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

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dc.contributor.advisorByrne, Stephenen
dc.contributor.advisorO'Mahony, Denisen
dc.contributor.authorCullinan, Shane
dc.date.accessioned2016-01-11T14:39:10Z
dc.date.available2016-01-11T14:39:10Z
dc.date.issued2015
dc.date.submitted2015
dc.description.abstractINTRODUCTION: 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.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationCullinan, S.P. 2015. Strategies to prevent potentially inappropriate prescribing and adverse drug reactions in older patients. PhD Thesis, University College Cork.en
dc.identifier.endpage309
dc.identifier.urihttps://hdl.handle.net/10468/2176
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2015, Shane P. Cullinan.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectInappropriate prescribingen
dc.subjectOlder patientsen
dc.subjectGeriatricsen
dc.subjectAdverse drug reactionsen
dc.subjectInterventionsen
dc.thesis.opt-outfalse
dc.titleStrategies to prevent potentially inappropriate prescribing and adverse drug reactions in older patientsen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorstephen.byrne@ucc.ie
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