Prevalence of Under-Prescription in Elderly Type 2 Diabetic Patients in the Primary Care Unit of a University Hospital
DOI:
https://doi.org/10.31584/jhsmr.2018.36.4.22Keywords:
diabetes, elderly, under-prescriptionAbstract
Objectives: This study aimed to assess the prevalence of under-prescription among elderly type 2 diabetic patients in the primary care unit of a university hospital in southern Thailand and identify the associated factors.
Material and Methods: A 1-year retrospective medical record review was conducted in elderly type 2 diabetic patients treated continuously in the primary care unit. Under-prescription was the primary outcome assessed from criteria developed from the START criteria (2015), Thailand’s clinical practice guideline for diabetes (2014), and for hypertension (2015).
Results: This study included 458 medical records that fit our inclusion criteria. The median age was 69.1 years old and more than 80% of them had a comorbidity of dyslipidemia or hypertension. The prevalence of under-prescription in elderly type 2 diabetic patients was 84.5%. The most commonly omitted medication was aspirin for primary prevention of cardiovascular disease. An increased number of medications received and having cardiovascular disease was associated with a lower risk of under-prescription.
Conclusion: The prevalence of the omission of beneficial medications in elderly type 2 diabetic patients in the primary care unit of a university hospital was high, especially under-prescription of aspirin for primary prevention of cardiovascular disease.
References
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17. Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging 2012;29:463-75.
18. Kuijpers MA, van Marum RJ, Egberts AC, Jansen PA. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008;65:130-3.
19. Turner RC, Carlson L. Indexes of Item-Objective Congruence for Multidimensional Items. Int J Test 2003;3:163-71.
20. Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK. Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: a hospital-based study. Arch Gerontol Geriatr 2012;55:148-51.
21. Mori AL, Carvalho RC, Aguiar PM, de Lima MG, Rossi MD, Carrillo JF, et al. Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study. Int J Clin Pharm 2017;39:386-93.
22. Sabitha P, Kamath A, Adhikari PM. Prescription of Aspirin for adults with Diabetes. Int J Diabetes Dev 2008;28:51-3.
23. Eidelman RS, Hebert PR, Weisman SM, Hennekens CH. An update on aspirin in the primary prevention of cardio vascular disease. Arch Intern Med 2003;163:2006-10.
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25. Ikeda Y, Shimada K, Teramoto T, Uchiyama S, Yamazaki T, Oikawa S, et al. Low-dose aspirin for primary prevention of cardio vascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. Jama 2014;312:2510-20.
26. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60.
27. Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117-25.
28. Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo controlled trial. Lancet 2003;361:2005-16.
29. American Diabetes Association. 15. Diabetes advocacy: standards of medical care in diabetes-2018. Diabetes Care 2018;41(Suppl 1):S152-3.
30. Thai Atherosclerosis Society. Clinical practice guideline on pharmacologic therapy of dyslipidemia for atherosclerotic cardiovascular disease prevention [homepage on the Internet]. Bangkok: The Society; 2016 [cited 2017 Jan 1]. Available from: https://www.thaiathero.org/thaiatherodetail.php?id=102
31. Remuzzi G, Macia M, Ruggenenti P. Prevention and treatment of diabetic renal disease in type 2 diabetes: the BENEDICT study. J Am Soc Nephrol 2006;17(4 Suppl 2):S90-7.
32. Barry PJ, Galla reening tool to detect prescribing omissions in elderly patients. Age Ageing 2007;36:632-8.
33. Frankenthal D, Lerman Y, Kalendaryev E, Lerman Y. Inter vention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc 2014;62:1658-65.
34. Dalleur O, Feron JM, Spinewine A. Views of general practitioners on the use of STOPP&START in primary care: a qualitative study. Acta Clin Belg 2014;69:251-61.
E0%B8%A3%E0%B8%AA%E0%B8%B3%E0%B8%A3%E0%B8%A7%E0%B8%88%
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E0%B8%97%E0%B8%A2.pdf
2. Soumerai SB, McLaughlin TJ, Spiegelman D, Hertzmark E, Thibault G, Goldman L. Adverse outcomes of underuse of beta blockers in elderly survivors of acute myocardial infarction. JAMA 1997;277:115-21.
3. Winkelmayer WC, Zhang Z, Shahinfar S, Cooper ME, Avorn J, Brenner BM. Efficacy and safety of angiotensin II receptor blockade in elderly patients with diabetes. Diabetes Care 2006;29:2210-7.
4. Naples JG, Handler SM, Maher RL, Schmader KE, Hanlon JT. Geriatric pharmacotherapy and polypharmacy. In: Brocklehurst JC, Woodhouse KW, Rockwood K, Fillit H, editors. Brocklehurst’s textbook of geriatric medicine and gerontology. 8th ed. Philadelphia: Saunders/Elsevier; 2017;p.849-54.
5. Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 2009;68:936-47.
6. Bruin-Huisman L, Abu-Hanna A, van Weert HC, Beers E. Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study. Age Ageing 2017;46:614-9.
7. Kara O, Arik G, Kizilarslanoglu MC, Kilic MK, Varan HD, Sumer F, et al. Potentially inappropriate prescribing according to the STOPP/START criteria for older adults. Aging Clin Exp Res 2016;28:761-8.
