Potentially inappropriate medication use among geriatric patients in primary health care centers by applying the list of risk drugs for Thai elderly criteria
Article Sidebar
Main Article Content
Abstract
Potentially inappropriate medications (PIM) are medications having a risk greater than benefit, leading to a high risk of adverse drug reactions and mortality in elderly patients. The List of Risk Drugs for Thai Elderly (LRDTE) was the criteria used for identifying PIM in Thai elderly. This study aimed to examine the prevalence of PIM use in primary care centers (PHCs) using the LRDTE and identify factors associated with PIM use. A retrospective, cross-sectional descriptive study was conducted in 2017 at eight PHCs in Thailand. Secondary data of eligible elderly patients aged 60 years and older were retrieved from the Health Data Center database. Descriptive statistics and multivariate logistic regression were used to identify patient characteristics and health service utilization variables of PIM use. A total of 20,671 prescriptions were included for analysis. The prevalence of PIM prescription was 45.7%. The top three PIMs were Anticholinergic drugs (40.5%), Non-steroidal anti-inflammatory drugs (7.5%) and Proton Pump Inhibitors (3.4%). Three severity levels of PIM (mild, moderate and severe) were identified by age group. We found 35.8% of elderly participants aged 60–74 years received mild PIM, while 16.1% of elderly participants aged 75 years and over were prescribed moderate PIM. The percentages of elderly participants aged 60-74 years and 75 years and older that were prescribed severe PIM were 0.03% and 0.02%, respectively. The likelihood of using PIM increased significantly in elderly patients aged 75 years and older [adjusted OR 1.3 95% CI 1.2-1.4] along with polypharmacy [adjusted OR 1.7; 95% CI 1.6-1.9]. The statistically significant factors associated with having PIM prescriptions were diabetes mellitus, hypertension, dyslipidemia, upper respiratory tract infection, dizziness, and muscle strain. Therefore, these factors should be addressed, and the PIM knowledge of health professionals in PHCs is important to avoid PIM prescription in elderly patients.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Foundation of Thai Gerontology Research and Development institute. Situation of the Thai elderly 2015. Bangkok: Amarin Printing & Publishing; 2017.
Aekplakorn W, Puckcharern H, Thaikla K, Satheannoppakao W. Fifth national health examination survey 2014. Bangkok: National Health Research Institute; 2016.
Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007; 370 (9582): 173-84.
Farrell LM, Bjerre LM, Ramsay T, Cahir C, Ryan C, Halil R, et al. Assessing potentially inappropriate prescribing (PIP) and predicting patient outcomes in Ontario’s older population: a population-base cohort study applying subsets of the STOPP/START and Beer’ s criteria in large health administrative database. BMJ Open. 2015; 5 (11) : 1-12.
Fadare JO, Desalu OO, Obimakinde AM, Adeoti AO, Agboola SM, Aina FO. Prevalence of inappropriate medication prescription in the elderly in Nigeria: A comparison of Beers and STOPP criteria. Int J Risk Saf Med. 2015; 27(4): 177-89.
Griebling TL. American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. J Urol. 2019;202(3): 438.
O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015; 44(2): 213-8.
Ployluermsang C, Tieankanitikul K, ChobPradit J, Suntorn S, Suwankasawong W. Development of medicine list for screening and reducing medication-related problem in Thai elderly. J Health Syst Res. 2015: 77-95. (in Thai)
Perez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ. 2018; 363: k4524.
do Nascimento MM, Mambrini JV, Lima-Costa MF, Firmo JO, Peixoto SW, de Loyola Filho AI. Potentially inappropriate medications: predictor for mortality in a cohort of community-dwelling older adults. Eur J Clin Pharmacol. 2017;73(5): 615-21.
Verdoorn S, Kwint HF, Faber A, Gussekloo J, Bouvy ML. Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria. Eur J Clin Pharmacol. 2015; 71(10): 1255-62.
