Potentially Inappropriate Prescribing in Older Adults with Hypertension or Diabetes Mellitus and Hypertension in a Primary Care Setting in Bahrain

Sex-based factors influencing perceived relocation stress and glycemic control among older adults with diabetes

This study investigated sex differences perceived relocation stress and glycemic control among older adults with type 2 diabetes in long-term care facilities. A cross-sectional correlation design was used to recruit 120 residents during their first year after moving into the facilities in southern Taiwan. The results showed that almost two-thirds of the participants (64.2%) were women. The mean age was 79.62 (SD = 1.71). Older women with diabetes were reported to have significantly lower levels of education and poor glycemic control but higher levels of perceived relocation stress than men; however, functional independence was significantly higher in men. Although perceived relocation stress significantly predicted HbA1c levels in both women and men, length of stay was also significant in predicting HbA1c levels in women. These findings indicate the need for effective physical and psychological measures to improve glycemic control during the first year of stay in long-term care facilities.

Prescribing Practices in Geriatric Patients with Cardiovascular Diseases

Inappropriate prescribing (IP) increases the risk of adverse medication reactions and hospitalizations in elderly patients. Therefore, it is crucial to evaluate prescribing patterns among this population. This study was designed to assess the prevalence of potentially inappropriate medication (PIMs) use and potential prescribing omissions (PPOs) among geriatrics with cardiovascular diseases (CVDs). In addition, it determined the predictors for IP in this population. A multi-center study was performed retrospectively on 605 patients' medical records collected randomly from seven governmental hospitals in Kuwait. Three of these hospitals have specialized cardiac centers (tertiary care). Inclusion criteria were age ≥ 65 years, diagnosed with at least one CVD, and attended the outpatient clinic during the last 6 months before data collection. A total of 383 patients (63.3%; 95% CI: 59.3-67.1%) were found using at least one PIM or having PPO or both, based on STOPP/START criteria. Three hundred and ninety-one patients (64.6%; 95% CI: 60.7-68.4%) were prescribed PIMs categorized as C and/or D medicines according to the Euro-FORTA list. Over one-quarter (28.8%; 95% CI: 25.2-32.6%) of the patients had drug-drug interactions class D that require therapy modification and/or X that should be avoided. Patients taking ≥ five medications had significantly higher PIMs based on STOPP and FORTA criteria, drug-drug interactions (p < 0.001), and significantly higher PPOs based on START criteria (p = 0.041). Patients with three or more chronic diseases had significantly higher PIMs based on STOPP and FORTA criteria and PPOs based on START criteria (p-values: 0.028, 0.035, and 0.005, respectively). Significantly higher PIMs based on STOPP criteria and PPOs based on START criteria were found in general hospitals compared to specialized cardiac centers (p= 0.002, p= 0.01, respectively). These findings highlight the need to develop and implement multifaceted interventions to prevent or minimize inappropriate prescribing among the geriatric population with CVDs in Kuwait.

Defining explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A systematic review

Introduction

Potentially inappropriate prescriptions (PIPs) of antidiabetic drugs (ADs) (PIPADs) to patients with type 2 diabetes mellitus (T2DM) have been reported in some studies. The detection of PIPs in electronic databases requires the development of explicit definitions. This approach is widely used in geriatrics but has not been extended to PIPADs in diabetes mellitus. The objective of the present literature review was to identify all explicit definitions of PIPADs in patients with T2DM.

Materials and methods

We performed a systematic review of the literature listed on Medline (via PubMed), Scopus, Web of Science, and, Embase between 2010 and 2021. The query included a combination of three concepts ("T2DM" AND "PIPs" AND "ADs") and featured a total of 86 keywords. Two independent reviewers selected publications, extracted explicit definitions of PIPADs, and then classified the definitions by therapeutic class and organ class.

Results

Of the 4,093 screened publications, 39 were included. In all, 171 mentions of PIPADs (corresponding to 56 unique explicit definitions) were identified. More than 50% of the definitions were related to either metformin (34%) or sulfonylureas (29%). More than 75% of the definitions were related to either abnormal renal function (56%) or age (22%). In addition, 20% (n = 35) mentions stated that biguanides were inappropriate in patients with renal dysfunction and 17.5% (n = 30) stated that sulfonylureas were inappropriate above a certain age. The definitions of PIPADs were heterogeneous and had various degrees of precision.

