Prescribing Trends of NSAIDs and Long-acting Benzodiazepines with High Risk for Unsafety in Elderly Patients
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Abstract
Objectives: To examine prescribing trends of nonsteroidal anti-inflammatory drugs (NSAIDs) and long-acting benzodiazepines (BZDs) with high risk for unsafety in elderly patients, and to compare prescribing trends pre- and post-implementation of the Rational Drug Use (RDU) Service Plan policy. Methods: The prescribing indicators included 1) percentage of NSAIDs prescribed in patients aged ≥ 65 years with osteoarthritis for ≥ 2 weeks without proton pump inhibitors (PPIs) and 2) percentage of long-acting BZDs prescribed in patients aged ≥ 65 years for more than 30 days. The study compared the indicators measured at pre- and post-RDU Service Plan policy implementation (fiscal years 2014-2016 vs. 2017-2018), using information from the outpatient electronic database obtained voluntarily from 15 hospitals under the Ministry of Public Health. The study variables included age, diagnosis codes, drug items, and duration prescribed. Unit of analysis in the study was prescription in each quarter, and the results in each indicator were calculated as percentage of prescription. Trends of change were estimated using interrupted time-series analysis. Results: The numbers of prescription of NSAIDs in patients aged ≥ 65 years with osteoarthritis for ≥ 2 weeks and the numbers of prescription of long-acting BZDs in patients aged ≥ 65 years were 77-120 and 132-179 prescriptions/quarter/hospital, respectively. Percentage of NSAIDs prescribed in patients aged ≥ 65 years with osteoarthritis for ≥ 2 weeks without PPIs was 51% in the fiscal year 2014 and had a decreasing trend for both pre- and post-RDU Service Plan policy implementation (-0.19 and -0.23 percentage point per quarter) but did not reach significant level. There were no pre-post differences in the NSAIDs indicator (-0.05 percentage points, P=0.897). Percentage of long-acting BZDs prescribed in patients aged ≥ 65 years for more than 30 days was 30% at quarter 2 of the fiscal year 2014 and increased by 0.77 (P<0.001) and 0.10 percentage point per quarter during pre- and post-policy implementation, respectively. There were no differences in the long-acting BZDs indicator between pre- and post-policy implementation (-0.67 percentage point, P=0.100). Conclusion: Prescribing of NSAIDs and long-acting BZDs with high risk for unsafety in elderly patients was approximately 30-50% and had no decreasing trend after the implementation of the RDU Service Plan policy.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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