Potentially Inappropriate Prescribing among Elderly Patients at a Primary Care Clinic in Oman

Ambulatory Medication Safety in Primary Care: A Systematic Review

PURPOSE

To review the literature on medication safety in primary care in the electronic health record era.

METHODS

Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.

RESULTS

Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm.

CONCLUSIONS

This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.

Comparison of the prevalence and nature of potentially inappropriate medication use in geriatric outpatients between tertiary and community healthcare settings: a multicenter cross-sectional study

Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65 years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.

Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait

BACKGROUND

Potentially inappropriate medications are major health concerns for patients aged ≥65 years. To investigate the prevalence of potentially inappropriate medications, Beer's criteria can be used. We estimated the prevalence of potentially inappropriate medications prescription among patients aged ≥65 years admitted to Kuwait's largest hospital and identified the predictors of prescribing a potentially inappropriate medication.

METHODS

A cross-sectional study was conducted retrospectively using inpatient records from the medical department at the Hospital in Kuwait from 1 January 2019 to 31 December 2019. The latest version of Beer's criteria was used to identify potentially inappropriate medications in patients' medical records. Data were analyzed descriptively to estimate the prevalence of potentially inappropriate medications and to describe participant characteristics. The predictors of potentially inappropriate medications prescribing were determined using binary logistic regression.

RESULTS

A total of 423 medical records of patients were collected. The mean age of the patients admitted was 76 ± 7 years, and 222 of them (52.5%) were women. Upon hospital admission, potentially inappropriate medication was prevalent in 58.4% of patients. The most prevalent potentially inappropriate medications identified were proton pump inhibitors (27.3%), diuretics (21.5%), antipsychotic agents (9%), selective serotonin reuptake inhibitors (5%), and methyldopa (4%). Polypharmacy, Alzheimer's disease, depression, irritable bowel syndrome, hypothyroidism, chronic kidney disease were predictors of potentially inappropriate medications prescription.

CONCLUSION

A high prevalence of potentially inappropriate medication prescription was observed among patients aged ≥65 years admitted to a hospital in Kuwait. The most likely predictor of potentially inappropriate medication prescription was polypharmacy.

Potentially inappropriate medications in older adults according to Beers criteria 2019: Prevalence and risk factors

AIM

Older patients are more prone to receive potentially inappropriate medications (PIMs) that are better to be avoided or dose adjusted to protect them from their unnecessary or harmful use. This study aims to detect the prevalence of PIMs among older patients discharged from Tawam hospital according to Beers criteria 2019. Moreover, the common risk factors of the older patients may subject them to PIMs use.

METHODS

A retrospective charts review study of older patients ≥65 years who were prescribed 5 or more medications and were discharged from Tawam hospital from 1 October 2018 to 31 December 2018. Each patient's medical record was scanned to detect PIMs. (PIMs) were classified according to Beers criteria 2019, and the predictors of PIMs were also assessed.

RESULTS

A total of 502 older patients (51.6% females and 48.4% males) medical charts were reviewed. The prevalence of PIMs among the study population was 34.7%. Antipsychotics (27.5%) and sulphonylurea's (16.8%) were among the most common avoided PIMs. Anticoagulants (40%) and ranitidine (35%) were the most PIMs based on the kidney function of the patient. Female gender [OR 1.8; 95% CI (1.22-2.66), P < .05] and increasing number of medications [OR 1.08; 95% CI (1.03-1.14), P < .05] were the independent predictors of PIMs.

CONCLUSION

Based on the prevalence of PIMs among older patients, it is recommended to revise each patient's medications prescription to avoid inappropriate prescribing and hence decrease the prevalence of PIMs.

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13-2.39). Persistent anger (AOR: 3.33; 1.71-6.47) and use of mobility aids (AOR: 2.41, 1.35-4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15-2.34) and health deterioration (AOR: 1.61, 1.11-2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified.

Prevalence and predictors of potentially inappropriate prescribing in middle-aged adults: a repeated cross-sectional study

Background

Potentially inappropriate prescribing (PIP) is common in older adults and known to be associated with polypharmacy and multimorbidity. Less is known about the prevalence and causes of PIP in middle-aged adults.

Aim

To determine the prevalence and predictors of PIP in middle-aged adults.

Design and setting

A repeated cross-sectional study was conducted using primary care data in London.

