On Tuesday 26 June 2007 15:32, Les Bolitho wrote: > FYI Many thanks!
""" The use of medicines identiļ¬ed as potentially inappro- priate in the elderly does appear to have the potential for increased harm. An observational study found that expo- sure to potentially inappropriate medicines in individuals is associated with increased hospitalization (odds ratio (OR) = 1.27, P = 0.002) and death (OR = 1.28, P = 0.01) compared with those not on these medicines after controlling for age, gender and nursing home stay. """ Guess what - I just realized that after adjusting for age, gender and nursing home stay (as above) I found that patients on Tamoxifen, Azathioprine, or even any kind of antibiotic are more likely to end up in hospital or die. So those must be potentially inappropriate too? The other study mentioned at least checked for co-morbidities, but that really tells us very little (eg my patients with CCF on Digoxin will usually fare worse than those not on Digoxin - simpy becaus ethose where I chose to prescribe it I am clutching for straws, whereas those with only mild disease are usually well controlled with other medications). """ appropriate medicine. Although in some instances, the medi- cines may be appropriate for selected individuals, for all the medicines listed, safer alternatives are considered to be available. """ says who? Without checking the individual indications, histories, circumstances? The authors would have made "excellent" politicians or sales reps, but I consider such unfounded jumping to conclusions unworthy of a good clinician Are these guys real world prescribers who see sufficient numbers of real world patients outside the ivory tower? I would be most interested what "safer alternatives" they have to offer regarding Oxybutynin and Amiodarone - if for I had certain life threatening arrythmias myself, with few causes excepted I would insist on getting Amiodarone regardless of age, because allother alternatives failed to prove increased survival rate. But of course patients receiving this drug will die more often or end up in hospital than their peers, matched for age etc. - because they are much sicker to boot with. I remain convinced that "studies" of this kind are at the very best an educational tool for the unexperienced prescriber (yellow flag increasing caution), but entirely unsuitable as evidence for decision support and absolutely unable to allow any conclusion regarding individual prescribers and patients Horst _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
