Norgep - Legemiddelhåndboka

Det var størst innbyrdes enighet blant spesialistene i geriatri, og størst innbyrdes uenighet blant allmennlegene. Studien omfattet forskrivninger av legemidler til 46 pasienter hvorav pasienter 19,8 prosent mottok én eller flere av de opplistede uhensiktsmessige for-skrivningene. Til sammen mottok de 13 uhensiktsmessige forskrivninger. Effekten av den pedagogiske intervensjonen er oppmuntrende. Foreløpige tall viser at relativ reduksjon av uheldige forskrivninger per lege var mer enn 12 prosent.

Eldre, mannlige leger hadde høyere andel uheldige forskrivninger ved baseline før intervensjonen , men kunne vise til forholdsvis større oppnådd reduksjon av uheldige forskrivninger på grunn av intervensjonen.

Videre analyser skal korrigere for sammensetningen av legenes pasientpolulasjoner og eventuelt clustereffekt innen etterutdanningsgruppene. Vel pasienter fikk tryggere legemiddelforskrivning som følge av dette KTVprosjektet. Studien er under publisering, men resultatene er lovende og motsvarer noe av det beste som er oppnådd i tilsvarende studier andre steder 3—5. De 36 eksplisitte kriteriene for uhensiktsmessige forskrivninger til eldre 4 kan benyttes til audit der den enkelte lege reflekterer rundt egen forskrivning, men kriteriene er primært utformet til å identifisere problemer knyttet til legemiddelforskrivning på gruppenivå, for eksempel i sykehjem og for større grupper av forskrivere.

Kriterielisten kan brukes som verktøy i pedagogiske intervensjoner og kan gjennom dette bidra til å bedre allmennlegers forskrivning av legemidler til eldre. MÅL Vi har utviklet en konsensusbasert liste med relevante, eksplisitte kriterier for potensielt uheldige forskrivninger til eldre pasienter i allmennpraksis. METODE Den pedagogiske intervensjon ble formidlet gjennom to besøk i allmennlegers etterutdanningsgrupper av opplærte kollegaer kollgakonsulenter og som blant annet hadde med seg en liste med eksplisitte kvalitetsindikatorer som dannet grunnlaget for læring og refleksjon i gruppene.

Explicit criteria for determining inappropriate medication use in nursing home residents. Vis innførsel    Hjem Det helsevitenskapelige fakultet Institutt for farmasi Mastergradsoppgaver i farmasi Vis innførsel.

Hjem Det helsevitenskapelige fakultet Institutt for farmasi Mastergradsoppgaver i farmasi Vis innførsel. JavaScript is disabled for your browser. Some features of this site may not work without it. Legemiddelbruk i sykehjem. Åpne thesis. Dato Type Master thesis Mastergradsoppgave. Forfatter Kucukcelik, Sinan. Sammendrag Bakgrunn Legemiddelbruk i sykehjem er omfattende. Polyfarmasi, aldring og sykdommer gjør at sykehjemspasienter er utsatt for interaksjoner og bivirkninger av legemidler.

Riktig legemiddelbruk hos eldre er et satsningsområde for helsemyndighetene. Forfatter Skogdalen, Kjersti. Sammendrag Beboere på sykehjem ofte flere og kompliserte medisinske problemer. Dette skyldes at de bruker i gjennomsnitt fem legemidler fast daglig og at alder, organfunksjon, mentalsvikt og ernæringstilstand kan gjøre dem mer følsomme for bivirkninger og interaksjoner.

Legemiddelbehandlingen blir derfor kompleks og medfører stor risiko for legemiddelrelaterte problemer. Legemiddelgjennomganger kan være et kvalitetssikrende tiltak for å håndtere legemiddelrelaterte problemer. Formålet med denne oppgaven var å finne en god arbeidsmetode for legemiddelgjennomganger på sykehjem, vurdere screening som metode og NORGEP-kriteriene som inklusjonskriterier.

Fire sykehjem ble inkludert i kartleggingen av NORGEP-kriteriene og seks sykehjemsleger ble invitert til å delta i legemiddelgjennomganger.

