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Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: A prospective cohort investigation among adults aged 45 years and over in Australia

Du, Wei; Gnjidic, Danijela; Pearson, Sallie-Anne; Hilmer, Sarah; McLachlan, Andrew; Blyth, Fiona; Viney, Rosalie; Joshy, Grace; Day, Catherine; Banks, Emily

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Objectives To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. Design Prospective cohort analysis. Settings, participants, measurements Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July...[Show more]

dc.contributor.authorDu, Wei
dc.contributor.authorGnjidic, Danijela
dc.contributor.authorPearson, Sallie-Anne
dc.contributor.authorHilmer, Sarah
dc.contributor.authorMcLachlan, Andrew
dc.contributor.authorBlyth, Fiona
dc.contributor.authorViney, Rosalie
dc.contributor.authorJoshy, Grace
dc.contributor.authorDay, Catherine
dc.contributor.authorBanks, Emily
dc.date.accessioned2019-11-25T00:29:15Z
dc.date.available2019-11-25T00:29:15Z
dc.identifier.issn2044-6055
dc.identifier.urihttp://hdl.handle.net/1885/186540
dc.description.abstractObjectives To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. Design Prospective cohort analysis. Settings, participants, measurements Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009–June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations. Primary outcome HMR receipt during the 5-year study period. Results Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5–9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5–9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy. Conclusions HMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
dc.description.sponsorshipThis study is funded by the National Health and Medical Research Council of Australia (Project Grant 1024450 and the NHMRC Centre of Research Excellence in Medicines and Ageing (1060407). EB and DG are supported by the NHMRC.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherBMJ Publishing Group
dc.rights© Author(s)
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.sourceBMJ Open
dc.titlePatterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: A prospective cohort investigation among adults aged 45 years and over in Australia
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume9
dc.date.issued2019
local.identifier.absfor111717 - Primary Health Care
local.identifier.ariespublicationu3102795xPUB1005
local.publisher.urlhttp://journals.bmj.com/site/authors/openaccess.xhtml
local.type.statusPublished Version
local.contributor.affiliationDu, Wei, College of Health and Medicine, ANU
local.contributor.affiliationGnjidic, Danijela, University of Sydney
local.contributor.affiliationPearson, Sallie-Anne, University of New South Wales
local.contributor.affiliationHilmer, Sarah, University of Sydney
local.contributor.affiliationMcLachlan, Andrew, University of Sydney
local.contributor.affiliationBlyth, Fiona, University of Sydney
local.contributor.affiliationViney, Rosalie, University of Technology Sydney
local.contributor.affiliationJoshy, Grace, College of Health and Medicine, ANU
local.contributor.affiliationDay, Catherine, College of Health and Medicine, ANU
local.contributor.affiliationBanks, Emily, College of Health and Medicine, ANU
dc.relationhttp://purl.org/au-research/grants/nhmrc/1024450
dc.relationhttp://purl.org/au-research/grants/nhmrc/1060407
local.bibliographicCitation.issue2
local.bibliographicCitation.startpage1
local.bibliographicCitation.lastpage13
local.identifier.doi10.1136/bmjopen-2018-027305
local.identifier.absseo920502 - Health Related to Ageing
dc.date.updated2019-05-19T08:20:20Z
local.identifier.scopusID2-s2.0-85061750550
dcterms.accessRightsOpen Access
dc.provenance© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ
dc.rights.licenseCC BY-NC
CollectionsANU Research Publications

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