Volume 16, Issue 2 (Summer 2021)
Salmand: Iranian Journal of Ageing 2021, 16(2): 274-287 |
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Eteraf Oskouei T, Vatankhah E, Najafi M. The Status of Potentially Inappropriate Medication Prescription by General Physicians for The Elderly in Tabriz (Iran) According to Beers Criteria. Salmand: Iranian Journal of Ageing 2021; 16 (2) :274-287
URL: http://salmandj.uswr.ac.ir/article-1-2089-en.html
URL: http://salmandj.uswr.ac.ir/article-1-2089-en.html
1- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
2- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. ,najafim@tbzmed.ac.ir
2- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. ,
Abstract: (4336 Views)
Objectives: Prescribing medication for the elderly is an important health issue. This study aimed to investigate the status of Potentially Inappropriate Medications (PIMs) prescription for the elderly by general physicians in Tabriz, Iran.
Methods & Materials: This descriptive cross-sectional study was conducted in 2019 on the prescriptions of general physicians for the elderly in Tabriz, Iran. After initial screening of 16842 prescriptions belonged to two insurance systems (social security insurance and health insurance), 1500 prescriptions were selected. The Beers criteria 2019 was used to assess PIM prescription status and their alternatives were suggested if needed. Data were expressed as Mean±Standard Deviation (SD) and No. (%), and analyzed in SPSS v. 21 software. The Mann-Whitney U test was used to examine the differences in the study factors between the prescriptions related to two insurance systems. The relationship between patients’ age and PIM prescription was examined using Spearman correlation test.
Results: The Mean±SD number of drugs in each prescription was 3.93±1.5 and the Mean±SD number of prescribed PIMs was 0.74±0.8. Polypharmacy was observed in 32.6% of the prescriptions, and 53.9% had at least one PIM. Non-steroidal anti-inflammatory drugs, antihistamines and benzodiazepines were the most PIM groups (45.6, 10.9 and 10.6%, respectively). The most common prescribed PIMs were Adult cold, Diclofenac, Glibenclamide, Ketorolac and Diphenhydramine. Number of PIMs in each prescription did were not statistically different between the prescriptions related to two insurance systems (P=0.343). Moreover, patients’ age and gender had no significant relationship with PIM prescription (P=0.312 and P=0.660, respectively).
Conclusion: About 54% of the prescriptions issued by general physicians for the elderly in Tabriz contain PIMs, and polypharmacy is present in about one third of the prescriptions. In order to improve this condition, it is necessary to hold appropriate training and continuous retraining courses in geriatric medicine for general physicians. Supervisions by the Iranian Ministry of Health and Iranian Medical Council can also play an important role in improving the current situation.
Methods & Materials: This descriptive cross-sectional study was conducted in 2019 on the prescriptions of general physicians for the elderly in Tabriz, Iran. After initial screening of 16842 prescriptions belonged to two insurance systems (social security insurance and health insurance), 1500 prescriptions were selected. The Beers criteria 2019 was used to assess PIM prescription status and their alternatives were suggested if needed. Data were expressed as Mean±Standard Deviation (SD) and No. (%), and analyzed in SPSS v. 21 software. The Mann-Whitney U test was used to examine the differences in the study factors between the prescriptions related to two insurance systems. The relationship between patients’ age and PIM prescription was examined using Spearman correlation test.
Results: The Mean±SD number of drugs in each prescription was 3.93±1.5 and the Mean±SD number of prescribed PIMs was 0.74±0.8. Polypharmacy was observed in 32.6% of the prescriptions, and 53.9% had at least one PIM. Non-steroidal anti-inflammatory drugs, antihistamines and benzodiazepines were the most PIM groups (45.6, 10.9 and 10.6%, respectively). The most common prescribed PIMs were Adult cold, Diclofenac, Glibenclamide, Ketorolac and Diphenhydramine. Number of PIMs in each prescription did were not statistically different between the prescriptions related to two insurance systems (P=0.343). Moreover, patients’ age and gender had no significant relationship with PIM prescription (P=0.312 and P=0.660, respectively).
