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Pharmacological Risk Assessment Among Older Patients with Polypharmacy Using the Clinical Decision Support System

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Polypharmacy in older adults poses significant risks due to drug interactions. The Janusmed Risk Profile system helped reduce risks like QT prolongation and sedation in elderly patients.

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacology
  • Health Informatics

Background:

  • Polypharmacy is increasing in older adults, leading to a higher risk of adverse drug events from pharmacodynamic interactions.
  • These interactions can cause serious effects such as falls, bleeding, serotonin syndrome, and QT prolongation.
  • The Janusmed Risk Profile is a clinical decision support system designed to identify these medication-related risks.

Purpose of the Study:

  • To assess the pharmacodynamic risks faced by older patients (65+) on polypharmacy (≥5 medications).
  • To evaluate the impact of implementing the Janusmed Risk Profile in electronic health records on prescribing practices for high-risk drug combinations.
  • To analyze changes in the proportion of patients exposed to nine defined adverse-effect categories.

Main Methods:

  • A retrospective, register-based study analyzed prescription data for individuals aged 65 and older using five or more concomitant medications.
  • Patient data were assessed for risks within the Janusmed Risk Profile categories before and after system implementation.
  • Proportions of patients with high/moderate risk were compared between two 4-month periods.

Main Results:

  • Over 127,000 patients were analyzed in each period. Significant reductions were observed in risks for QT prolongation (17.2% to 10.8%) and sedation.
  • Statistically significant decreases in high-risk cases were noted for hemorrhage, orthostatism, QT prolongation, and sedation.
  • The Janusmed Risk Profile implementation showed a notable impact on reducing specific medication-related risks.

Conclusions:

  • Older individuals on polypharmacy are susceptible to severe adverse effects from interacting medications.
  • Healthcare providers appear to respond effectively to alerts for QT prolongation generated by the Janusmed Risk Profile.
  • The system's integration into electronic health records demonstrates potential for improving medication safety in the elderly.