期刊
PHARMACEUTICALS
卷 15, 期 8, 页码 -出版社
MDPI
DOI: 10.3390/ph15080977
关键词
older adults; appropriateness; medication adherence; digital health; adverse drug reactions; polypharmacy
资金
- Italian Ministry of University and Research
This article provides an updated description of strategies and tools to improve appropriateness of drug use in older adults by reviewing published literature. The effectiveness and sustainability of each strategy and tool largely depend on local and heterogeneous experiences, resulting in contrasting results. Three main steps, prescription, patient acceptance, and continuous monitoring, should be considered in improving appropriateness. The appropriateness support also depends on the specific care setting and available resources.
Through this structured review of the published literature, we aimed to provide an up-to-date description of strategies (human-related) and tools (mainly from the digital field) facilitating the appropriateness of drug use in older adults. The evidence of each strategy and tool's effectiveness and sustainability largely derives from local and heterogeneous experiences, with contrasting results. As a general framework, three main steps should be considered in implementing measures to improve appropriateness: prescription, acceptance by the patient, and continuous monitoring of adherence and risk-benefit profile. Each step needs efforts from specific actors (physicians, patients, caregivers, healthcare professionals) and dedicated supporting tools. Moreover, how to support the appropriateness also strictly depends on the particular setting of care (hospital, ambulatory or primary care, nursing home, long-term care) and available economic resources. Therefore, it is urgent assigning to each approach proposed in the literature the following characteristics: level of effectiveness, strength of evidence, setting of implementation, needed resources, and issues for its sustainability.
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