Conclusion: About 54% of the prescriptions issued by general physicians for the elderly in Tabriz contain PIMs, and polypharmacy is present in about one third of the prescriptions. In order to improve this condition, it is necessary to hold appropriate training and continuous retraining courses in geriatric medicine for general physicians. Supervisions by the Iranian Ministry of Health and Iranian Medical Council can also play an important role in improving the current situation.
Keywords: Potentially inappropriate medications, Elderly, General physicians, Beers criteria, Tabriz
Type of Study: Applicable |
Subject:
Pharmacy
Received: 2020/09/03 | Accepted: 2020/11/17 | Published: 2021/07/01
Received: 2020/09/03 | Accepted: 2020/11/17 | Published: 2021/07/01
References
1. United Nations. World Population Ageing 2017 [Internet]. 2017. Available from: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf. Accessed: Agu 19 2020-08-2020.
2. Ghasemi S KMN, Mohammadi Shahboulaghi F, Ramezankhani A, Mehrabi Y. Physical Health Status of the Elderly Living at Home in Tehran City, Iran. Salmand: Iranian Journal of Ageing. 2019;13:652-65. [DOI:10.32598/SIJA.13.Special-Issue.652]
3. Karami MB. Ageing in Iran in 1410, a warning to health care system. Iranian Journal of Ageing. 2013;3(1):17-27.
4. Vali L, Pourreza A, Ahmadi B, Akbari Sari A. Quality assessment tools and Management for medication prescription in elderly. Hospital Journal. 2013;11(4):23-8.
5. Esmaeili Shahmirzadi S, Shojaeizadeh D, Azam K, Salehi L, Tol A, Moradian Sorkhkolaei M. The Impact Of Chronic Diseases On The Quality Of Life Among The Elderly People In The East Of Tehran. Payavard Salamat. 2012;6(3):225-35. eng.
6. Peiman H, Yaghoubi M, Seyed Mohammadi A, Delpishe A. Prevalence of Chronic Diseases in the Elderly in Ilam. Salmand: Iranian Journal of Ageing. 2012;6(4):7-13. eng.
7. Woo E-k, Han C, Jo SA, Park MK, Kim S, Kim E, et al. Morbidity and related factors among elderly people in South Korea: results from the Ansan Geriatric (AGE) cohort study. BMC Public Health. 2007;7(1):10-9. [DOI:10.1186/1471-2458-7-10]
8. Ghicavii V, Podgurschi L, Pogonea I, Rakovski T. Peculiarities of using drugs in the elderly. The Moldovan Medical Journal. 2017;60(4):20-4. [DOI:10.26416/FARM.183.3.2018.1963]
9. Vali L, Pourreza A, Foroushani AR, Sari AA, Pharm DHH. An investigation on inappropriate medication applied among elderly patients. World Applied Sciences Journal. 2012;16(6):819-25.
10. Dianati M, Shojaegharebag GA, Mesdaghinia A, Taghadosi M, Shenasa F, Taiebi A, et al. Polypharmacy and its related factors among the elderly population in Kashan, Iran during 2011-2012. Kashan University of Medical Sciences Journal. 2015;18(6):578-84.
