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Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed-methods study.

Atiya K Mohammad1,2, Jacqueline G Hugtenburg3, Joost W Vanhommerig4,5

  • 1Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.

Journal of the American Geriatrics Society
|September 21, 2024
PubMed
Summary
This summary is machine-generated.

Prescribing cascades, where one drug causes an adverse reaction leading to another prescription, are common and problematic, especially for older adults. This study identified and quantified these cascades to help reduce medication burden.

Keywords:
adverse drug reactionappropriate prescribingpharmacotherapyprescribing cascadesprescription sequence symmetry analysis

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Geriatric Medicine

Background:

  • A prescribing cascade is when a medication causes an adverse drug reaction (ADR), necessitating additional prescriptions.
  • These cascades increase medication burden, a significant concern for the elderly population.
  • This study aimed to identify and quantify problematic prescribing cascades for clinical application.

Purpose of the Study:

  • To identify and quantify potentially problematic prescribing cascades.
  • To assess the impact of multiple medications causing the same ADR.
  • To provide data supporting interventions to reduce medication burden in older adults.

Main Methods:

  • A mixed-methods approach combining literature review and expert panel assessment.
  • A cohort study using Dutch community pharmacy data (2015-2020) to quantify cascades.
  • Prescription sequence symmetry analysis (adjusted sequence ratios - aSRs) to identify cascade occurrence (aSR >1.0).

Main Results:

  • 66 out of 79 identified prescribing cascades (83.5%) were deemed potentially problematic.
  • 41 (62.1%) cascades showed a significant positive aSR, indicating a cascade.
  • High aSRs were observed for amiodarone-induced hypothyroidism and ACE-inhibitor-induced UTIs; older adults showed significant cascades.

Conclusions:

  • An inventory of clinically relevant, potentially problematic prescribing cascades was created.
  • Findings can guide healthcare providers in intervening to decrease medication burden.
  • Reducing prescribing cascades is crucial for improving patient safety, particularly in older adults.