Conclusion

Our results showed that researchers focused primarily on the at-risk situations related to biguanide prescriptions in patients with renal dysfunction and the prescription of sulfonylureas to older people. Our systematic review of the literature revealed a lack of consensus on explicit definitions of PIPADs, which were heterogeneous and limited (in most cases) to a small number of drugs and clinical situations.

Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review

BACKGROUND

People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate prescribing is associated with poorer health outcomes.

AIM

The aim of this scoping review was to explore and map studies conducted on potentially inappropriate prescribing among adults living with diabetes and to identify gaps regarding identification and assessment of potentially inappropriate prescribing in this group.

METHOD

Studies that reported any type of potentially inappropriate prescribing were included. Studies conducted on people aged < 18 years or with a diagnosis of gestational diabetes or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases.

RESULTS

Of the 190 included studies, the majority (63.7%) were conducted in high-income countries. None of the studies used an explicit tool specifically designed to identify potentially inappropriate prescribing among people with diabetes. The most frequently studied potentially inappropriate prescribing in high-income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying drug-drug interactions. The specific events and conditions that were considered as inappropriate were inconsistent across studies.

CONCLUSION

Contraindications, prescribing omissions and dosing problems were the most commonly studied types of potentially inappropriate prescribing. Prescribers should carefully consider the individual prescribing recommendations of medications. Future studies focusing on the development of explicit tools to identify potentially inappropriate prescribing for adults living with diabetes are needed.

Medication error trends in Middle Eastern countries: A systematic review on healthcare services

Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications for patients. Studies concerning such errors have not been undertaken as much in the Middle Eastern region. The aim of this study was to systematically review and identify studies done in the Middle Eastern nations to recognize the principle contributory factors included and to estimate the prevalence in the region. A review of the retrospective, prospective, cohort, and case-control studies based on MEs in the Middle Eastern nations was directed in January 2020 utilizing the accompanying databases: Embase, Medline, PubMed, Ebsco, Cochrane, Scopus, and Prospero. The search methodology incorporated all ages and in English only dating back to 2010. The search methodology included articles about MEs in the Middle East with errors in people of all ages, articles in English, and articles dating back to 2010. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses appraisal instrument was used to assess the quality of the included articles. Individual data extraction, pooled analysis, and the accompanying databases were used for data analysis of the MEs in eligible studies. Fifteen of the 18 articles reviewed from four Middle Eastern countries had low risk of bias, while three out of 18 had medium risk of bias. A total of 58,221 reported people were studied, with a total of 34,730.9 reported MEs. The pooled analysis showed that numbers of errors were mainly prescribing errors (n = 22,715.25), general prescription errors (n = 8097.16), and commission errors (n = 158.2). Iran had the highest rate amid the reported administration errors, at 25.07% (599.11/2388.9). Measuring a patient's clinical laboratory values was another less common type of prescription ME. Lebanon reported to have the highest monitoring errors, with a rate of 13.13% (277.91/2117). A negative trend was shown in the amount of MEs in the vast majority of the nations under the examination. The under-reporting or uncertain information recommended that significan changes are needed in the healthcare sector. There is solid need of literature on healthcare services in the region to completely understand and address the MEs and issues.

Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes

Aims

Polypharmacy is common in people with diabetes and is associated with the use of potentially inappropriate medication (PIM). This study aimed to assess trends in the prevalence of polypharmacy and PIM in older and middle‐aged people with diabetes.

Methods

A repeated cross‐sectional study using the University Groningen IADB.nl prescription database was conducted. All people aged 45 years and over who were treated for diabetes registered in the period 2012–2016 were included. Polypharmacy was assessed for three age groups. PIMs were assessed using Beers criteria for people ≥65 years old, and PRescribing Optimally in Middle‐aged People's Treatments (PROMPT) criteria for 45–64 years old. Chi‐square tests and regression analysis were applied.

Results

The prevalence of polypharmacy increased significantly in all age groups in the study period. In 2016, the prevalence of polypharmacy was 36.9% in patients aged 45–54 years, 50.3% in those aged 55–64 years, and 66.2% in those aged ≥65 years. The prevalence of older people with at least one PIM decreased by 3.1%, while in the middle‐aged group this prevalence increased by 0.9% from 2012 to 2016. The most common PIMs in both age groups were the use of long‐term high‐dose proton pump inhibitors, benzodiazepines and strong opioids without laxatives. Of those, only benzodiazepines showed a decreasing trend.