Jano E, Aparasu RR. Healthcare outcomes associated with beers' criteria: a systematic review. Ann Pharmacother. 2007; 41(3): 438-47.
Vatcharavongvan P, Puttawanchai V. Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria. Pharm Pract (Granada). 2019; 17(3): 1494.
Prasert V, Akazawa M, Shono A, Chanjaruporn F, Ploylearmsang C, Muangyim K. Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use. Res Social Adm Pharm. 2018; 14(5): 451-8.
O'Dwyer M, Peklar J, Mccallion P, Mccarron, Henman CM. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ. 2016:1e11.
Buck M, Atreja A, Brunker CP, et al. Potentially inappropriate medication prescribing in outpatient practices: prevalence and patient characteristics based on electronic health record. Am J Geriatr Pharmacother. 2009;7: 4e92.
Onda M, Imai H, Takada Y, Fujii S, Shono T, Nanaumi Y. Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ. 2015;5(8): 1e9.
Jitramontree N, Thayansin S. Social welfare for older persons in Thailand: Policy and recommendation. Journal of Public Health and Development. 2013;11(3): 39-47. (in Thai)
World Health Organization. International statistical classification of diseases and related health problems 10th Revision version for 2016. [Internet]. [Cited 2017 July 20]. Available from: http://apps.who.int/classifications/ icd10/browse/2016/en#/V.
World Health Organization collaborating centre for drug statistics methodology. [Internet]. [Cited 2017 April 20]. Availablefrom: http://www. whocc.no/ atc_ddd_index/>.
Ploylearmsang C, Kerdchantuk P, SoonKang K, Worasin P, Kedhareon P. Drug related problems and factors affecting on medicine use problems in elderly of Banmakok kantharawichai, Mahasarakham province J Sci Technol MSU. 2014: 804-12. (in Thai)
Bruin-Huisman L, Abu-Hanna A, van Weert H, Beers E. Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study. Age Ageing. 2017; 46(4): 614-9.
Oliveira MG, Amorim WW, de Jesus SR, Heine JM, Coqueiro HL, Passos LC. A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care. J Eval Clin Pract. 2015;21(2): 320-5.
Prasert V, Shono A, Chanjaruporn F, Ploylearmsang C, Boonnan K, Khampetdee A. Effect of a computerized decision support system on potentially inappropriate medication prescriptions for elderly patients in Thailand. J Eval Clin Pract. 2019 ;25(3): 514-20.
Gwee K.A, Goh V, Lima G, Setia S. Coprescribing proton-pump inhibitors with nonsteroidal anti-inflammatory drugs: risks versus benefits. J Pain Res. 2018; 11: 361–74.
Secora A, Alexander GC, Ballew SH, Coresh J, Grams ME. Kidney Function, Polypharmacy, and Potentially Inappropriate Medication Use in a Community-Based Cohort of Older Adults. Drugs Aging. 2018;35(8): 735-50.
Shi S, Morike K, Klotz U. The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol. 2008;64(2): 183-99.
Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152(4): 706–15.
Lee TC, McDonald EG. Deprescribing Proton Pump Inhibitors: Overcoming Resistance. JAMA Intern Med. 2020;180(4): 571-73
Abdulah R, Insani WN, Destiani DP, Rohmaniasari N, Mohenathas ND, Barliana MI. Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. Ther Clin Risk Manag. 2018;14: 1591-7.
Projovic I, Vukadinovic D, Milovanovic O, Jurisevic M, Pavlovic R, Jacovic S. Risk factors for potentially inappropriate prescribing to older patients in primary care. Eur J Clin Pharmacol. 2016; 72(1): 93-107.
Burt J, Elmore N, Campbell SM, Rodgers S, Avery AJ, Payne RA. Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. BMC med. 2018;16(1) :91.
Hill-Taylor B, Sketris I, Hayden J, Byrne S, O'Sullivan D, Christie R. Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther. 2013;38(5): 360-72.
Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5): 827-34.
Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015; 49(1): 29-38.