The epidemiology of polypharmacy
|
|
- Janel Wiggins
- 6 years ago
- Views:
Transcription
1 The epidemiology of polypharmacy Dr Rupert Payne University of Cambridge
2 The ageing population ONS, 2010
3 The burden of multimorbidity Barnett K, Lancet 2012
4 The burden of multimorbidity Barnett K, Lancet 2012
5 Guidelines everywhere Prostate cancer Osteoarthritis Surgical management of OME Irritable bowel syndrome Antenatal care Diabetes in pregnancy Prophylaxis against infective endocarditis Perioperative hypothermia (inadvertent) Type 2 diabetes Lipid modification Stroke Respiratory tract infections Induction of labour Familial hypercholesterolaemia Attention deficit hyperactivity disorder (ADHD) Chronic kidney disease Surgical site infection Metastatic spinal cord compression Medicines adherence Antisocial personality disorder Borderline personality disorder (BPD) Rheumatoid arthritis Breast cancer (early & locally advanced) Breast cancer (advanced) Schizophrenia Critical illness rehabilitation Diarrhoea and vomiting in children under 5 Glaucoma Coeliac disease Type 2 Diabetes - newer agents Low back pain When to suspect child maltreatment Depression in adults Depression with a chronic physical health problem Venous thromboembolism - reducing the risk Donor breast milk banks Unstable angina and NSTEMI Chest pain of recent onset Neuropathic pain - pharmacological management Lower urinary tract symptoms Neonatal jaundice Constipation in children and young people Alcohol-use disorders: physical complications Chronic obstructive pulmonary disease Bacterial meningitis and meningococcal septicaemia Delirium Metastatic malignant disease of unknown primary origin Motor neurone disease - noninvasive ventilation Barrett's oesophagus - ablative therapy Hypertension in pregnancy Chronic heart failure Transient loss of consciousness in adults and young people Pregnancy and complex social factors Nocturnal enuresis - the management of bedwetting in children and young people Sedation in children and young people Anxiety Anaemia management in people with CKD Alcohol dependence and harmful alcohol use Food allergy in children and young people Tuberculosis Colonoscopic surveillance for prevention of colorectal cancer Diabetic foot problems - inpatient management Psychosis with coexisting substance misuse Lung cancer Ovarian cancer Common mental health disorders Hip fracture Peritoneal dialysis Stable angina Hypertension Autism in children and young people Multiple pregnancy Hyperglycaemia in acute coronary syndromes Colorectal cancer Caesarean section Self-harm (longer term management) Anaphylaxis Organ donation Service user experience in adult mental health Epilepsy Patient experience in adult NHS services Infection control Opioids in palliative care Acute upper GI bleeding Autism in adults Sickle cell acute painful episode Venous thromboembolic diseases Spasticity in children and young people Osteoporosis fragility fracture Lower limb peripheral arterial disease Urinary incontinence in neurological disease Antibiotics for early-onset neonatal infection Headaches Neutropenic sepsis Crohn s disease Psoriasis Ectopic pregnancy and miscarriage
6 Guidelines everywhere Years since randomisation NICE, CG127, Hypertension UKPDS38, BMJ 1998
7 Guidelines everywhere Nephropathy Erectile dysfunction Gastroparesis Metformin Sulphonylurea Gliptins Glitazones Exenatide Insulin Dyslipidaemia Antithrombotic Neuropathic pain NICE, CG87, Type 2 diabetes
8 Guidelines everywhere Guidelines generally fail to make it clear when or how to stop drugs
9 Guidelines everywhere
10 age + multimorbidity + guidelines = lots of medicines
11 Prevalence of use of multiple medicines Analysis of 180,815 adult patient (age >20 years) 40 representative GP surgeries across Scotland Primary care data (demographics, prescribing, 40 long-term diagnoses) Linked secondary care admission data