Method

PIP was defined using the PRescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria. Prescribing and demographic data were extracted from Lambeth DataNet (LDN), a pseudonymised database of all patients registered at general practices in Lambeth, for those aged 45–64 years prescribed ≥1 medicines in each year from 2014–2019 (n = 46 633–52 582). Prevalence and trends over 6 years were investigated, including the association of PIP with polypharmacy, multimorbidity, deprivation, sex, and age.

Results

The prevalence of PIP decreased from 20% in 2014 to 18% in 2019. The most prevalent PROMPT criteria in 2019 were the use of ≥2 drugs from the same pharmacological class (7.6%), use of non-steroidal anti-inflammatory drugs for >3 months (7.1%) and use of proton pump inhibitors above recommended maintenance dosages for >8 weeks (3.1%). Over the study period, the prevalence of multimorbidity increased (47–52%) and polypharmacy remained stable (27%). Polypharmacy, multimorbidity, deprivation, and age were independently associated with PIP. Sex was the only variable not associated with PIP.

Conclusion

Almost one-fifth of middle-aged adults prescribed medicines are exposed to PIP, as defined by the PROMPT criteria. This is likely to be linked with exposure to avoidable adverse drug events. The PROMPT criteria may provide a useful aid in interventions to optimise prescribing.

Prevalence and incidence of osteoarthritis among people living in the Gulf Cooperation Council countries: a systematic review and meta-analysis

Osteoarthritis (OA) is a common degenerative disease affecting joints with an increasing prevalence around the world and in the Middle East region. Research about the prevalence/incidence of OA in the Gulf Cooperation Council (GCC) countries was limited with inconsistent findings. Therefore, the aim of this study was to conduct a systematic review and meta-analysis for studies reporting the prevalence/incidence of OA among people living in the GCC countries. A comprehensive search was performed using MEDLINE, PubMed, CINAHL, Web of Science, and Google Scholar from inception to December 2020 to identify eligible studies examining the prevalence/incidence of OA in the GCC countries. Meta-analysis was conducted, and the Newcastle Ottawa Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilized to evaluate methodological quality. Thirteen studies were included (12 studies reported prevalence and one study reported incidence), with a total of 24,625 participants with an estimated overall prevalence of 16.13% and incidence of 3.5% of OA in the GCC countries. The quality of the included studies was unsatisfactory (six studies), satisfactory (six studies), and good quality (one study). Common risk factors were being older adult, female, obese, and having lower scores for quality of life. This study shows a high prevalence of OA among individuals living in the GCC countries at approximately 16.13%. Only one study reported incidence of 3.5% of OA in this population. This prevalence rate needs to be confirmed in future research with a similar population and at the site of joint OA levels. Common risk factors should be interpreted with caution since only a few studies reported risk factors. Key Points • The pooled prevalence of Osteoarthritis in the Gulf Cooperation Council countries was 16.13% based on 12 included studies.

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

INTRODUCTION

Pharmacological therapy plays an important role in disease control in the elderly; unfortunately, this comes with a high prevalence in the use of medications classified as potentially inappropriate.

OBJECTIVE

To analyze the incidence, risk factors, and survival of elderly people using potentially inappropriate medications (PIM).

METHOD

A ten-year follow-up assessment of elderly participants residing in a capital of Central Brazil was conducted. The initial assessment (baseline) included 418 elderly people. Data were collected through home interviews guided by a questionnaire covering socioeconomic, demographic, living conditions, and health variables. The medication information obtained comprised active ingredient, dosage, route, and regimen for the medications. The PIMs were classified according to 2019 Beers Criteria. The analyses were performed using STATA 15.0. For survival analysis, a Cox Regression was performed with the respective Kaplan Meier curve.

RESULTS

The incidence of PIM was 44.1 cases (95% CI: 35.2-54.7) per 1,000 people a year. The most used PIMs were nifedipine, glibenclamide, and sodium diclofenac. The risk factors were polypharmacy (aRR: 3.00; 95% CI: 1.31-6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03-2.39). We identified no statistically significant association between survival and the use of PIM.

CONCLUSION

The study highlights the high consumption of PIM among the elderly causing polypharmacy risks. Health professionals working in drug treatment need to be alert to polypharmacy risks to ensure the rational use of medications to prevent adverse reactions and other health problems.