Conclusions

Polypharmacy increased in older and middle‐aged people with diabetes. While the prevalence of PIM decreased over time in older age, this trend was not observed in middle‐aged people with diabetes. Efforts are needed to decrease the use of PIMs in populations already burdened with many drugs, notably at middle age.

Effect of a Rational Drug Use Policy on the prescribing safety in outpatient settings in Thailand

OBJECTIVE

In Thailand, the 'Rational Drug Use (RDU) policy' has been implemented in the Ministry of Public Health (MOPH) hospitals since October 2016. This study aimed to explore the effects of the RDU policy on prescribing safety indicators for elderly patients and those with common chronic diseases.

METHOD

Electronic outpatient databases were obtained from 15 MOPH hospitals. The selected indicators were the (1) glibenclamide prescribing in patients with diabetes mellitus who were elderly or had renal impairment; (2) duplicate prescribing of renin angiotensin system (RAS) blockers in patients with hypertension; (3) non-steroidal anti-inflammatory drugs (NSAIDs) prescribing in patients with chronic kidney disease stages 3-5; and (4) long-acting benzodiazepines prescribing in patients ≥65 years. The policy effects in terms of changes in prescribing trends were estimated using interrupted time-series analysis based on quarterly (Q) data. The postpolicy trends (2016, Q4-2017, Q4) were compared with the prepolicy trend (2014, Q1-2016, Q3).

KEY FINDINGS

The unsafe prescribing of glibenclamide in patients with diabetes mellitus was 19.2% in Q1, 2014 and decreased significantly due to the RDU policy to 11.0% in Q4, 2017 (-4.23 percentage points quarterly, P < 0.001). The unsafe prescribing of RAS blockers and long-acting benzodiazepines was relatively low in Q1, 2014 (1.0% and 1.1%, respectively) and did not decrease further after the RDU policy. The unsafe prescribing of NSAIDs was 4.2% in Q1, 2014, increased abruptly one quarter after the policy and decreased afterwards.

CONCLUSION

The RDU policy seemed to be a contributing factor that decreased the unsafe prescribing of glibenclamide, while the policy effect was minimal for the other indicators.

Prevalence, Determinants And Associated Risk Of Potentially Inappropriate Prescribing For Older Adults In Qatar: A National Retrospective Study

Purpose

To assess the prevalence and associated risk of potentially inappropriate prescribing (PIP) in older adults.

Methods

This was a national 3-year retrospective study of outpatient older adults exposed to potentially inappropriate medication (PIM) or polypharmacy. We used the Beers Criteria 2019 list to identify PIM to be avoided in older adults. We define moderate polypharmacy (MoP) and major polypharmacy (MaP) as using 6–10 or >10 chronic medications, respectively. Determinants of PIP included patients’ demographics, lab results, medications, comorbidities, and home healthcare services. We used Chi-square (for categorical variables), Unpaired t-test and ANOVA (for continuous variables as applicable) to assess the association of these determinants with PIP. Univariate followed by multivariate logistic regression models were used to get the crude and adjusted odds ratios of exposure to PIM or polypharmacy within patients who had emergency department (ED) admissions, bone fractures, falls, or constipation, compared to those who had not.

Results

3537 patients were included. 62.6%, 40.4%, and 27.2% were exposed to PIM, MoP and MaP, respectively. Determinants of PIP included age, gender, ethnicity, weight, kidney function, sodium levels, hypertension, diabetes, heart failure, CAD, and home healthcare services (all with p-value < 0.05). PIM was associated with risk of ED admission, bone fracture and constipation with adjusted OR (p-values) of 1.27 (0.002), 1.33 (0.005), and 1.40 (<0.001), respectively. MoP was associated with the risk of ED admission, bone fracture, and constipation, with adjusted OR (p-values) of 1.27 (0.012), 1.34 (0.019), and 1.47 (<0.001), respectively. MaP was associated with a higher risk of ED admission, bone fracture, falls, and constipation with adjusted OR (p-values) of 1.46 (0.001), 1.59 (0.002), 1.39 (0.023), and 2.07 (<0.001), respectively.

Conclusion

PIP is common and is associated with an increased risk of poor clinical outcomes in older adults.