PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATIONS IN AYDER REFERRAL HOSPITAL, TIGRAY REGION, NORTHERN ETHIOPIA: PROSPECTIVE STUDY
Background: Potentially inappropriate medication (PIM) use includes the use of drugs with higher risk where adverse drug effect outweighs the clinical benefit, especially when more effective alternative therapy is available.
Objective: The aim of this study was to assess prevalence and risk factors associated with the use of PIMs in elderly patients at medical ward of Ayder Referral Hospital (ARH), Tigray region, Northern Ethiopia.
Methods: A facility based prospective cross sectional study was conducted among 140 elderly patients from February 6, 2014 to May 05, 2014 in ARH. Patients with age â‰¥ 60 years admitted to medical ward during the study period were randomly selected. Data were collected with a structured questionnaire and analyzed using statistical package for social science (SPSS, IBM Corporation) version 20. Binary logistic regression was used to analyze factors associated with occurrence of PIM.
Results: Of 140 patients, 52.1% were males and forty (28.6%) of patients received at least one potentially inappropriate medication. The most commonly used potential inappropriate medications were metoclopramide (25.58%), nifedipine (16.28%), diazepam (13.95%) and meperedine (13.95%). Above half of (58%) patients encountered polypharmacy. Thirty eight percent of the participantsâ€™ had comorbid conditions. In the binary logistic analysis, patients with polypharmacy were more likely to receive PIMs [AOR 4.163: 95 % CI 1.75â€“ 9.92, p=0.001].
Conclusions: Prevalence of PIMs in elderly patients admitted to ARH was high. Polypharmacy was identified as the independent predicator of the uses of PIMs. Clinical pharmacistsâ€™ are in a position to alert and monitor the exposure to PIMs as part of multidisciplinary team.
Keywords:Â Elderly, Potential inappropriate medication, Beerâ€™s criteria, Ethiopia
2. Gillespie U. Effects of Clinical Pharmacists' Interventions: on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients. 2012.
3. Organization WH. Proposed Working Definition of an Older Person in Africa for the MDS Project: Definition of an older or elderly person2013.
4. Hamilton HJ, Gallagher PF, O'Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC geriatrics. 2009;9(1):5.
5. Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? The Lancet. 2007;370(9582):173-184.
6. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of internal medicine. 1991;151(9):1825-1832.
7. Rodrigues AB, Takahashi JA, Secoli S, Nobre MC, MÃ³nica M, GarridoJulio F. Mortality Associated with the Use of Inappropriate Drugs According Beers Criteria: a Systematic Review. Advances in Pharmacology and Pharmacy. 2013;1(2):74-84.
8. Fick DM, Mion LC, Beers MH, L Waller J. Health outcomes associated with potentially inappropriate medication use in older adults. Research in nursing & health. 2008;31(1):42-51.
9. Hedna K, Hakkarainen KM, Gyllensten H, JÃ¶nsson AK, Petzold M, HÃ¤gg S. Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study. European journal of clinical pharmacology. 2015;71(12):1525-1533.
10. Popovic B, Quadranti NR, Matanovic SM, et al. Potentially inappropriate prescribing in elderly outpatients in Croatia. European journal of clinical pharmacology. Jun 2014;70(6):737-744.
11. Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. European journal of clinical pharmacology. 2011;67(11):1175-1188.
12. de Lima TJV, Garbin CAS, Garbin AJÃ, Sumida DH, Saliba O. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes. BMC geriatrics. 2013;13(1):52.
13. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Archives of internal medicine. 1997;157(14):1531-1536.
14. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of internal medicine. 2003;163(22):2716-2724.
15. Campanelli CM. American Geriatrics Society updated beers criteria for potentially inappropriate medication use in older adults: the American Geriatrics Society 2012 Beers Criteria Update Expert Panel. Journal of the American Geriatrics Society. 2012;60(4):616.
16. Mekonnen BA, Bhagavathula SA. Inappropriate medication use in the elderly population attending gondar University hospital: a preliminary assessment. Int J Pharm Pharm Sci. 2014;6(10):540-543.
17. Dagli RJ, Sharma A. Polypharmacy: a global risk factor for elderly people. Journal of international oral health: JIOH. 2014;6(6):i.
18. Bongue B, Laroche ML, Gutton S, et al. Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system. European journal of clinical pharmacology. Dec 2011;67(12):1291-1299.
19. Rothberg MB, Pekow PS, Liu F, et al. Potentially inappropriate medication use in hospitalized elders. Journal of hospital medicine. 2008;3(2):91-102.