8. Castillo-Paramo A, Claveria A, Verdejo Gonzalez A, Rey Gomez Serranillos I, Fernandez-Merino MC, Figueiras A. Inappropriate prescribing according to the STOPP/START criteria in older people from a primary care setting. Eur J Gen Pract 2014;20:281-9.
9. Galvin R, Moriarty F, Cousins G, Cahir C, Motterlini N, Bradley M, et al. Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA). Eur J Clin Pharmacol 2014;70:599-606.
10. Wright RM, Sloane R, Pieper CF, Ruby-Scelsi C, Twersky J, Schmader KE, et al. Underuse of indicated medications among physically frail older US veterans at the time of hospital discharge: results of a cross-sectional analysis of data from the Geriatric Evaluation and Management Drug Study. Am J Geriatr Pharmacother 2009;7:271–80.
11. Formiga F, Vidal X, Agusti A, Chivite D, Roson B, Barbe J, et al. Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabet Med 2016;33:655-62.
12. 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;44:213-8.
13. Thai Hypertension Society. Thai guidelines on the treatment of hypertension [homepage on the Internet]. Bangkok: Thai Hypertension Society; 2015 [cited 2017 Jan 1]. Available from: https://www.thaihypertension.org/files/13.08Dec2006 14-AttachFile1165561514.pdf
14. Diabetes Association of Thailand. Clinical practice guideline for diabetes [homepage on the Internet]. Bangkok: Diabetes Association of Thailand; 2017 [cited 2017 Jan 1]. Available from: www.lpnh.go.th/newlp/wp-content/uploads/2013/10/CPG 2560-25-7-60-A5.pdf
15. Fu AZ, Zhang Q, Davies MJ, Pentakota SR, Radican L, Seck T. Underutilization of statins in patients with type 2 diabetes in US clinical practice: a retrospective cohort study. Curr Med Res Opin 2011;27:1035-40.
16. Winkelmayer WC, Fischer MA, Schneeweiss S, Wang PS, Levin R, Avorn J. Underuse of ACE inhibitors and angiotensin II receptor blockers in elderly patients with diabetes. Am J Kidney Dis 2005;46:1080–7.
17. Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging 2012;29:463-75.
18. Kuijpers MA, van Marum RJ, Egberts AC, Jansen PA. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008;65:130-3.
19. Turner RC, Carlson L. Indexes of Item-Objective Congruence for Multidimensional Items. Int J Test 2003;3:163-71.
20. Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK. Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: a hospital-based study. Arch Gerontol Geriatr 2012;55:148-51.
21. Mori AL, Carvalho RC, Aguiar PM, de Lima MG, Rossi MD, Carrillo JF, et al. Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study. Int J Clin Pharm 2017;39:386-93.
22. Sabitha P, Kamath A, Adhikari PM. Prescription of Aspirin for adults with Diabetes. Int J Diabetes Dev 2008;28:51-3.
23. Eidelman RS, Hebert PR, Weisman SM, Hennekens CH. An update on aspirin in the primary prevention of cardio vascular disease. Arch Intern Med 2003;163:2006-10.
24. Sanmuganathan PS, Ghahramani P, Jackson PR, Wallis EJ, Ramsay LE. Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomised trials. Heart 2001;85:265-71.
25. Ikeda Y, Shimada K, Teramoto T, Uchiyama S, Yamazaki T, Oikawa S, et al. Low-dose aspirin for primary prevention of cardio vascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. Jama 2014;312:2510-20.
26. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60.
27. Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117-25.
28. Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo controlled trial. Lancet 2003;361:2005-16.
29. American Diabetes Association. 15. Diabetes advocacy: standards of medical care in diabetes-2018. Diabetes Care 2018;41(Suppl 1):S152-3.
30. Thai Atherosclerosis Society. Clinical practice guideline on pharmacologic therapy of dyslipidemia for atherosclerotic cardiovascular disease prevention [homepage on the Internet]. Bangkok: The Society; 2016 [cited 2017 Jan 1]. Available from: https://www.thaiathero.org/thaiatherodetail.php?id=102
31. Remuzzi G, Macia M, Ruggenenti P. Prevention and treatment of diabetic renal disease in type 2 diabetes: the BENEDICT study. J Am Soc Nephrol 2006;17(4 Suppl 2):S90-7.
32. Barry PJ, Galla reening tool to detect prescribing omissions in elderly patients. Age Ageing 2007;36:632-8.
33. Frankenthal D, Lerman Y, Kalendaryev E, Lerman Y. Inter vention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc 2014;62:1658-65.
34. Dalleur O, Feron JM, Spinewine A. Views of general practitioners on the use of STOPP&START in primary care: a qualitative study. Acta Clin Belg 2014;69:251-61.
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2018-09-17
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Ananchaisarp T, Duangkamsee N, Burapakiat B, Buppodom T, Rojanusorn U, Katawatee K, Nawalerspunya P, Siriwong T, Haruthaiborrirux P, Saktiwarawat K. Prevalence of Under-Prescription in Elderly Type 2 Diabetic Patients in the Primary Care Unit of a University Hospital. J Health Sci Med Res [Internet]. 2018 Sep. 17 [cited 2024 Nov. 26];36(4):259-67. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/109581
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