12 Prevalence of use of multiple medicines Payne RA, unpublished data
13 Prescribing is increasing Prescribing Cost Analysis, England
14 Prescribing is increasing Prescribing Cost Analysis, England
15 Prescribing is increasing Guthrie B, SAPC 2012
16 Factors associated with polypharmacy Payne RA, unpublished data
17 Factors associated with polypharmacy Payne RA, unpublished data
18 Factors associated with polypharmacy Payne RA, unpublished data
19 Factors associated with polypharmacy Payne RA, unpublished data
20 Factors associated with polypharmacy Payne RA, unpublished data
21 Factors associated with polypharmacy Payne RA, unpublished data
22 Factors associated with polypharmacy Payne RA, unpublished data
23 Factors associated with polypharmacy Betteridge TM, Int Med J 2011
24 So what?
25 Drug interactions Pharmacodynamic Common effects Common receptors Indirect effects Pharmacokinetic Absorption (chelation, gut motility, gastric ph) Distribution (plasma protein binding competition) Metabolism (cytochrome P450 induction/inhibition) Excretion (renal, bile) Guthrie B, SAPC 2012
26 Adverse drug reactions Hospitalisation for ADRs in UK 6.5% of admissions Mean stay 8 days 466 million Most are avoidable Calderón-Larrañaga A, BJGP 2012
27 Medication errors Adjusted OR 95% CI Female Number of drugs Age 0 to to to Practice Dispensing Non-training Rural (cf. urban) List size < Ref > Medication errors in UK primary care 1 in 8 patients 1 in 20 prescription items Most mild-moderate severity Type of perscribing error % of all errors Incomplete information 30 Dose/strength 17.8 Timing 10.5 Frequency 8.1 Omission of concomitant Rx 7.7 Other 25.9 Avery AJ, The PRACtICe Study, 2012
28 High-risk prescribing Guthrie B, BMJ 2011
29 Medication adherence Gellad WF, Am J Geriatr Pharmacother 2011
30 The elderly Altered pharmacokinetics Altered absorption Changes in fat distribution Altered sensitivity to adverse reactions Impaired gait/balance Cognitive impairment Impaired renal function Impaired liver function
31 Polypharmacy is sometimes bad
32 Polypharmacy is sometimes not bad Payne RA, unpublished data
33 Polypharmacy is sometimes not bad Ref Emergency admission p<0.001 Potentially preventable emergency admission p=0.79 None Number of cardiovascular medicines Appleton S, unpublished data
34 Revisiting the definition of polypharmacy Consider polypharmacy as a continuum Consider polypharmacy in context Appropriate polypharmacy Prescribing for an individual for multiple/complex conditions in circumstances where medicines use can be optimised and the medicines are prescribed according to best evidence. The intent should be maintaining quality of life or improving longevity, whilst minimising harm Problematic polypharmacy Prescribing of multiple medications inappropriately, or where the intended benefit of the medication is not realised
35 Summary Our population is ageing and multimorbidity is the norm, and polypharmacy is increasingly common Polypharmacy is driven by various patient factors, as well as evidencebased clinical guidance Polypharmacy is associated with various adverse outcomes, such as prescribing errors, ADRs and non-adherence Polypharmacy can be both appropriate and problematic, and this should be considered when defining it
achieve compliance Ref Date Title Carms Pembs Cere Compliance CG172. Urinary HB Continence Forum: baseline incontinence in
NICE clinical guidelines: Hywel Dda Health Board status Summary: Status at HB Carmarthenshire Pembrokeshire Ceredigion Update/review required 49 50 50 Response awaited 9 11 8 Compliant 20 15 18 Partially
More informationPharmacotherapy Handbook
Pharmacotherapy Handbook Eighth Edition Barbara G. Wells, PharmD, HP, FCCP, BCPP Dean and Professor Executive Director, Research Institute of Pharmaceutical Sciences School of Pharmacy, The University
More informationPharmacy Prep. Qualifying Pharmacy Review
Pharmacy Prep 2014 Misbah Biabani, Ph.D Director, Tips Review Centres 5460 Yonge St. Suites 209 & 210 Toronto ON M2N 6K7, Canada Luay Petros, R.Ph Pharmacy Manager, Wal-Mart, Canada 1 Disclaimer Your use
More informationBarbara G. Wells, PharmD, FASHP, FCCP, BCPP Dean and Professor School of Pharmacy, The University of Mississippi Oxford, Mississippi
Barbara G. Wells, PharmD, FASHP, FCCP, BCPP Dean and Professor School of Pharmacy, The University of Mississippi Oxford, Mississippi Joseph T. DiPiro, PharmD, FCCP Panoz Professor of Pharmacy, College
More information2018 MIPS Reporting Family Medicine
2018 MIPS Reporting Family Medicine Quality Reporting Requirements: Report on 6 quality measures or a specialty measure set Include at least ONE outcome or high-priority measure Report on patients of All-Payers
More information2016 General Practice/Family Practice Preferred Specialty Measure Set
