Suchergebnisse

Inappropriate medication use is the use of a medication where the potential risks associated with use outweigh the potential benefits. Inappropriate medication use among older people is known to contribute to adverse health outcomes including hospitalisation and death. Proton pump inhibitors (PPIs) are medications which are commonly used to treat gastric-acid related disorders. Long-term use of PPIs has been associated with several risks including Clostridium Difficile infection, pneumonia, kidney disease and potentially dementia. Inappropriate PPI use is common in older people with up to 80% of patients using a PPI inappropriately. This study explored the appropriateness of PPI prescribing in an inpatient psychogeriatric population which is a vulnerable and understudied patient cohort. Pilot data obtained from 67 inpatients showed that 33% of patients were using a PPI at the time of admission. PPI use was found to be potentially inappropriate in 68% of cases. Un-investigated GORD was the most commonly identified inappropriate indication with 41% of patients using a PPI for this reason. The average frailty score was increased by 10% and the Katz index for independence in activities of daily living was reduced by 15% in PPI users compared to non-users. Both nationally and internationally, PPIs are listed as the most commonly prescribed medications and the costs to the government and the individual are significant. This study demonstrates that there is an opportunity to deprescribe PPIs in psychogeriatric patients which would not only reduce the risk of adverse health outcomes but also result in significant cost saving.

INTRODUCTION: Older people with hip fractures often require long-term care and a crucial aspect is the provision of quality health information to patients and their carers to support continuity of care. If patients are well informed about their health condition and caring needs, particularly posthospital discharge into the community setting, this may support recovery and improve quality of life. As internet and mobile access reach every household, it is possible to deliver a new model of service using a digital education platform as a personal health hub where both patients and their providers of care can establish a more efficient information integration and exchange process. This protocol details proposed research, which aims to develop a 'model of care' by using a digital health solution that will allow delivery of high quality and patient-centred information, integrated into the existing process delivered within the community setting. METHODS AND ANALYSIS: This phase of the study uses a pragmatic mixed-methods design and a participatory approach through engagement of patients, their carers and healthcare providers from multiple disciplines to inform the development of a digital health platform. Quantitative methods will explore health literacy and e-health literacy among older people with hip fractures admitted to the two public tertiary care hospitals in Adelaide, South Australia. Qualitative methods will provide an understanding of aspects of content and context required for the digital health platform to be developed in order to deliver quality health information. The study will use appropriate theoretical frameworks and constructs to guide the design, analysis and overall conduct of the research study. The scope of the study intends to ultimately empower patients and their carers to improve self-management and to better use coordinated services at the community level. This could prevent further falls including associated injuries or new fractures; reduce new hospital admissions and improve confidence and engagement by limiting the psychologically restrictive 'fear of falls'. ETHICS AND DISSEMINATION: The study has been approved by the Human Research Ethics Committee of the Central Adelaide Local Health Network, South Australia (SA) Health, Government of South Australia and the University of Adelaide Human Research Ethics Committee. Findings from the study will be published in suitable peer-reviewed journals and disseminated through workshops or conferences. ; Lalit Yadav, Tiffany K Gill, Anita Taylor, Unyime Jasper, Jen De Young, Renuka Visvanathan, Mellick J Chehade

First published as 10.1136/bmjopen-2018-026319 on 19 June 2019 ; INTRODUCTION:Australia's ageing population puts significant demands on the aged care and healthcare sectors. To monitor the provision of aged care and healthcare services to older people, each government body has an individual data collection system. Together these systems can be the basis for creating the evidence necessary to support future allocation of resources for our ageing community. The Registry of Older South Australians (ROSA) is a cross-sector multidisciplinary (ie, aged care and healthcare) platform built to address the challenges of monitoring people in aged care settings. This protocol describes the ROSA's framework and plans. METHODS AND ANALYSIS:A registry to capture 16 000 South Australians/year undergoing an aged care eligibility assessment was designed. ROSA will contain information captured by the Commonwealth and South Australian state Health Authority, linked by two data integrating authorities, and housed on a secured data platform. ROSA will contain information on the sociodemographic, health, function, psychological, social, home and safety assessment and concerns characteristics, aged care services, general health services, and mortality of people receiving aged care services. Registered participants will be prospectively monitored until their death and yearly updates of their aged care and healthcare services information will be added to the registry. ETHICS AND DISSEMINATION:ROSA will longitudinally monitor the services provided to a population that puts costly demands on the state healthcare and aged care systems, identify unwanted variation, and underpin future research. ROSA's expected outputs include an annual report, a research agenda that focuses on high burden conditions and potentially economically impactful questions, educational materials, and risk profiling tools. ROSA was approved by the South Australian Department for Health and Ageing HREC (HREC/17/SAH/125) and the Australian Institute of Health and Welfare HREC (EO2018/2/429). ; Maria C Inacio, Sarah Catherine Elizabeth Bray, Craig Whitehead, Megan Corlis, Renuka Visvanathan, Keith Evans, Elizabeth C Griffith, Steve L Wesselingh