Assessment of Potentially Inappropriate Medications and Prescription Appropriateness in Geriatics at Teritiary Care Hospital
A Prospective Observational Study
Background: Elder people are a diversified group commonly presenting with multiple comorbid illnesses resulting into multiple prescriptions which in turn increases adverse effects and polypharmacy. Potentially inappropriate medications (PIM) further contribute to this risk. Therefore, the aim of this study was to assess the prescription appropriateness and (PIM) in geriatrics as per WHO core prescribing indicators and Beer’s Criteria, 2015 respectively.
Methods: A prospective observational study was conducted in Osmania General Hospital, a Tertiary Care Teaching Hospital from December 2018 to May 2019. A total of 100 case records of inpatients greater than or equal to 60 years of age, in general medicine wards were reviewed. Relevant information was recorded in a structured proforma and data was evaluated.
Results: Out of 100 patients, 70 patients were male and 30 patients were female. Majority of them were from the age group of 65-70 years. There were 34% patients prescribed at least one PIM. Polypharmacy was observed in all patients. Average no. of drugs per prescription was 10.5%.Percentage of drugs prescribed from EDL (Essential drug list) were 84%.The p value of WHO core prescribing indicators was assessed using chi square test and was found to be significant.
Conclusion: Our study found WHO core prescribing indicators to be deviated from the optimum values set by WHO and high prevalence of Potentially Inappropriate Medications as per Beers criteria 2015. This highlights the need of future research work, strategies and regulatory measures focusing on geriatric patients and also encouraging prescribers to use the WHO core prescribing indicators and Beers criteria while prescribing elderly for providing optimum healthcare.
Keywords: Beer’s criteria, Geriatrics, WHO prescribing indicators, Polypharmacy. Ageing, Potentially Inappropriate Medications.
2. Geriatric knowledge today elderly population. Available at http:/www.gktoday.in/indias-elderlypopulation-some-fundamentals/
3. British Geriatric Society-definition-geriatrics. Available at http:/www.bgs.org.uk/index.php/policydigest/228-about/administration/981geriatricsdefined.
4. Madgaonkar CS. Family medicine. A clinical and applied orientation 2 nd Ed Jaypee medical publishers (p) lt.
5. Public relations bureau-reports-elderly population 2012. Available at http:/www.prb.org/publications/reports/2012/indiaolder-population.aspx. d; 2015:247.
6. Jiron M, Pate V, Hanson LC, Lund JL, Jonsson Funk M, Strümer T. Trends in prevalence and determinants of potentially inappropriate prescribing in the United States: 2007 to 2012. J Am Geriatric Soc. 2016; 64(4):788–97.
7. Suehs BT, et al. Effect of potentially inappropriate use of antimuscarinic medications on healthcare use and cost in individuals with overactive bladder. J Am Geriatr Soc. 2016; 64(4):779–87
8. Page RL, II SA, Bryant LL, Ruscin JM. “Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions”. 2010; 75–87,
9.Sisay M, Mengistu G, Molla B, Amare F, Gabriel T. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study. BMC Health Serv Res. 2017; 17(1):161. Published 2017 Feb 23. Doi: 10.1186/s12913-017-2097-3
10. Panel, A.G.S.B.C.U.E, et al. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015; 63(11):2227–46.
11.Lu WH, Wen YW, Chen LK, Hsiao FY. Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study. CMAJ. 2015; 187(4):E130-7.
12.Fick DM, Mion LC, Beers MH, L. Waller J. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health. 2008; 31(1):42–51.
13.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 J Pharmacol 2010; 42(2):95-8
14.Kanagasanthosh K, Topno I, Aravindkumar B. Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: A prospective study from a tertiary care hospital. Int J Res Med Sci 2015; 3(8):2062-72.
15.Shah RB, Gajjar BM, Desai SV. Drug utilization pattern among geriatric patients assessed with the anatomical therapeutic chemical classification defined daily dose system in a rural tertiary care teaching hospital. Int J Nutr Pharmacol Neurol Dis 2012; 2(3):258-65.