Syv pasienter fikk sin legemiddelbehandling vurdert i en legemiddelgjennomgang. Fem pasienter hadde treff på fire kriterier.

Data collected included residents' demographic and clinical status and all medications, regular and on demand. Results: patients from 30 institutions mean Female residents received more often than males at least one potentially inappropriate regular medication OR 1.

Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs.

Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration odds ratio 1.

Conclusions: Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population.

The other 24 All proposed criteria were included in the final list Table I. For all criteria the SD was reduced from first to third round, reflecting fewer outliers at the lower end of the scale. For criteria 27—29, a safe strategy for re-evaluation is first to taper dosage, then stop the drug while monitoring clinical condition; 9 risperidone, olanzapine, quetiapine, aripiprazole; 10 behavioural and psychological symptoms in dementia.

Notes: 1 The clinical relevance for each of the criteria is scored from 1 to 10 by a panel of experts during a three-round consensus process. Figures are mean scores with standard deviation, MS SD. Through all three rounds 27 criteria were assessed three times by the panel while seven were scored twice, resulting in 95 means altogether see Table II.

This three-round Delphi process, carried out among 80 participants, resulted in a list of 34 criteria for potentially inappropriate medication use in NHs. Both the degree of consensus and the average scores for clinical relevance increased throughout the Delphi process.

A Delphi technique is said to be useful when a problem does not lend itself to precise analytical techniques, but can benefit from subjective judgements on a collective basis [ 22 ]. However, the initial 27 suggestions, and the seven criteria suggested by the panel, are all based on a combination of experience among both the authors and the panel and evidence from the literature.

All suggestions have been scrutinized through literature searches and relevant references were provided to the panel during the consensus process. The standard deviations of the means can be interpreted as a measure of the degree of discord among the participants.

Still, a larger SD implies that a larger number of participants scored well below the mean. The Delphi technique in itself can be said to be conservative in the respect that it takes quite a lot for a proposed criterion to be rejected. The main reasons for the Delphi method to fail are imposing monitor views and preconceptions upon the respondent group, and ignoring and not exploring disagreements [ 22 ].

In a case with a high degree of disagreement, as seen by a high SD, the average minus SD will thus be lower than in a case with a high general agreement and thus a low SD. In this way, a controversial criterion will be less likely to be included in the list than a less controversial. Still no criterion was voted out through the three rounds. The survey was lengthy, with a lot of text and many references, and this might have added to the withdrawal percentage.

However, participants who completed all three rounds were in large part active throughout the process, providing numerous comments and suggestions for further references in both rounds one and two, thus giving the impression of an involved and independent panel. It has been argued that one of the most critical aspects when designing a Delphi survey is the selection of qualified experts [ 22 ]. In some earlier surveys, among them the Beers consensus process and its later updates [ 7 , 8 , 10 ], the recruitment process differed from the present study in that the panel consisted of considerably fewer, hand-picked experts: 12 and six in the case of Beers criteria for NHs.

At present there is no vocational training leading to a clinical speciality within NH medicine in Norway. To check for robustness with regard to this matter we tested the average scores and the development of consensus throughout the survey's three rounds for these participants versus the rest of the panel.

The final list of explicit criteria would have been unaltered had only either one of the two participant groups undertaken the survey. It has been suggested that the term should be adopted internationally by researchers and practitioners engaged in this area [ 27 ].

Three criteria in this latter group concern preventive drug use when expected remaining life span is short: one concerning the use of preventive medication in general, the other two concerning the use of, respectively, bisphosphonates and statins. One can argue that the two latter criteria are redundant. However, since there was consensus to include all three criteria throughout the survey, they were included in the final list.

A similar argument applies to using NSAIDs in different combinations, all of which could have been substituted by a single general criterion.

However, since some of the combinations are particularly risky, the combination criteria still may serve a purpose in attracting attention to these potential threats. Because this represented relatively new knowledge at the time of the survey, the lower score can be viewed as healthy scepticism, as one could argue that more research was needed. After this study was completed, new research has strengthened the evidence for the clinical relevance of avoiding this combination, which is associated with increased risk for fractures [ 28 , 29 ].

