Letter to the Editor Regarding the Article: "Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward"

Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto Rodrigues

Publication

Letter to the Editor Regarding the Article: "Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward"

2019-05-31Journal article

dc.contributor.author	Simões, Pedro Augusto Gomes Rodrigues Marques
dc.contributor.author	Santiago, Luiz Miguel de Mendonça Soares
dc.contributor.author	Simões, José Augusto Rodrigues
dc.date.accessioned	2019-06-27T11:16:20Z
dc.date.available	2019-06-27T11:16:20Z
dc.date.issued	2019-05-31
dc.description.abstract	Dear Editor, We read with interest an article about inappropriate prescribing to elderly patients in an internal medicine ward and a letter to the editor regarding the same paper. We developed a similar study in the Portuguese primary care setting with a nation-wide representative sample of 757 elderly patients in accordance to its distribution in Portuguese health regions and we found that 77% of them were on ≥ 5 medications (with a mean of 8.2) and that 68% had at least one potentially inappropriate medication according the to 2015 Beers Criteria (with a mean of 1.72). The most common potentially inappropriate pharmacological classes were proton pump inhibitors (45.6%), non-steroid anti-inﬂammatory agents (34.5%) and benzodiazepines (27.3%). As such, we were also surprised with the low proportion of inappropriate prescribing at admission and at discharge reported in the study. One of the explanations, that was already reported, is the restricted number of pharmacologica classes used. This does raise many questions. Are we managing the various problems of our population in the best way? Is it necessary to rethink the polypharmacy cut-off since with the aging of the population there is an increase in the number of chronic diseases and consequently an increase in the number of drugs necessary to control them? Do we have to practice according to the guidelines or according to our clinical judgement of pathophysiology? Does this defnition of fve drugs for polypharmacy put people at a higher risk of undermedication, instead of overmedication?5 Shouldn’t we think of a new defnition for polypharmacy that isn’t the same for all people, but which takes into account the burden of disease that it is subject to? E.g. does it make sense to use the same polypharmacy cut-off for a healthy individual and a post-myocardial infarction patient? We consider this issue as fundamental, since as already mentioned the management of multimorbidity and polypharmacy (more specifcally of potentially inappropriate medication) are essential pillars in the provision of health care nowadays, both in primary and secondary care. So this raises the question of time since, in medical education, when should this topic be addressed and by whom? It is also important to analyze if there are differences between the work at the different health care levels regarding the management of multimorbidity, polymedication and potentially inappropriate medication. Are we all working towards the same goal?	pt_PT
dc.description.version	info:eu-repo/semantics/publishedVersion	pt_PT
dc.identifier.citation	Simões PA, Santiago LM, Simões JA. Letter to the Editor Regarding the Article: "Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward". Acta Med Port. 2019 May 31;32(5):409. doi: 10.20344/amp.12212. Epub 2019 May 31.	pt_PT
dc.identifier.doi	10.20344/amp.12212	pt_PT
dc.identifier.issn	1646-0758
dc.identifier.uri	http://hdl.handle.net/10400.6/7112
dc.language.iso	eng	pt_PT
dc.peerreviewed	yes	pt_PT
dc.relation.ispartofseries	32;5
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	pt_PT
dc.subject	Aged	pt_PT
dc.subject	Deprescriptions	pt_PT
dc.subject	Inappropriate Prescribing	pt_PT
dc.subject	Polypharmacy	pt_PT
dc.subject	Portugal	pt_PT
dc.title	Letter to the Editor Regarding the Article: "Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward"	pt_PT
dc.title.alternative	Carta ao Editor a Propósito do Artigo: “Prescrição Inapropriada em Idosos numa Enfermaria de Medicina Interna”	pt_PT
dc.type	journal article
dspace.entity.type	Publication
oaire.citation.conferencePlace	Lisboa, Portugal	pt_PT
oaire.citation.startPage	409	pt_PT
oaire.citation.title	Acta Médica Portuguesa	pt_PT
person.familyName	Simões
person.familyName	Santiago
person.familyName	Rodrigues Simões
person.givenName	Pedro Augusto
person.givenName	Luiz Miguel
person.givenName	José Augusto
person.identifier	L-4695-2016
person.identifier.ciencia-id	5111-BB0F-F1F2
person.identifier.ciencia-id	AB13-2946-9E61
person.identifier.ciencia-id	E419-CED2-38BA
person.identifier.orcid	0000-0003-4692-2003
person.identifier.orcid	0000-0002-9343-2827
person.identifier.orcid	0000-0003-2264-7086
person.identifier.rid	O-3955-2017
person.identifier.rid	P-9545-2018
person.identifier.scopus-author-id	36896116500
rcaap.rights	openAccess	pt_PT
rcaap.type	article	pt_PT
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