16.Prasad SN, Revankar S,Vedavathi H, Chidanand KN, Murray JL,Manjunath H. A study on prescription analysis and utilization of antibiotics in geriatric in-patients admitted in Shimoga institute of medical sciences tertiary care hospital, Shimoga, Karnataka, India.Int J Basic Clin Pharmacol 2016; 5:904-9.
17.Gopinath S, Rajalingam B, SriramS, Subash V. An individual based study of the geriatric population: a polypharmacy.International Journal of Pharmacy and Pharmaceutical Sciences. 2011; 3(4):63-6
18.Nayaka SR, Rajeshwari B, Venkatadri TV. Drug utilization pattern in geriatric inpatients of medicine department in a Tertiary Care Teaching Hospital. Int J Basic Clin Pharmacol 2015; 3(4):568-73.
19.Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AF. The development of standard values for the WHO drug use prescribing indicators. ICUM/EDM/WHO. Available from: http://www.archives.who.int/prduc2004/rducd/ICIUM_Posters/1a2_txt.htm.
20. Prasanjit K Debnath* et al.A Study of drug utilization pattern of geriatric patients in the department of geriatric medicine in geriatric in a tertiary care hospital, Guwahati, Assam, India. Asian J Pharm Clin Res, 2010; 10(2):122-126
21.Supriya KH, Shashikumar NS, Prakash GM, Sareetha AV. A prospective observational study of prescription appropriateness of elderly hypertensive patients using Beers criteria in a tertiary care teaching hospital. Int J Basic ClinPharmacol 2017; 6:2545-50
22.Austin RP. Poly-pharmacy a risk factor in the treatment of type 2 diabetes. Diabetes Spectrum. 2006; 19(1):13-6..
23.C. S. van der Hooft et al Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria – a population-based cohort study.Br J ClinPharmacol.
24. D. Fialová& G. Onder Medication errors in elderly people:contributing factors and future perspectives Br J ClinPharmacol DOI:10.1111/j.1365-2125.2009.03419.x
25.Prakash Goudanavar et al.: Asian Journal of Biomedical and Pharmaceutical Sciences, 2016; 6(56):23-27.
26.AnithaNandagopal et al. Assessment of Rational Drug Prescribing Pattern in Geriatric Patients in Hyderabad Metropolitan Indian Journal of Pharmacy Practice, 2017; 10(3).
27.Neha Sharma et al.Screening of prescriptions in geriatric population in a tertiary care teaching hospital in north India The Journal of Phytopharmacology 2013; 2(5):38-45.
28.Bhaveshaikh N et al. Drug prescribing patterns in elderly patients in a tertiary level hospital Int J Basic ClinPharmacol. 2017 Apr; 6(4):759-764
29.Binaya Shrestha et al Assessment of Drug Use Pattern Using WHO Prescribing Indicators JNHRC 2018; Vol. 16 No. 3 Issue 40
30.Eman Elayeh et al. Assessment of appropriate medication use by 2015 Beers criteria among elderly critically ill patients in Jordan Clin. Pract. 2018; 15(4):765-774
31.. Sultan H, Sayegh K, Mohammad A, et al. Prescribing pattern of drugs in the geriatric patients in jazan province, KSA. Pharm PharmacolInt J. 2015; 2(1):30‒34. DOI: 10.15406/ppij.2015.02.00013
32 Edward K. Osei et al. Prevalence of Beers Criteria Medications Among Elderly Patients in a Military Hospital.Gerontology& Geriatric Medicine Volume 2: 1–6
33. Hsu WH, Hsiao PJ, Lin PC, Chen SC, Lee MY, Shin SJ. Effect of metformin on kidney function in patients with type 2 diabetes mellitus and moderate chronic kidney disease. Oncotarget. 2017; 9(4):5416-5423. Published 2017 Dec 17. doi:10.18632/oncotarget.23387
34.Gavilán Moral E, Morales Suárez-Varela MT, Hoyos Esteban JA, Pérez Suanes AM. Inappropriate multiple medication and prescribing of drugs immobile elderly patients living in the community. Aten Primaria. 2006; 38(9):476–480
35.Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006; 54(10):1516–1523
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