In a previous study we found that one-third of the total population of home-dwelling elderly in Norway were exposed to at least one PIM over the course of one year, according to a modified version of the NORGEP criteria [ 14 ]. The present list, although primarily developed for the especially frail patients in nursing homes, can also be useful as a tool for GPs undertaking medication reviews for elderly patients outside institutions. There is a need for more research on the effects of implementing the NORGEP-NH and similar lists with explicit criteria in clinical practice on outcomes like quality of life, morbidity, and mortality.

The authors would like to thank all the participants of this Delphi study for their interest, effort and time. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. National Center for Biotechnology Information , U. Scand J Prim Health Care. June, ; 33 2 : — Author information Article notes Copyright and License information Disclaimer.

Corresponding author. E-mail: on. Copyright © The Author s. This article has been cited by other articles in PMC. Abstract Objective. Keywords: Delphi technique, explicit criteria, general practice, inappropriate medication use, Norway, nursing homes, pharmacoepidemiology.

The list may serve as a tool in the prescribing process and in medication reviews. The list may also be used in quality assessment and for research purposes.

Introduction The nursing home NH population of Western countries has become increasingly frail and ill, with specific and extensive needs in terms of health care. Material and methods We conducted a three-round consensus process using the Delphi technique [ 22 ]. Open in a separate window. Figure 1. Statistics For each criterion, degree of consensus was based on the average Likert score and corresponding standard deviation SD. Results We received altogether 92 responses from 34 Oslo nursing home physicians, nine members of the Reference Group for NH medicine some of whom also were physicians in Oslo nursing homes , 13 members of NFKF, 38 members of NGF, and all five pharmacists.

Table I. Chlometiazole Poor safety record. Anti-psychotics incl. Anticholinesterase inhibitors Temporary symptomatic benefits only. Any preventive medicine Assess risk—benefit in relation to life expectancy.

Table II. Tricyclic antidepressants TCAs for depression 7. NSAIDs 8. First-generation antihistamines 7. Diazepam 9. Nitrazepam 8. Flunitrazepam 9. Chlometiazole 8. Concomitant use of three or more psychotropic drugs 9. Anti-psychotics 7. Anti-depressants 8. Urologic spasmolytics 8. Anticholinesterase inhibitors 9. Statins 9. Discussion This three-round Delphi process, carried out among 80 participants, resulted in a list of 34 criteria for potentially inappropriate medication use in NHs.

Acknowledgements The authors would like to thank all the participants of this Delphi study for their interest, effort and time. Declaration of interest The authors report no conflicts of interest. The provision of care for residents dying in UK nursing care homes. Age Ageing ; 43 —9. Nursing and care services Statistics on services and recipients. Oslo: Statistics Norway; Report No. Dementia and neuropsychiatric symptoms in nursing-home patients in Nord-Trondelag County.

Tidsskr Nor Legeforen ; —9. Adverse drug reactions caused by drug—drug interactions in elderly outpatients: A prospective cohort study. Eur J Clin Pharmacol ; 68 — Beyond the Beers criteria: A comparative overview of explicit criteria. Ann Pharmacother ; 44 — Comparison of published explicit criteria for potentially inappropriate medications in older adults.

Drugs Aging ; 27 — Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med ; — Explicit criteria for determining potentially inappropriate medication use by the elderly: An update. Arch Intern Med ; —6. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. J Am Geriatr Soc ; 60 — Consensus validation. Int J Clin Pharmacol Ther ; 46 — Dtsch Atztebl Int ; —

❶– Smuglet barn til Norge|To av tre stryker. Nå skal Lars Erik (28) gjennom Sjøforsvarets hardeste utdanning.|||Aldring og legemidler: NorGeP-kriteriene - marcus-design.eu|]

Background: Frail residents in the nursing home sector call for extra care in prescribing. Norgep aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use norgep nursing home residents and kåte damer bilder possible associated factors. Methods: Cross-sectional observational pharmacoepidemiological study from residents in nursing homes norgep the county of Vestfold, Norway.