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Background Most studies assessing the effect of central nervous system (CNS)-acting medicines on cognitive disturbances have focused on the use of individual medicines. The impact on cognitive function when another CNS-acting medicine is added to a patient's treatment regimen is not well known. Objective To determine risk of hospitalization for confusion, delirium, or dementia in older people associated with increasing numbers of CNS-acting medicines taken concurrently, as well as the number of standard doses taken each day (measured as defined daily doses). Design Retrospective cohort study, from July 2011 to June 2012, using health claims data. Setting Australian veteran population. Participants A total of 74,321 community-dwelling individuals aged 65 years and over, who were dispensed at least 1 CNS-acting medicine in the year before study entry. Patients with prior hospitalization for confusion or delirium, and those with dementia or receiving palliative care, were excluded. Main outcome measure Hospitalization for confusion, delirium, or dementia. Results Over the 1-year study period, 401 participants were hospitalized with confusion, delirium, or dementia. Adjusted analyses showed the risk of hospitalization was 2.4 times greater with the use of 2 CNS-acting medicines compared with no use [incident rate ratio (IRR) 2.39, 95% confidence interval (CI) 1.79–3.19, P < .001], and more than 19 times greater when 5 or more CNS-acting medicines were taken concurrently (IRR 19.35, 95% CI 11.10–33.72, P < .001). Similarly, the risk of hospitalization was significantly increased among patients taking between 1.0 and 1.9 standard doses per day (IRR 2.64, 95% CI 1.99–3.50, P < .001) and between 2.0 and 2.9 standard doses per day (IRR 3.43, 95% CI 2.07–5.69, P < .001) compared with no use. Conclusions Use of multiple CNS-acting medicines or higher doses is associated with an increased risk of hospitalization for confusion, delirium, or dementia. Health care professionals need to be alert to the contribution of CNS-acting medicines among patients presenting with confusion or delirium and consider strategies to reduce treatment burden where possible. [ABSTRACT FROM AUTHOR]

Rationale Interventions asking patients to commit to speaking with their doctor about a health-related issue could be used to improve quality of care. Objective To evaluate the impact of commitment questions targeting patients on the uptake of recommended health services within a national quality improvement program (Veterans' MATES). Methods Patients targeted in the home medicines reviews (HMRs), dose administration aids (DAAs), renal function testing and diabetes interventions were posted educational information and response forms which asked whether they intended to talk to their general practitioner (GP) about the targeted service. Uptake of the service after each intervention was determined using health claims data. Log binomial regression models compared the monthly rate of service use in the nine months post-intervention among patients answering ‘yes’ to a commitment question with non-responders and patients answering ‘no’ or ‘unsure’. Results Each intervention targeted up to 58,000 patients. The average response rate was 28%. Positive responses were associated with increased uptake of HMRs (rate ratio ( RR ) 2.64, 95% CI 2.39–2.92; p < 0.0001), dose administration aids ( RR 2.53, 95% CI 2.29–2.79; p < 0.0001), renal function tests ( RR 1.18, 95% CI 1.13–1.24; p < 0.0001), GP management plans ( RR 1.30, 95% CI 1.14–1.48; p < 0.0001) and diabetes care plans ( RR 1.47, 95% CI 1.24–1.75; p < 0.0001) compared to non-responders. Similar increases in uptake were also observed among positive responders when compared to patients responding ‘no’ or ‘unsure’ to the commitment question. Conclusion Positive responses to commitment questions distributed as part of national, multifaceted interventions were consistently associated with increased uptake of targeted services. [ABSTRACT FROM AUTHOR]