Evaluation of Appropriateness of Drug Utilization in Elderly Patients in a Non-communicable Disease Clinic Using the Modified STOPP/START Criteria in a Community Hospital

Abstract

Objective: To determine the incidence and factors associated with the prescribing of potentially inappropriate medications (PIMs), potentially prescribing omissions (PPOs), and the occurrence of adverse drug events (ADEs) from PIMs in the elderly in a non-communicable disease (NCD) clinic in a community hospital Methods: This cross-sectional study retrospectively collected data from 400 randomly selected prescriptions of chronically ill outpatients aged 60 years and over from the Him-pro database of the hospital in fiscal year 2020 with no repeated patients. The assessment of PIMS, PPOs and ADEs was conducted by applying 93 items of the STOPP/START 2015 criteria. Results: The incidences of PIMs and PPOs were 6.94 and 2.32%, respectively. At least one PIM and PPO was identified in 30.50 and 11.75% of the prescriptions, respectively. Three most common PIMs-associated drugs were lorazepam, aspirin, and omeprazole (33.73%, 11.83, and 10.65, respectively). The most common cause of PPOs was prescribing omission of ACEI or ARB drugs in diabetic patients with proteinuria >30mg/24 hours. 21.30% of ADEs were associated with 36 total PIMs. 83.33% of ADEs were at low risk. Those having 5-9 drug items were 2 times more likely to have PIMs (Adj OR 2.02, 95%CI=1.02-3.98, P=0.043). An 8.7-fold increase of PIMs (Adj OR 8.74, 95%CI=3.80-20.10, P<0.001) was found when drug items increased to 10-14. Hypertension was associated with an approximately 1.7-fold increase in the likelihood of PIMs (Adj OR 1.70, 95%CI= 1.05-2.75, P=0.031). Psychiatric related disorders were associated with a 3/4-fold reduction in the likelihood of PIMs (Adj OR 0.22, 95%CI=0.11-0.45, P<0.001). Diabetes, cardiovascular diseases, and 1-2 hospitalizations per year were associated with an approximately 3.9, 2.6, and 2.1-fold increase in the likelihood of PPOs (Adj OR 3.90, 95%CI=1.91-7.94, P< 0.001; 2.58, 95%CI=1.19-5.63, P=0.017 and 2.08, 95%CI=1.03-4.23, P=0.042), respectively. Conclusion: The incidences of PIMs and PPOs among the elderly with NCDs were 6.94% and 2.32%, respectively. Most common drug associated with PIMs was lorazepam, while most common cause of PPOs was prescribing omission of ACEI or ARBs. Therefore, relevant health professionals should cooperate to achieve rational use of drugs and reduce the incidence of PIMs or PPOs in the elderly population who are likely to need treatments with multiple drugs.