction was relatively high for inappropriately prescribed medications.