A prevalence study of potentially inappropriate medications use in hospitalized Pakistani elderly

Mazhar, Faizan; Akram, Shahzad; Malhi, Saima Mahmood; Haider, Nafis

doi:10.1007/s40520-017-0742-7

Cited by 25 publications

(15 citation statements)

References 34 publications

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“…Due to this reason, a national survey in the USA described the use of insulin among 206 older patients per 100,000 outpatient prescription visits as one of the major reasons for unplanned hospitalization [ 45 ]. Another study conducted in Karachi, Pakistan had revealed that at least 1 PIM was prescribed to more than half (64%) of the older population [ 46 ]. It is suggested that many of the PIMs like antihistaminic agents (e.g., diphenhydramine), proton pump inhibitors (e.g., omeprazole and esomeprazole) and analgesics (e.g., aspirin and non-steroidal anti-inflammatory drugs (NSAIDS)) are more frequently used by older people than any other age group [ 47 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

2018

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Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

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Section: Discussionmentioning

confidence: 99%

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

2018

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“…A national survey in the USA described that the use of insulin among 206 elderly patients per 100,000 outpatient prescription visits is one of the major reasons for unplanned hospitalization because of its association with hypoglycemic events and seizures 36. Another study conducted in Karachi, Pakistan, had declared that at least one PIM was prescribed to 64% of the geriatric population 37. It is estimated that antihistaminic agents (eg, diphenhydramine), proton pump inhibitors (eg, omepra-zole and esomeprazole), and analgesics (eg, aspirin and nonsteroidal anti-inflammatory drugs) are more frequently used by elderly people than by any other age groups 38–40.…”

Section: Discussionmentioning

confidence: 99%

Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

Sarwar¹,

Dar²,

Mahar³

et al. 2018

CIA

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Background and objectivesDue to physiological and pharmacological variations, geriatrics are at high risk of experiencing life-threatening outcomes related to the use of potentially inappropriate medications (PIMs). Thus, the present study aims to evaluate prescribing practices of PIMs among elderly patients who may lead to unplanned hospitalization and associated risk factors.MethodsA cross-sectional study was conducted in different hospitals of Lahore, Pakistan. The study population consisted of geriatric patients aged ≥65 years. Data were collected from the medical records of geriatric patients, who attended these selected hospitals between December 1, 2017, and February 28, 2018. Data were analyzed using SPSS (IBM SPSS Statistics for Windows, Version 21.0) and Microsoft Excel (MS Office 2010).ResultsThe records of 385 geriatric patients were investigated. More than half (60.8%) of the patients were subjected to polypharmacy, which can be defined as the utilization of 5–9 drugs by the patient at the same time, whereas 36.4% were prescribed with one PIM and 56.4% were hospitalized due to PIMs. Majority of them were prescribed with PIMs including N02BA01 (aspirin, 32.4%), A02BC01 (omeprazole, 23.6%), A10AB02 (insulin, 17.4%), A02BC05 (esomeprazole, 8.5%), C08CA01 (amlodipine, 8.3%), and R06AA02 (diphenhydramine, 5.9%). Results of regression analysis revealed that patients exposed to polypharmacy (OR=2.556, 95% CI=1.579–4.135, P-value≤0.001) and excessive polypharmacy (OR=37.828, 95% CI=4.754–300.9, P-value≤0.001) were significantly associated with unplanned hospitalization, whereas factors such as age 75–84 years (OR=0.343, 95% CI=0.156–0.756, P-value=0.008) and polypharmacy (OR=2.480, 95% CI=1.219–5.048, P-value=0.012) were significantly correlated with PIMs.ConclusionThe utilization of PIMs listed in Beers criteria among geriatric population can cause unplanned hospitalization. As the patients receiving polypharmacy are at high risk of unplanned hospitalization, so caution must be exercised in prescribing PIMs for elderly people.

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“…[52] As osteoarthritis and other musculoskeletal problems are very common in the elderly, they are often prescribed NSAIDs and take them on a regular basis. [53] The findings of our study indicate that nearly two-thirds (61.8%) of prescriptions had DDIs. This is in line with a study conducted in Northern Ethiopia which reported a prevalence of 62.2% for drug interactions among elderly patients.…”

Section: Discussionmentioning

confidence: 54%

“…The NSAIDs are categorized as the commonest prescribed analgesics, especially in ambulatory settings . As osteoarthritis and other musculoskeletal problems are very common in the elderly, they are often prescribed NSAIDs and take them on a regular basis …”

Section: Discussionmentioning

confidence: 99%

Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan

Saqib

Atif

Scahill

2018

J Pharm Health Serv Res

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Objectives Ageing and its associated physiological changes make elderly more prone to chronic diseases, ultimately leading to escalated drug use. The aim of this study was to execute retrospective drug utilization evaluation among elderly patients discharged from the hospital. Methods A descriptive, retrospective, cross‐sectional study design was employed. Data were collected from the medical records of discharged elderly patients admitted between July 2016 and December 2016 in Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan. Statistical Package for Social Sciences (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, version 21.0. Armonk, NY, USA: IBM Corp.) was used for analysing the data. Multiple linear regression analysis was used to find the independent factors associated with increased utilization of drugs. P‐value < 0.05 was considered statistically significant. Key findings The average number of drugs per prescription was 4.74 (SD = 1.4). The most commonly prescribed drug classes were as follows: A – alimentary tract and metabolism (77.8%), J: anti‐infectives for systemic use (68.5) and C: cardiovascular system (67.5%) respectively. The total drug consumption varied between 0.02 defined daily dose (DDD)/1000 patient days and 77.1 DDD/1000 patient days. The maximally consumed drug in all the medical wards was omeprazole. 48.3% patients were prescribed at least one potentially inappropriate medication independent of disease or condition. 10.2% patients were prescribed at least one inappropriate medication dependent on disease or condition. 61.8% prescriptions had drug interactions. The total number of drug interactions found in the prescriptions was 781, and among them, majority (74.2%) were moderate interactions. Conclusions Our study identified that drug use in elderly is not appropriate and special emphasis must be put on rationalizing the drug use in this population. The findings of this study may provoke the policymakers and healthcare professionals to formulate appropriate strategies for ensuring rational drug use.

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A prevalence study of potentially inappropriate medications use in hospitalized Pakistani elderly

Abstract: Our findings support the need for measures to improve the quality of drug treatment in the elderly Pakistani population, especially among dependent patients with polypharmacy.

Cited by 25 publications

References 34 publications

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan

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