20. Morin L, Fastbom J, Laroche ML, Johnell K. Potentially inappropriate drug use in older people: a nationwide comparison of different explicit criteria for population-based estimates. British journal of clinical pharmacology. Aug 2015;80(2):315-324.
21. Frankenthal D, Lerman Y. The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division. International journal of clinical pharmacy. Feb 2015;37(1):60-67.
22. Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers Criteria as a proxy for inappropriate prescribing of other medications among older adults. Annals of Pharmacotherapy. 2011;45(11):1363-1370.
23. Holmes HM, Luo R, Kuo YF, Baillargeon J, Goodwin JS. Association of potentially inappropriate medication use with patient and prescriber characteristics in Medicare Part D. Pharmacoepidemiology and drug safety. 2013;22(7):728-734.
24. Moriarty F, Bennett K, Fahey T, Kenny RA, Cahir C. Longitudinal prevalence of potentially inappropriate medicines and potential prescribing omissions in a cohort of community-dwelling older people. European journal of clinical pharmacology. 2015;71(4):473-482.
25. Fadare JO, Agboola SM, Opeke OA, Alabi RA. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Therapeutics and clinical risk management. 2013;6:115-120.
26. Ay P, Akici A, Harmanc H. Drug utilization and potentially inappropriate drug use in elderly residents of a community in Istanbul, Turkey. International journal of clinical pharmacology and therapeutics. Apr 2005;43(4):195-202.
27. 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. Apr 2010;42(2):95-98.
28. Teixeira JJV, Crozatti MTL, dos Santos CA, Romano-Lieber NS. Potential drug-drug interactions in prescriptions to patients over 45 years of age in primary care, southern Brazil. 2012.
29. Steinman MA, Seth Landefeld C, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. Journal of the American Geriatrics Society. 2006;54(10):1516-1523.
30. Rahmawati F, Pramantara I, Rohmah W, Sulaiman S. Polypharmacy and unnecessary drug therapy on geriatric hospitalized patients in yogyakarta hospitals, Indonesia. Int J Pharm Pharm Sci. 2009;1(1):6-11.
31. Weng MC, Tsai CF, Sheu KL, et al. The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases. QJM : monthly journal of the Association of Physicians. Nov 2013;106(11):1009-1015.
32. Lao CK, Chan KK, Tou CF, Tong HHY, Chan A. Potentially inappropriate prescribing and drugâ€“drug interactions among elderly Chinese nursing home residents in Macao. International journal of clinical pharmacy. 2013;35(5):805-812.
33. Guaraldo L, Cano FG, Damasceno GS, Rozenfeld S. Inappropriate medication use among the elderly: a systematic review of administrative databases. BMC geriatrics. 2011;11(1):79.
34. Eiras A, Teixeira MA, Gonzalez-Montalvo JI, Castell MV, Queipo R, Otero A. [Consumption of drugs in over 65 in Porto (Portugal) and risk of potentially inappropriate medication prescribing]. Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria. May 23 2015.
35. Frankenthal D, Lerman Y, Kalendaryev E. Potentially inappropriate prescribing among older residents in a geriatric hospital in Israel. International journal of clinical pharmacy. Oct 2013;35(5):677-682.
36. de Oliveira MA, Francisco PM, Costa KS, Barros MB. [Self-medication in the elderly population of Campinas, Sao Paulo State, Brazil: prevalence and associated factors]. Cadernos de saude publica. Feb 2012;28(2):335-345.
37. Santos TR, Lima DM, Nakatani AY, Pereira LV, Leal GS, Amaral RG. Medicine use by the elderly in Goiania, Midwestern Brazil. Revista de saude publica. Feb 2013;47(1):94-103.
38. Teni FS, Gedif T. Prevalence and Predictors of Inappropriate Medications Prescribing Among Elderly Outpatients at a University Hospital in Northwestern Ethiopia: A Retrospective Cross-Sectional Study. Ethiopian Pharmaceutical Journal. 2015;30(2):124-132.
39. Jhaveri BN, Patel TK, Barvaliya MJ, Tripathi C. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India. Perspectives in Clinical Research. 2014;5(4):184.
40. Vezmar Kovacevic S, Simisic M, Stojkov Rudinski S, et al. Potentially inappropriate prescribing in older primary care patients. PloS one. 2014;9(4):e95536.
41. 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. Aug 2012;34(4):626-632.
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