11. Skov J, Bladbjerg EM, Sidelmann J, Vamosi M, Jespersen J. Plenty of pills: polypharmacy prevails in patients of a Danish anticoagulant clinic. European Journal of Clinical Pharmacology. 2011 Nov;67(11):1169-74. PubMed PMID: 21562976. Epub 2011/05/13. [DOI:10.1007/s00228-011-1045-0]
12. Lai H-Y, Hwang S-J, Chen Y-C, Chen T-J, Lin M-H, Chen L-K. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clinical therapeutics. 2009;31(8):1859-70. [DOI:10.1016/j.clinthera.2009.08.023]
13. Mirzaei M, Kavosi Z, Vali L, Mahmoodi L. Study of Inappropriate Medication Prescribed to Elderly Hospitalized Patients Using the Screening Tool to Alert Doctors to Right Treatment. Iranian Journal of Ageing. 2016;11(2):280-9. [DOI:10.21859/sija-1102280]
14. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2019;67(4):674-94. [DOI:10.1111/jgs.15767]
15. Niwata S, Yamada Y, Ikegami N. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities. BMC Geriatrics. 2006;6(1):1-16. [DOI:10.1186/1471-2318-6-1]
16. Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jonsson P, Carpenter G, et al. Potentially InappropriateMedication Use Among Elderly Home Care Patients in Europe. JAMA : the journal of the American Medical Association. 2005 04/01;293:1348-58. [DOI:10.1001/jama.293.11.1348]
17. Cahir C, Bennett K, Teljeur C, Fahey T. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. British Journal of Clinical Pharmacology. 2014 Jan;77(1):201-10. PubMed PMID: 23711082. Pubmed Central PMCID: PMC3895361. Epub 2013/05/29. [DOI:10.1111/bcp.12161]
18. Vali L, Pour Reza A, Rahimi Foroushani A, Ahmadi B, Akbari Kamrani AA. Analysis of Inappropriate Medication Use in Older Adults Discharged From Hospitals Affiliated With Tehran University of Medical Sciences (TUMS) Using the Beers Criteria in 2010. Salmand: Iranian Journal of Ageing. 2011;6(3):56-65. eng.
19. Van Heerden JA, Burger JR, Gerber JJ. Inappropriate medicine prescribing in older South Africans: A cross-sectional analysis of medicine claims data. South African Medical Journal. 2016 Sep 9;106(10):1010-6. PubMed PMID: 27725022. Epub 2016/10/12. [DOI:10.7196/SAMJ.2016.v106i10.10627]
20. Khamis S, Abdi AM, Uzan A, Basgut B. Applying Beers Criteria for elderly patients to assess rational drug use at a university hospital in Northern Cyprus. Journal of pharmacy & bioallied sciences. 2019;11(2):133-41. [DOI:10.4103/JPBS.JPBS_208_18]
21. Rajeev A, Paul G, George S, Vijayakumar P. The study on use of potentially inappropriate medications in elderly patients presenting to a tertiary care hospital in Kerala. International Journal of Science and Research. 2018;7:3542-4. [DOI:10.18535/ijmsci/v5i2.10]
22. Jhaveri BN, Patel TK, Barvaliya MJ, Tripathi C. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India. Perspect Clin Res. 2014;5(4):184-9. PubMed PMID: 25276629. eng. [DOI:10.4103/2229-3485.140562]
23. Momin TG, Pandya RN, Rana DA, Patel VJ. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria. Indian journal of pharmacology. 2013;45(6):603-19. [DOI:10.4103/0253-7613.121372]
24. Talebi Taher M, Moosavi J, Ali S, Taherian S, Barati M. Surveying the inappropriate drug adminstrution using Beers criteria in elderly patients at the internal medicine ward of Rasoul-e-Akram Hospital of Tehran in 2012. Journal of Arak University of Medical Sciences. 2014;17(2):33-9.
25. Heidari S AA, Naebi A, Khoramirad A. Frequency of use of potentially inappropriate medications and its associated factors in elderly people in Qom city 2012. Qom university of medical sciences journal. 2014;8(4):44-52.
26. Zargarzadeh AH, Sadeghi K, Mirmoghtadaei P. Prescribing of Potentially Inappropriate Medications to Elderly People by Medical Specialists in Isfahan, Iran. Iranian Journal of Pharmaceutical Sciences. 2008;4(4):241-6.
27. Ghadimi H, Esmaily HM, Wahlstrom R. General practitioners' prescribing patterns for the elderly in a province of Iran. Pharmacoepidemiology Drug Safety. 2011 May;20(5):482-7. PubMed PMID: 21523850. Epub 2011/04/28. [DOI:10.1002/pds.2106]
28. Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly Quality Measures. J Am Geriatr Soc. 2015 Dec;63(12):e8-e18. PubMed PMID: 26447889. Pubmed Central PMCID: PMC4890629. Epub 2015/10/09. eng. [DOI:10.1111/jgs.13807]
29. Clinical Resource, Potentially Harmful Drugs in the Elderly: Beers List. Pharmacist's Letter/Prescriber's Letter March 2019.
