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46 Médecine à l’acte/médecine au forfait – ANNEXES KCE Reports 85 S (If a vulnerable elder) If a person age 75 or over does not need control for seizures, then barbiturates should NOT be used (35,37) If a vulnerable elder has heart failure and AF, then he or she should be offered anticoagulation achieved an INR of 2.0 to 3.0 (37) (If a vulnerable elder ) If a person age 75 or older is newly diagnosed with heart failure, then he or she should undergo the following studies within 1 month of the diagnosis ( unless they have already been performed within the prior 3 months): chest x-ray, electrocardiogram, CBC , serum sodium and potassium, serum creatinine, and TSH in patients with atrial fibrillation or heart failure with no obvious etiology (35,37) (If a vulnerable elder) If a person age 75 or older is newly diagnosed with heart failure, then he or she should be offered an evaluation of left ventricular ejection fraction within 1 month (35,37) (If a vulnerable elder)If a patient age 75 or older has heart failure, has left ventricular ejection fraction ≤ 40%, and is New York Association Class I to III, then he or she should be offered a beta-blocker unless a contraindication (e.g. uncompensated heart failure) has been documented (35,37) If a patient age 75 or older has heart failure, has left ventricular ejection fraction ≤ 40% and does not have atrial fibrillation, then from among the three generations of calcium channel blocker medications, he or she should not be treated with a first or second generation calcium channel blocker (35) If a patient age 75 or older has heart failure and left ventricular ejection fraction ≤ 40%then he should not be treated with a type I antiarrhytmic agent unless an implantable cardioverter defibrillator is in place (35) If a female vulnerable elder is newly diagnosed with osteoporosis, then the patient should be offered treatment with HRT, or bisphosphonates or calcitonin within 3 months of diagnosis (37) If a person age 75 or over (a vulnerable elder) has an acute myocardial infarction or unstable angina, did not undergo angiography, and does not have contraindications to revascularisation, then he or she should be offered non invasive stress testing 4-21 days after the infarction or anginal event. (35,37) If a diabetic person age 75 or older has one additional cardiac risk factor (i.e. smoker, hypertension, hypercholesterolemia or renal insufficiency / microalbuminuria), then he or she should be offered an ACE inhibitor or receptor blocker (35) Les indicateurs relatifs à la prise en charge en aigu des patients avec acute myocardial infarction ou unstable angina ne sont pas repris ici, puisqu’ils ne seront probablement pas mesurables : on n’a pas accès à ces types de prises en charge. (35,37) indicateurs non mesurables car concernent des dosages ou des début et fin de traitement indéterminables avec suffisamment de précision. If a person age 75 or older is being treated for depression with antidepressants, then the antidepressants should be prescribed at appropriate starting doses, and they should have an appropriate titration schedule to a therapeutic dose, therapeutic blood levels, or remission of symptoms by 12 weeks. (35) (If a vulnerable elder) If a person age 75 or older requires pharmacotherapy for treatment of hypertension in the outpatient setting, then a once- or twicedaily medication should be used unless there is documentation regarding the need for agents that require more frequent dosing (35,37)
KCE Reports 85 S Médecine à l’acte/médecine au forfait – ANNEXES 47 If a person age 75 or older (a vulnerable elder ) requires analgesia, then meperidine should not be used (35,37) If a person age 75 or older (a vulnerable elder) is taking a serotonin reuptake inhibitor (SRI), then a monoamine oxidase inhibitor (MAOI) should NOT be used for at least 2 week after termination of paroxetine, sertraline, fluvoxamine and citalopram, and for at least 5 weeks after termination of fluoxetine. (35,37) indicateurs concernent des médicaments non remboursés. If a person age 75 or older is started with a COX non – selective NSAID, then he or she should be offered concomitant treatment with either misoprostol or a pump proton inhibitor (35) If a person age 75 or older is taking corticosteroids for more than 1 month, then the patient should be offered calcium and vitamin D (35) If oral pharmacologic therapy is initiated to treat osteoarthritis, then acetaminophen should be the first drug used, unless there is a documented contraindication to use (35) If a person age 75 or older with no history of allergy to the pneumococcal vaccine is not known to have already received a pneumococcal vaccine or if the patient received it more than 5 years ago (if prior to age 65), then a pneumococcal vaccine should be offered (35) indicateurs jugés non pertinents par experts If a person age 75 or older (a vulnerable elder) is prescribed an oral hypoglycemic drug, the chlorpropramide should NOT BE used (35,37) : car traitement rare. All persons age 75 or older (vulnerable elders) should not be prescribed a medication with strong anticholinergic effects if alternatives are available (35,37) : car trop complexe All persons age 75 or older should have a hearing screen as part of the initial evaluation (35) : car indicateurs trop peu précis : quel type de test auditif ? If a person age 75 or older (a vulnerable elder) has hypertension and asthma, then a beta-blocker for hypertension should NOT be used (35,37) : rare selon étude déjà réalisée dans mutuelles. indicateurs concernent tests à délais trop longs pour être analysables lors de cette étude All persons age 75 or older should be offered screening for colorectal cancer at least once with fecal occult blood testing or should have had sigmoidoscopy in the last 5 years or colonoscopy in the last 10 years (35) indicateurs de structure If a health care organization cares for elderly patients, then it should have a formal plan to offer and encourage influenza vaccination among its employees (35)
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KCE reports 1. Efficacité et renta
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74. Oxygénothérapie Hyperbare: Ra
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