1 0059 5 0081 41 N/A 50 N/A 65 0069, EHR 66 0002, EHR Effective Clinical Care Effective Clinical Care Effective Clinical Care Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%): Percentage of patients
More informationHEALTH MATTERS, INC. SUMMARY OF PROJECTS AND KEY ACCOMPLISHMENTS TO 2016
Selected 2016 Highlights Epidemiologic research on chronic kidney disease and fistula patency, solid and hematologic malignancies Health economics and outcomes research on beta3-agonist treatment for overactive
More informationGuideline scope Persistent pain: assessment and management
National Institute for Health and Clinical Excellence [document type for example, IFP, QRG] on [topic] Document cover sheet Date Version number Editor 30/08/2017 1 NGC Action 1 2 3 4 5 6 7 8 9 10 11 12
More informationNew indicators to be added to the NICE menu for the QOF and amendments to existing indicators
New indicators to be added to the for the QOF and amendments to existing indicators 1 st September 2015 Version 1.1 This document was originally published on 3 rd August 2015, it has since been updated.
More information9 Diabetes care. Back to contents
Back to contents Diabetes is a major risk factor for the development of peripheral vascular disease and 349/628 (55.6%) of the patients in this study had diabetes. Hospital inpatients with diabetes are
More informationOptimising prescribing in primary care in the face of multimorbidity and polypharmacy
University of Dundee School of Medicine Optimising prescribing in primary care in the face of multimorbidity and polypharmacy Bruce Guthrie Professor of Primary Care Medicine, University of Dundee NICE
More informationClinical Pharmacology and Drug Therapy
Oxford Textbook of Clinical Pharmacology and Drug Therapy THIRD EDITION D. G. Grahame-Smith CBE, MBBS, PhD, FRCP Emeritus Professor of Clinical Pharmacology, University of Oxford and J.K. Aronson MBChB,
More informationDelirium and Dementia
Delirium and Dementia Elder Friendly Care in Acute Care Seniors Health Strategic Clinical Network Acute Care Stress Blender Poor Poor sleep At-Risk Older Adult TREAT CAUSE immediately & aggressively. Increased
More informationCHRONIC TREATMENT GUIDELINES
CHRONIC TREATMENT GUIDELINES REGISTRATION OF CHRONIC CONDITIONS You can only access benefits for chronic medication, as listed below, if your prescribing/treating doctor or pharmacist registers your chronic
More informationPREAMBLE GENERAL DIAGNOSTIC RADIOLOGY
PREAMBLE The General Diagnostic Radiology category is intended to cover the body of knowledge a practicing board certified Diagnostic Radiologist should know. Since the range of content relevant to the
More informationWestern University of Health Sciences, College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of
Western University of Health Sciences, College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Topic UAN# Target Audience A
More informationIn your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed.
Name: SS# In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Patient Medical, Surgical and Family History Review
More informationTable of Contents. Course CME Credits. General Principles Topic CME Credit(s)
Table of Contents Course Course CME Credits Med-Challenger SPEX Comprehensive Review 266.0 CME Credits General Principles 21.0 CME Credit(s) Abdominal Pain 1.0 Acute Pelvic Pain in Women 1.0 Acute Vaginal
More informationJanuary Intravenous Nurse Day ALL MONTH LONG SUN MON TUE WED THU FRI SAT. Blood Donor Month. Glaucoma Awareness Month
January 1 2 3 4 5 6 Blood Donor Month 7 8 9 10 11 12 13 Glaucoma Awareness Month Volunteer Blood Donor Month Cervical Health Awareness Month 14 15 16 17 18 19 20 Thyroid Awareness Month Birth Defects Prevention
More informationTABLE 1. Eligible to participate. Yes* Yes*
1 6th National Project of the Royal College of Anaesthetists 2 Acute coronary syndrome or Acute myocardial infarction (MINAP) 3 Adult Asthma (BTS) 4 Adult Bronchiectasis (BTS) Not applicable (audit did
More informationEFFECTIVE SHARE CARE AGREEMENT. FOR THE off license use of GLP1 mimetics in combination with insulin IN DUDLEY
Specialist details Patient identifier Name Tel: EFFECTIVE SHARE CARE AGREEMENT FOR THE off license use of GLP1 mimetics in combination with insulin IN DUDLEY The aim of Effective Shared Care Guidelines
More informationOCHSNER PHYSICIAN PARTNERS. PQRS Measures by Specialty (FINAL)
OCHSNER PHYSICIAN PARTNERS PQRS Measures by Specialty (FINAL) Allergy and Immunology 2. Asthma: Pharmacologic Therapy for Persistent Asthma - Ambulatory Care Setting (PQRS 53) 3. Patients aged 18 years
More informationGuideline Summary Code Guideline Title Keyword Practice guideline for the treatment of patients with obsessivecompulsive.
