Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use

Prasert, Vanida; Akazawa, Manabu; Shono, Aiko; Chanjaruporn, Farsai; Ploylearmsang, Chanuttha; Muangyim, Kamolnut; Wattanapongsatit, Thanased; Sutin, Uthen

doi:10.1016/j.sapharm.2017.05.012

Cited by 11 publications

(23 citation statements)

References 20 publications

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“…Of 430 outpatients in a district tertiary hospital in southern Thailand, 28.1% received at least one PIM, as identified by the 2012 Beers criteria 14. In contrast, based on lists of risk drugs for Thai elderly adults, 79% of Thai elderly adults in a community secondary hospital received at least one PIM 15…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Vatcharavongvan¹,

Puttawanchai²

2019

Pharm Pract (Granada)

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Objective:The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors.Methods:This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors.Results:A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs.Conclusions:PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.

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Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Vatcharavongvan¹,

Puttawanchai²

2019

Pharm Pract (Granada)

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“…Other recently developed tools are the European Union list of potentially inappropriate medications (EU(7)-PIM list) (Renom-Guiteras et al, 2015), PRISCUS (developed in Germany) (Holt et al, 2010), and Improved Prescribing in the Elderly Tool (IPET) (Naugler et al, 2000) developed in Canada. Emerging economies like Brazil and Thailand have also developed their own context-specific instruments to screen for inappropriate medications in the elderly building on the foundation of the older instruments (Almeida et al, 2018; Prasert et al, 2018). The Beers list, an explicit criterion initially developed in 1991, has been regularly updated to cater for new scientific findings regarding appropriateness of medications in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Physician’s Knowledge of Appropriate Prescribing for the Elderly—A Survey Among Family and Internal Medicine Physicians in Nigeria

et al. 2019

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Background: Prescription and use of inappropriate medications have been identified as a major cause of morbidity among the elderly. Several screening tools have been developed to identify inappropriate medications prescribed for elderly patients. There is dearth of information about the knowledge of Nigerian physicians regarding these screening tools and appropriate prescribing for the elderly in general. The primary objective of this study was to assess the knowledge of Nigerian physicians about these screening tools and appropriate prescribing of medications for the elderly. Methods: The study was a cross-sectional questionnaire-based study conducted among physicians working in Family Medicine and Internal Medicine departments of four tertiary health care facilities in Nigeria. The questionnaire consisted of sections on general characteristics of respondents and their knowledge of four selected screening tools for inappropriate medications in the elderly. Ten clinical vignettes representing different therapeutic areas (using the best option type questions) about medicine use in the elderly were included with a score of 1 and 0 for correct and wrong answers, respectively. The knowledge of respondents was classified as (total score, over 10): poor (score, < 5), average (score, 5-6), and good (score, 7-10). Results: One hundred and five physicians returned completed questionnaires. Twenty percent of respondents knew about Beers criteria, whereas 15.6% were familiar with the STOPP criteria. Majority (83; 84.7%) of the respondents were confident of their ability to prescribeappropriately for elderly patients. The mean knowledge score was 5.3 ± 2.0 with 32 (30.5%), 41 (39%), and 32 (30.5%) having low, average, and good scores, respectively. The association between the knowledge score, duration of practice, and seniority was statistically significant (OR, 3.6, p = .004 and OR, 3; p = .012), respectively. Conclusion: There are significant gaps in the knowledge of Nigerian physicians about screening tools for inappropriate medications. There is a need for stakeholders involved in the care of elderly Nigerian patients to develop new strategies to improve services being offered. These may include introduction of modules on appropriate prescribing in the curriculum of undergraduate and postgraduate medical education and the routine use of some screening tools for inappropriate medications in daily clinical practice.

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“…Prescriber barriers for discontinuing PIM prescription was related to the limitation of alternative medications . Several studies have presented strategies for reducing PIM prescription, such as revision of formulary, educational campaigns, and deprescribing process …”

Section: Discussionmentioning

confidence: 99%

“…This province is an industrial city with diverse population. A high PIM prevalence was found in this area . According to the information provided by the hospitals and personal interviews conducted by us, each hospital had different characteristics in terms of physician type, hospital formulary, and CDSS.…”

Section: Methodsmentioning

confidence: 99%

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Effect of a computerized decision support system on potentially inappropriate medication prescriptions for elderly patients in Thailand

Prasert

Shono

Chanjaruporn

et al. 2018

Evaluation Clinical Practice

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Rationale, aims, and objectives: The prescription of potentially inappropriate medication (PIM) is a global issue associated with increased adverse drug events, mortality, and health care expenditure. Computerized decision support system (CDSS) for the detection of PIM is a novel alert system in Thailand for reducing PIM prescriptions. The aim of this study was to evaluate the effect of a CDSS on PIM prescriptions for elderly patients in Thai community hospitals. Methods: The study design comprised two phases with a duration of 12 months each: pre-CDSS implementation (October 2015-March 2016) and post-CDSS implementation (October 2016-March 2017). Medical services and prescription claims data from four hospitals were used to calculate the prevalence of PIM prescriptions among elderly patients aged 60 years and older. Chi-square tests were used to analyse changes in PIM prescriptions across hospitals post CDSS.Results: The overall prevalence of PIM prescriptions post-CDSS implementation significantly decreased from 87.7% to 74.4%. The severity of mild and moderate PIMs was significantly reduced from 71.9% to 49.0% and from 64.5% to 48.7%, respectively. All hospitals had only one severe PIM, which was hyoscine. It was reduced from 4.7% to 1.5%, but the change was not significant (P = 0.74). The proportion of frequently prescribed PIMs in all PIM levels was significantly decreased, regardless of existing alternative medications.Conclusions: Specific CDSS for PIM in community hospital setting was associated with a reduction of PIM prescription in elderly patients. This CDSS can change physician's prescription behaviour to avoid inappropriate medications. KEYWORDS computerized decision support system, elderly patients, potentially inappropriate medication prescription

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Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use

Cited by 11 publications

References 20 publications

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Physician’s Knowledge of Appropriate Prescribing for the Elderly—A Survey Among Family and Internal Medicine Physicians in Nigeria

Effect of a computerized decision support system on potentially inappropriate medication prescriptions for elderly patients in Thailand

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