Development of Indicators for Quality Drug Use in Elderly Patients in Community Hospitals Based on Adverse Health Outcomes and the Beers Criteria
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Abstract
Objective: To determine associations between polypharmacy and adverse health outcomes in elderly patients and develop quality indicators for medication use in elders in community hospitals. Methods: This study was a mixed-method design divided into two phases. The first phase was a quantitative retrospective cohort study of 7,702 elderly patients who received outpatient services at Nong Han Hospital between October 2023 and June 2024. Data from the HosXp version 4 system was used to determine associations between polypharmacy and the four adverse health outcomes including readmission within 48 hours, visiting the hospital before the appointment date, hospitalization within 3 months, and in-hospital mortality within 6 months. The second phase was a qualitative study using a modified Delphi technique to develop quality indicators for medication use in elderly patients. The study involved 17 experts consisting of 7 physicians, 8 pharmacists, and 2 nurses. Results: The polypharmacy group (6-9 medications) and excessive polypharmacy group (≥10 medications) were significantly associated with visiting the hospital before the appointment date (RR = 1.6, 95% CI: 1.5, 1.8 and RR = 1.7, 95% CI: 1.5, 1.9 respectively) and rehospitalization within 3 months (RR = 2.8, 95% CI: 2.0, 3.9 and RR = 5.6, 95% CI: 3.8, 8.2 respectively). Cardiovascular diseases, respiratory diseases, and kidney and reproductive system diseases were significantly associated with adverse health outcomes. The development of quality indicators for medication uses in elderly patients resulted in fourteen indicators accepted by the experts. Conclusion: Polypharmacy in the elderly is associated with adverse health outcomes, especially in certain chronic disease groups. The developed quality indicators for medication use can be applied to assess and improve the quality of medication use in elderly patients in community hospitals. However, further studies are needed to confirm the effectiveness of these indicators in real-world situations and to further develop them to better suit the context of Thailand.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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