Guideline Summary Code Guideline Title Keyword Practice guideline for the treatment of patients with obsessivecompulsive disorder. Found in Folder # obsessive compulsive disorder 1 NGC-5841 Delirium and
More informationPolypharmacy. Polypharmacy. Suboptimal Prescribing in Older Adults. Kenneth Schmader, MD Professor of Medicine-Geriatrics
Polypharmacy Kenneth Schmader, MD Professor of Medicine-Geriatrics Polypharmacy Definition Causes Consequences Prevention/management Suboptimal Prescribing in Older Adults Overuse Polypharmacy Underuse
More informationNHS Outcomes Framework: at-a-glance
April 2016 NHS Outcomes Framework: at-a-glance List of outcomes and indicators in the NHS Outcomes Framework for 2016-17 Domain 1: Preventing people from dying prematurely 1a Potential years of life lost
More informationPRESCRIBING IN THE ELDERLY. CARE HOME PHARMACY TEAM Bhavini Shah, Eleesha Pentiah & Puja Vyas
PRESCRIBING IN THE ELDERLY CARE HOME PHARMACY TEAM Bhavini Shah, Eleesha Pentiah & Puja Vyas LEARNING OUTCOMES Medicines Optimisation The effects of aging on health and medicines. Polypharmacy Acute Kidney
More information2015 PQRS Registry. Source Measure Title Measure Description CITIUS1
1 CQ-IQ covers 65 CMS defined measures that Eligible Providers (EPs) have to report on to assess quality of care provided to the patients. Version Supported: PQRS Registry 2015 65 measures Reporting Period:
More informationGuideline scope Hypertension in adults (update)
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Hypertension in adults (update) This guideline will update the NICE guideline on hypertension in adults (CG127). The guideline will be
More informationMeasuring Long-Term Conditions in Scotland - A summary report
Measuring Long-Term Conditions in Scotland - A summary report Introduction This summary report provides insight into: What are the most common long-term conditions in Scotland? What is the population prevalence
More informationPRESCRIBING GUIDELINES
The Maudsley The South London and Maudsley NHS Foundation Trust & Oxleas NHS Foundation Trust PRESCRIBING GUIDELINES 10th Edition David Taylor Carol Paton Shitij Kapur informa healthcare Contents Authors
More informationSCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs. January 2018 WALK INS ARE ACCEPTED BUT WE ADVISE STUDENTS TO PRE-REGISTER BEFORE THURSDAY
SCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs January 201 DATE DAY TIME TOPICS January 04 January 11 January 1 January 25 9:00AM 9:00AM 9:00AM 9:00AM 1. Understanding Fibromyalagia 2. Diabetes
More informationSCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs. January 2018
January 201 DATE DAY TIME TOPICS TOTAL January 04 1. Understanding Fibromyalagia 2. Diabetes and Cardiovascular Disease 3. Prostate Cancer 4. Hepatitis C 5. Understanding Hepatitis B January 11 1. Dysphagia
More informationSCHEDULE OF CONTINUING EDUCATION COURSES FOR RN s and CNAs. January 2019
January 2019 DATE DAY TIME TOPICS TOTAL January 03 1. Alcoholism 2. Nutrition for the Elderly 3. Uterine Fibroids 4. HIPAA 5.Arthritis 6. Childhood Obesity January 10 1. Understanding Epilepsy: Latest
More informationFollowing the health of half a million participants
Following the health of half a million participants Cathie Sudlow UK Biobank Scientific Conference London, June 2018 Follow-up of participants in very large prospective cohorts Aim: identify a wide range
More informationCreighton University Internal Medicine Residency Curriculum Cycle of 33 months
Creighton University Internal Medicine Residency Curriculum Cycle of 33 months Cardiology: 13 lectures and once a month EKG lecture, 25 total 1. EKG interpretation Once a month 2. Heart failure: 2 lectures.
