Strategies to prevent potentially inappropriate prescribing and adverse drug reactions in older patients

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dc.contributor.advisor Byrne, Stephen en
dc.contributor.advisor O'Mahony, Denis en
dc.contributor.author Cullinan, Shane
dc.date.accessioned 2016-01-11T14:39:10Z
dc.date.available 2016-01-11T14:39:10Z
dc.date.issued 2015
dc.date.submitted 2015
dc.identifier.citation Cullinan, S.P. 2015. Strategies to prevent potentially inappropriate prescribing and adverse drug reactions in older patients. PhD Thesis, University College Cork. en
dc.identifier.endpage 309
dc.identifier.uri http://hdl.handle.net/10468/2176
dc.description.abstract INTRODUCTION: Potentially inappropriate prescribing (PIP) is a major contributor to adverse drug reactions and overall increased healthcare costs. The aim of this thesis was to identify, develop and implement strategies with the potential to prevent PIP and ADRs in older patients. METHODS: A systematic review of the qualitative literature (Meta-synthesis); A qualitative study in Irish hospitals; A randomised controlled trial (RCT) to assess the impact of an online educational module on doctors’ prescribing knowledge and confidence; Exploration of the potential for a frailty index score to enable doctors identify patients at increased risk of PIP and ADRs; Exploration of the potential for the SHiM tool to enable doctors to optimise prescribing for older patients. RESULTS: The meta-synthesis identified four key concepts: (i) Desire to please the patient; (ii) Feeling of being forced to prescribe; (iii) Tension between experience and guidelines; (iv) Prescriber fear. Similar themes also emerged from the qualitative study. In the RCT, the online educational module resulted in a highly significant 22% difference in test scores between intervention and control groups. The studies exploring the frailty index score showed a significant positive relationship between a patient’s frailty status and their likelihood of experiencing PIP/ADRs. Patients above a frailty threshold of 0.16 were at least twice as likely to experience PIP/ADRs. SHiM was found to be a useful tool in terms of reconciling patients’ medications. However, the evidence for it being capable of preventing clinically relevant adverse events was poor. CONCLUSION:Qualitative research in this thesis has proposed novel theories relating to the causative factors of PIP in older patients. In doing so, it has identified several areas for intervention and laid down a road map for future research. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2015, Shane P. Cullinan. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Inappropriate prescribing en
dc.subject Older patients en
dc.subject Geriatrics en
dc.subject Adverse drug reactions en
dc.subject Interventions en
dc.title Strategies to prevent potentially inappropriate prescribing and adverse drug reactions in older patients en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text available en
dc.check.info No embargo required en
dc.description.version Accepted Version
dc.description.status Not peer reviewed en
dc.internal.school Pharmacy en
dc.check.type No Embargo Required
dc.check.reason No embargo required en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.embargoformat Not applicable en
ucc.workflow.supervisor stephen.byrne@ucc.ie
dc.internal.conferring Spring Conferring 2016 en


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© 2015, Shane P. Cullinan. Except where otherwise noted, this item's license is described as © 2015, Shane P. Cullinan.
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