Articles: ninos.
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Acute Care for Elders (ACE) programs improve outcomes for older adults; however, little is known about whether impact varies with comorbidity severity. ⋯ The greatest reductions in cost and LOS were in patients with greater comorbidity scores. Risk stratification may help hospitals prioritize admissions to ACE units to maximize the impact of the more intensive intervention.
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Gabapentinoid prescriptions are increasing in North America, with frequent off-label use despite limited proven efficacy. This retrospective cohort study describes prescribing trends among hospitalized patients with a focus on dosing and deprescribing. We examined consecutive inpatients between December 2013 and July 2017 on a 52-bed medical unit in Montréal, Canada. ⋯ A minority (94/552, or 17%) were for approved indications. Although it was uncommon for gabapentinoids to be newly prescribed in hospital, preadmission gabapentinoids were also seldom deprescribed (65/495 patients discharged alive, or 13%). Given a high prevalence of use, limited efficacy, and potential harms, gabapentinoids may represent an ideal target for re-evaluation of indication and effectiveness in hospitalized adults, with consideration given to deprescribing.
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Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR™) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR™ series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.