More informationGeriatric Pharmacology
Geriatric Pharmacology Janice Scheufler R.Ph.,PharmD, FASCP Clinical Pharmacist Hospice of the Western Reserve Objectives List three risk factors for adverse drug events in the elderly Discuss two physiological
More informationWITBANK COALFIELDS MEDICAL AID SCHEME (WCMAS) CHRONIC MEDICINE PROGRAMME GENERAL INFORMATION LETTER
WITBANK COALFIELDS MEDICAL AID SCHEME (WCMAS) CHRONIC MEDICINE PROGRAMME GENERAL INFORMATION LETTER The Prescribed Minimum Benefit Chronic Disease List In terms of the Medical Scheme Act Regulations that
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE. Type 2 diabetes: the management of type 2 diabetes (update)
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Type 2 diabetes: the management of type 2 diabetes (update) 1.1 Short title Type 2 diabetes (update) 2 Background a) The National
More informationFamily Medicine for English language students of Medical University of Lodz. Seminar 12. Elderly care. Przemysław Kardas MD PhD
Family Medicine for English language students of Medical University of Lodz Seminar 12 Elderly care Przemysław Kardas MD PhD Europe is facing demographic challenge 2014 2080 2 3 Old vs young: major differences
More informationWelcome to the Routine frailty identification in the GP contract webinar presented by Dawn Moody
Welcome to the Routine frailty identification in the GP contract webinar presented by Dawn Moody The presentation will begin at 12.00pm. Attendees will be muted during the presentation to avoid interference.
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Williams CM, Maher CG, Latimer J, et al. Efficacy
More informationPublic Dissemination Effective: January 2018
Board of Pharmacy Specialties Board Certified Geriatric Pharmacist (BCGP) Detailed Content Outline 1. GENERAL PRINCIPLES OF AGING (20%) A. Apply the knowledge of physiologic changes associated with aging
More informationNORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES
NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES Using Clinical Risk Groups to Focus Board Strategic Initiatives July 26, 2013 Copyright 2013 by The Segal Group, Inc., parent of The Segal
More informationTaking the harm out of Polypharmacy Step by step. Karen Reid and Claire Stein Lead Integrated Care Pharmacist NHS Lothian
Taking the harm out of Polypharmacy Step by step Karen Reid and Claire Stein Lead Integrated Care Pharmacist NHS Lothian Presentation: Polypharmacy Overview of the 2015 guidelines The Seven Steps Application
More information2017 ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives
2017 ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives Shock Syndromes and Sepsis, Pulmonary Disorders, Hepatic Failure/GI/Endocrine Emergencies, Supportive and
More informationEvolve180 / Ideal Northwest Health Profile
Evolve180 / Ideal Northwest Health Profile ABOUT YOU First Name: Last Name: Address: City: State: Zip: Phone: Email: Date of Birth: Age: Height: Occupation: How did you find out about our program? Marital
More informationSUMMARY TABLE OF MEASURE CHANGES
Summary Table of Measure 1 SUMMARY TABLE OF MEASURE CHANGES Guidelines for Physician Measurement Adult BMI Assessment Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
More informationSt Andrew s College Medical Questionnaire.
Page 1 of 5 St Andrew s College Medical Questionnaire. It is important that you answer all questions in full. Where possible any supporting medical documents should be sent with this form. Failure to disclose
More informationHorizon Scanning Technology Summary. Liraglutide for type 2 diabetes. National Horizon Scanning Centre. April 2007
Horizon Scanning Technology Summary National Horizon Scanning Centre Liraglutide for type 2 diabetes April 2007 This technology summary is based on information available at the time of research and a limited
More informationBriefing Document on Medication use and Falls
Briefing Document on Medication use and Falls This document is intended as a briefing document and is not to be regarded as a document offering definitive legal advice in relation to the subject matter.