30. Torabi B, Mohammadi M, Aboozade Gatabi K, Ghanbari Moghaddam A. study of prescribing unsuitable drugs and polypharmacy in the elderly admitted to the Vasei Hospital of Sabzevar, 2017. Journal of Gerontology. 2018;3(1):48-55. [DOI:10.29252/joge.3.1.48]
31. Azoulay L, Zargarzadeh A, Salahshouri Z, Oraichi D, Berard A. Inappropriate medication prescribing in community-dwelling elderly people living in Iran. European Journal of Clinical Pharmacology. 2005 Dec;61(12):913-9. PubMed PMID: 16307268. Epub 2005/11/25. [DOI:10.1007/s00228-005-0036-4]
32. Alhawassi TM, Alatawi W, Alwhaibi M. Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatrics. 2019;19(1):154-63. [DOI:10.1186/s12877-019-1168-1]
33. Oliveira MG, Amorim WW, de Jesus SR, Rodrigues VA, Passos LC. Factors associated with potentially inappropriate medication use by the elderly in the Brazilian primary care setting. International journal of clinical pharmacy. 2012;34(4):626-32. [DOI:10.1007/s11096-012-9656-9]
34. Koyama A, Steinman M, Ensrud K, Hillier TA, Yaffe K. Ten‐year trajectory of potentially inappropriate medications in very old women: importance of cognitive status. Journal of the American Geriatrics Society. 2013;61(2):258-63. [DOI:10.1111/jgs.12093]
35. Bhatt AN, Paul SS, Krishnamoorthy S, Baby BT, Mathew A, Nair BR. Potentially inappropriate medications prescribed for older persons: A study from two teaching hospitals in Southern India. Journal of Family Community Mededicine. 2019 Sep-Dec;26(3):187-92. PubMed PMID: 31572049. Pubmed Central PMCID: PMC6755761. Epub 2019/10/02.
36. Zaveri HG, Mansuri SM, Patel VJ. Use of potentially inappropriate medicines in elderly: A prospective study in medicine out-patient department of a tertiary care teaching hospital. Indian journal of Pharmacology. 2010;42(2):95-9. [DOI:10.4103/0253-7613.64499]
37. Cannon KT, Choi MM, Zuniga MA. Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. The American journal of geriatric pharmacotherapy. 2006;4(2):134-43. [DOI:10.1016/j.amjopharm.2006.06.010]
38. Pugh MJV, Fincke BG, Bierman AS, Chang BH, Rosen AK, Cunningham FE, et al. Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration? Journal of the American Geriatrics Society. 2005;53(8):1282-9. [DOI:10.1111/j.1532-5415.2005.53402.x]
39. Nam YS, Han JS, Kim JY, Bae WK, Lee K. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. BMC Geriatr. 2016 Jun 2;16(1):118-28. PubMed PMID: 27255674. Pubmed Central PMCID: PMC4890525. Epub 2016/06/04. [DOI:10.1186/s12877-016-0285-3]
40. Raji MA, Ostir GV, Markides KS, Espino DV, Goodwin JS. Potentially inappropriate medication use by elderly Mexican Americans. Annals of Pharmacotherapy. 2003;37(9):1197-202. [DOI:10.1345/aph.1C480]
41. Windle A, Elliot E, Duszynski K, Moore V. Benzodiazepine prescribing in elderly Australian general practice patients. Australian and New Zealand Journal of Public Health. 2007 Aug;31(4):379-81. PubMed PMID: 17725021. Epub 2007/08/30. [DOI:10.1111/j.1753-6405.2007.00091.x]
42. Guina J, Merrill B. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of Clinical Mededicine. 2018 Jan 30;7(2):17-26. PubMed PMID: 29385731. Pubmed Central PMCID: PMC5852433. Epub 2018/02/02. [DOI:10.3390/jcm7020017]
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