Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria

Almeida, Thiago Augusto; Reis, Edna Afonso; Pinto, Isabela Vaz Leite; Ceccato, Maria das Graças Braga; Silveira, Micheline Rosa; Lima, Marina Guimarães; Reis, Adriano Max Moreira

doi:10.1016/j.sapharm.2018.06.002

Cited by 57 publications

(64 citation statements)

References 40 publications

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“…NSAIDs, first‐generation antihistamines or skeletal muscle relaxants). Although benzodiazepines are the most frequently initiated class in our study (33.9%) and most studies report a high prevalence of this class among older people worldwide, the 1‐year persistence with benzodiazepines was weak (10.9%). This result compares with the proportions of 12.1% and 7.6% of older adults in Quebec and in Finland, respectively, who were chronic users of benzodiazepines (defined as the presence of at least two claims and 180 cumulative supply days over the year) .…”

Section: Discussioncontrasting

confidence: 52%

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Roux

Sirois

Simard

et al. 2020

Brit J Clinical Pharma

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Aims: To assess the 1-year persistence of potentially inappropriate medication (PIM) use and identify associated factors in community-dwelling older adults in Quebec, Canada.Methods: A population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System. Individuals insured by the public drug plan and aged ≥66 years who initiated a PIM between 1 April 2014 and 31 March 2015 were followed-up for 1 year. PIMs were identified using the 2015 Beers criteria. One-year persistence of PIM use was defined as continuous treatment with any PIM, without interruption for more than 60 days between prescriptions refills.Poisson regression models were performed to identify factors associated with 1-year persistence of any PIM.Results: In total, 25.1% of PIM initiators were persistent at 1 year. In non-persistent individuals, the median time to PIM discontinuation was 31 days (interquartile range 21-92). Individuals were more persistent at 1 year with antipsychotics (43.9%), longduration sulphonylureas (40.2%), antiarrhythmics/immediate-release nifedipine (36.5%) and proton pump inhibitors (36.0%). Factors significantly associated with persistence were an increased age, being a man and having a high number of medications and chronic diseases, especially dementia, diabetes and cardiovascular diseases. Conclusions:One-quarter of community-dwelling older adults are continuously exposed to PIMs. To optimize medication prescribing in the older population, further interventions are needed to limit the use of PIMs most likely to be continued, especially in individuals most at risk of being persistent and also particularly vulnerable to adverse events.

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Section: Discussioncontrasting

confidence: 52%

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Roux

Sirois

Simard

et al. 2020

Brit J Clinical Pharma

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“…Notably, the use of tramadol, NSAIDs, and anticholinergic medications decreased between 2007 and 2013, perhaps at least partly due to medication reviews performed in the county of Västerbotten [25]. The prevalence of PIMs among older patients according to the EU (7)-PIM list is also in line with previous studies using the same identification tool, a prevalence between 41% and 67% has been reported [6, 7, 26–28]. According to the EU (7)-PIM list, apixaban was the most commonly prescribed PIM in the present study.…”

Section: Discussionsupporting

confidence: 83%

Assessment of potentially inappropriate medications using the EU (7)-PIM list and the Swedish quality indicators

2019

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Background Several tools to evaluate the appropriateness of prescriptions have been developed over the years. Objective To compare the prevalence of potentially inappropriate medication (PIM) among elderly, using the European Union (EU) (7)-PIM list and the Swedish quality indicators. Secondary objectives were to investigate factors associated with the use of PIMs using the two tools. Setting Medical ward in a hospital in Northern Sweden. Methods Medical records for patients aged ≥ 65 years admitted to the medical ward were reviewed by clinical pharmacists from September to November 2015 and from February to April 2016. PIMs were identified through the abovementioned identification tools. Main outcome measure Prevalence of PIMs. Results Of 93 patients, 18.3% had one PIM according to the Swedish quality indicators. The most common PIM class was non-steroidal anti-inflammatory drugs and diclofenac was one of the most commonly prescribed PIMs. According to the EU (7)-PIM list, 45.2% of the study population was prescribed one or more PIMs. The most common PIM class was hypnotic and sedative drugs, and the most frequently prescribed PIM was apixaban. No significant associations between PIMs and different factors were found using either identification tool. Conclusion The prevalence of PIMs was relatively low in the study sample according to the Swedish guidelines but high according to the EU (7)-PIM list. Different evaluation tools might give inconclusive results, but it is still important to continuously evaluate the need for PIMs in older patients in order to improve drug treatment and to decrease the risk of adverse drug reactions.

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“…As expected, the number of medications affects the number of PIMs, since with an increased number of drugs there is an increased probability of adverse drug reactions and drug–drug interactions. This association is described in the literature 22,24,26…”

Section: Discussionmentioning

confidence: 75%

<p>Prevalence Of Potentially Inappropriate Medication In The Older Adult Population Within Primary Care In Portugal: A Nationwide Cross-Sectional Study</p>

Simões¹,

Santiago²,

Maurício³

et al. 2019

PPA

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BackgroundIn potentially inappropriate medications harm potentially outweighs benefits. Even appropriately prescribed medications may become inappropriate. They can lead to a high risk of adverse drug reactions, morbidity and mortality. The aim of this study was to determine the prevalence of potentially inappropriate medication in the older adult population attending primary care in Portugal and to identify associated sociodemographic and clinical factors.MethodsWe conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred March 2018 and we studied sociodemographic characteristics, clinical profile and medication. We used 2015 Beers Criteria to assess potentially inappropriate medications. Logistic regression analyses were performed to determine associations between potentially inappropriate medications’ prescriptions and other variables.ResultsPotentially inappropriate medication was present in 68.6% and 46.1% of the sample had two or more. The likelihood of having potentially inappropriate medication increased significantly with being female (OR=1.56 [1.05 to 2.31]), number of chronic health problems (OR=1.06 [1.01 to 1.13]), number of pharmacological subclasses (OR=1.40 [1.30 to 1.51]) and number of prescribers (OR=1.34 [1.09 to 1.65]). Proton-pump inhibitors, nonsteroidal anti-inflammatory drugs and benzodiazepines were the most commonly found ones.ConclusionPotentially inappropriate medication in older adults was found to be a common occurrence in Portugal. It is important that doctors are aware of this problem, namely in the primary care setting due to the longitudinal care.

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Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria

Cited by 57 publications

References 40 publications

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Assessment of potentially inappropriate medications using the EU (7)-PIM list and the Swedish quality indicators

<p>Prevalence Of Potentially Inappropriate Medication In The Older Adult Population Within Primary Care In Portugal: A Nationwide Cross-Sectional Study</p>

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