More informationpat hways Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16
pat hways Anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs) Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16 Options for local implementation NICE
More informationSelected tables standardised to Segi population
Selected tables standardised to Segi population LIST OF TABLES Table 4.2S: Selected causes of death, all-ages, 2000 2004 (Segi Standard) Table 5.3S: Public hospitalisations by major cause of admission
More informationThe Challenges of Managing the Older Persons
IAG Presidential Oration The Challenges of Managing the Older Persons G.S. Shanthi Professor & Head, Department of Geriatric Medicine, Madras Medical College, Chennai Globally, due to shifting demographics,
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Myocardial infarction: secondary prevention in primary and secondary care for patients following a myocardial infarction 1.1
More informationPhysical comorbidity with bipolar disorder: lessons from UK data
Physical comorbidity with bipolar disorder: lessons from UK data Daniel Smith Symposium 33: Big data and bipolar disorder in the UK A failure of social policy and health promotion, illness prevention and
More informationSTART, STOPP, Beers Oh My! Navigating the World of Geriatric Pharmacy
START, STOPP, Beers Oh My! Navigating the World of Geriatric Pharmacy Jessica DiLeo, PharmD Kate Murphy, PharmD OBJECTIVES Identify pharmacodynamic and pharmacokinetic parameters that may influence treatment
More informationCRACKCast E181 Approach to the Geriatric Patient
CRACKCast E181 Approach to the Geriatric Patient Italicized text refers to passages quoted from Rosen s Emergency Medicine (9 th Ed). Key concepts: We are in the midst of a silver tsunami, with 10,000
More informationSummary of the risk management plan (RMP) for Synjardy (empagliflozin / metformin)
EMA/217413/2015 Summary of the risk management plan (RMP) for Synjardy (empagliflozin / metformin) This is a summary of the risk management plan (RMP) for Synjardy, which details the measures to be taken
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acetaminophen, for geriatric surgical patients, 569 570 Acute kidney injury, critical care issues in geriatric patients with, 555 556
More informationOverview of Current Quality Measures that can be Impacted by Ambulatory Pharmacists
Overview of Current Quality Measures that can be Impacted by Ambulatory Pharmacists Measure Name Measure Domain Measure Focus Comment/Explanation CMS Value-based Purchasing Program (CMS VBP) AMI 30-day
More informationproposed set to a required subset of 3 to 5 measures based on the availability of electronic
CMS-0033-P 143 proposed set to a required subset of 3 to 5 measures based on the availability of electronic measure specifications and comments received. We propose to require for 2011 and 2012 that EP's
More informationRational Pharmacotherapy for LUTS in Older People. Dr William Gibson MBChB MRCP
Rational Pharmacotherapy for LUTS in Older People Dr William Gibson MBChB MRCP Frailty Frailty = state of increased vulnerability resulting from agingassociated decline in reserve and function NOT synonymous
More informationPriorities Forum Statement
Priorities Forum Statement Number 48 Subject Complementary and Alternative Medicine (CAM) Date of decision August 2016 Date refreshed March 2017 Date of review August 2018 Recommendations GUIDANCE Interventions
More informationThe Acupuncture Evidence Project: Plain English Summary
The Acupuncture Evidence Project: Plain English Summary The following is a plain English summary of the findings of the Acupuncture Evidence Project (McDonald J, and Janz S, 2017). The full document (81
More informationNew and Emerging Evidence
New and Emerging Evidence Greg Deputy, Chief Engagement and Dissemination Officer National Academy for State Health Policy October 23, 2017 1 New and Emerging Evidence Lots on the way: 1) Uterine Fibroids
More information2016 PQRS Recommended Measures for: General/Family Practice
Measures Groups Choose 1 Measures Group Report on a minimum of 20 eligible patients (at least 11 must be Medicare Part B FFS patients) #130: Documentation of Current Medications in the Medical Record #204:
More informationAudit of perioperative management of patients with fracture neck of femur
Audit of perioperative management of patients with fracture neck of femur *M Dissanayake 1, N Wijesuriya 2 Registrar in Anaesthesia 1, Consultant Anaesthetist 2, North Colombo Teaching Hospital, Ragama,
More informationSCE Revision Course Geriatric Medicine & Other
SCE Revision Course Geriatric Medicine & Other Geriatric Medicine: what the curriculum says you should know Physiology of ageing Atypical presentations: the Geriatric Giants Falls and fragility fractures
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Dapagliflozin in combination therapy for the Final scope Remit/appraisal objective To appraise the clinical and
More informationPrescribing in the Elderly. Dr Alison Macrae and Dr Debbie Vest GPST2 Drs in Psychiatry
Prescribing in the Elderly Dr Alison Macrae and Dr Debbie Vest GPST2 Drs in Psychiatry 24 th September 2014 Objectives Understand the significance of polypharmacy in the elderly Become familiar with the
More informationCOMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK
COMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK Robert L Alesiani, PharmD, CGP Chief Pharmacotherapy Officer CareKinesis, Inc. (a Tabula Rasa Healthcare Company) 2 3 4 5 Pharmacogenomics
More informationPatient Name Date of Birth MALE / FEMALE Date. Left handed or Right handed. Marital Status: Single Married Divorced Widowed Children?
PH NEW PATIENT HISTORY Patient Name Date of Birth MALE / FEMALE Date Occupation: Left handed or Right handed Marital Status: Single Married Divorced Widowed Children? Y or N # Previous Treating Physician:
More informationDiabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care
open access Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care Julia Hippisley-Cox, Carol Coupland Division of Primary Care, University
More informationENROLLMENT : Line of Business Summary
ENROLLMENT : Line of Business Summary Date Range : JAN 2017 through DEC 2017 COMPREHENSIVE MAJOR MEDICAL Print Date : 1/19/2018 9:43:49AM Page 1 of 1 Month Year Single 2 Person : Emp/Spouse 2 Person :
More informationAcute Kidney Injury (AKI) Undergraduate nurse education
Acute Kidney Injury (AKI) Undergraduate nurse education Year One Developed Summer 2017 Overview Basic A & P of: Urinary system Kidneys Followed by: Introduction to Acute Kidney Injury Urinary System The
More informationHospice and Palliative Medicine
Hospice and Palliative Medicine Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationTOP 5 DRUGS.. TO AVOID IN THE ELDERLY
TOP 5 DRUGS.. TO AVOID IN THE ELDERLY Debbie Kwan, BScPhm., MSc., FCSHP Canadian Geriatrics Society, April 20, 2013 Disclosure of Potential for Conflict of Interest: Financial Disclosure: None Mar 26,
More informationHow much do you know about illnesses or health problems for your parents, grandparents, brothers, sisters, and/or children? 1 A lot Some None at all
Family Health History Please answer each question as honestly as possible. There are no right or wrong answers to nay of the questions. It is important that you answer as many questions as you can. We
More informationShared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins
Tameside Hospital NHS Foundation Trust and NHS Tameside and Glossop Shared Care Protocol for the Prescription and Supply of Low Molecular Weight Heparins Version 5.2 Version: 5.2 Authorised by: Joint Medicines
More informationEXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens
EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens This document should be read in conjunction with the current Summary of Product Characteristics http://www.medicines.org.uk 1.
More informationeappendix A. Opioids and Nonsteroidal Anti-Inflammatory Drugs
eappendix A. Opioids and Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs Nonselective nonsteroidal anti-inflammatory drugs Diclofenac, etodolac, flurbiprofen, ketorolac, ibuprofen,
More informationHu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff (Millwood). 2014;33(5).
Appendix Definitions of Index Admission and Readmission Definitions of index admission and readmission follow CMS hospital-wide all-cause unplanned readmission (HWR) measure as far as data are available.
More informationNational Institute for Health and Clinical Excellence Health Technology Appraisal
National Institute for Health and Clinical Excellence Health Technology Appraisal Rivaroxaban for the prevention of venous thromboembolism after elective orthopaedic surgery of the lower limbs Comment
More informationLiver Health: Do you have liver problems? Yes No If so, please specify:
Medical History General Last Name: First Name: Date of Birth: Age: Contact Number: Are you in good health to the best of your knowledge Medical Information: Please list any physicians you see and their
More informationJoseph S. Weiner, MD, PC Patient History Form
Date: / / NAME: Last First M. I. Age: Sex: q F q M Birthdate: / / What specific questions or goals do you have for this appointment? Please list the names of other clinicians you have seen for this problem:
More informationPharmacology for the Health Care Professions
Pharmacology for the Health Care Professions Christine M. Thorp University of Salford, UK )WILEY-BLACKWELL A John Wiley & Sons, Ltd., Publication Contents Foreword Preface Acknowledgements xüi xv xvii
More informationCUMULATIVE ILLNESS RATING SCALE (CIRS)
CUMULATIVE ILLNESS RATING SCALE (CIRS) The CIRS used in this protocol is designed to provide an assessment of recurrent or ongoing chronic comorbid conditions, classified by 14 organ systems. Using the
More informationNew Patient Paperwork
New Patient Paperwork Date: Phone: Patient: Last Name First Name Initial Street Address: City/State/Zip Code: Sex: M F Age: Birthdate: Single Married Widowed Separated Divorced Email: Newsletter? Y N Insured
More informationCHAPTER 2. GERIATRICS, SELF-ASSESSMENT QUESTIONS
CHAPTER 2. GERIATRICS, SELF-ASSESSMENT QUESTIONS 1. The following is an accurate description of the aging population: A. The number of older adults will reach 17 million in 2030 B. The ratio of women to
More informationUnderstanding and Assessing for Frailty
Understanding and Assessing for Frailty Dr Gloria Yu Clinical Head of Bexley Integrated Care Consultant Physician in Elderly, General and Stroke Medicine 8 July 2015 Learning objectives What is frailty?
More informationCardiovascular Consent Form
Cardiovascular Consent Form Dear Primary Care Provider, A patient currently under your care for a cardiovascular condition has come to the Kingsbury Club Therapy Center to receive a therapeutic massage.
More informationMISCELLANEOUS AGENTS - ALPHA-AGONISTS
Documentation A. FDA Approved Indications ADHD (Clonidine, Guanfacine) Documentation B. Non-FDA approved, commonly used psychiatric indications 1. Alcohol and opiate dependence 2. Opioid withdrawal 3.
More informationFrontline First Aid EMR Homework Supplement. Worksheet solutions found in Emergency Care Manual and Frontline EMR Student Supplement
Worksheet solutions found in Emergency Care Manual and Frontline EMR Student Supplement Reference your Course Layout to determine which assignments are due for each session Spinal Worksheet... 5 Medical
More informationMitigating Risks While Optimizing the Benefits of Pharmacologic Agents to Manage Pain in the Elderly
Mitigating Risks While Optimizing the Benefits of Pharmacologic Agents to Manage Pain in the Elderly Mary Lynn McPherson, PharmD, MDE, MA, BCPS, CPE Professor and Executive Director, Advanced Post-Graduate
More informationCHRONIC MEDICINE PROGRAMME GENERAL INFORMATION LETTER
RAND WATER MEDICAL SCHEME RAND WATER MEDICAL SCHEME CHRONIC MEDICINE PROGRAMME GENERAL INFORMATION LETTER LIST OF CHRONIC CONDITIONS Conditions covered under s chronic medication benefit are detailed below.
More informationRadiology. Undergraduate Radiology Curriculum
Radiology Undergraduate Radiology Curriculum April 2012 INTRODUCTION This curriculum is intended to form a framework for undergraduate learning and teaching in radiology. It refers to the relevant competencies
More informationACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives
ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives Module 1 Critical Care Pharmacy Evolution and Validation, Practice Standards, Training, and Professional Development,
More informationShared Care Guideline for Olanzapine (Zyprexa )
Shared Care Guideline for Olanzapine (Zyprexa ) Development Process This guidance has been produced by Sarah Hudson Lead Pharmacist SWYPFT following an AMBER classification status of Olanzapine by the
More informationRosen s Emergency Medicine 2018, 9/e Table of Contents
Rosen s Emergency Medicine 2018, 9/e Table of Contents Dr.hamidmirjalili@gmail.com Telegram: @medup PART I : Fundamental Clinical Concepts Section One : CRITICAL MANAGEMENT PRINCIPLES 1. Arway >> page
More informationCONTENT OUTLINE FOR THE PHARMACOTHERAPY CERTIFICATION EXAMINATION
CONTENT OUTLINE FOR THE PHARMACOTHERAPY CERTIFICATION EXAMINATION The following domains, tasks and knowledge statements were delineated by the BPS Specialty Council on Pharmacotherapy and validated through
More information