Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

Sarwar, Muhammad Rehan; Dar, Abdur-Rehman; Mahar, Saad Yousaf; Riaz, Tayyab; Danish, Usman; Iftikhar, Sadia

doi:10.2147/cia.s173942

Cited by 15 publications

(10 citation statements)

References 47 publications

(47 reference statements)

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“…In Colombia, the pharmacological group most frequently associated with potentially inappropriate medications was that of NSAID with almost 12% of prescriptions in this age group (11). In our study, proton pump inhibitors without clear indication represented almost 17% of all potentially inappropriate medications prescriptions similar to reports from other countries such as Pakistan, where they accounted for 25% (36).…”

Section: Discussionsupporting

confidence: 82%

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults

et al. 2021

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Introduction: Potentially inappropriate medication is associated with adverse health and functional outcomes, as well as increased health care costs.Objective: To estimate the prevalence and types of potentially inappropriate medication according to the Beers criteria in community-dwelling older persons and to identify the major clinical and functional consequences of potentially inappropriate medication during two years of following.Materials and methods: We conducted a longitudinal, descriptive, and observational study that included 400 65-year or older community-dwelling people (48% women) selected by simple random sampling in 2012. In 2014, 372 people were re-evaluated and classified into two groups based on the presence or absence of potentially inappropriate medication through the follow-up period.Results: In total, 31% had polypharmacy (5-9 medications) and 1,8% had excessive polypharmacy (10 or more medications). The mean of the number of medications was higher in the potentially inappropriate medication group (3 vs. 5.78; p<0.001) and 21.9% still had the potentially inappropriate medication status during the follow-up; of them, 75% had one potentially inappropriate medication and 23% two. The presence of potentially inappropriate medication was more frequent among frail and depressed male individuals with a bad health self-assessment and comorbidities, especially diabetes mellitus and chronic obstructive pulmonary disease. In the group with sustained potentially inappropriate medication, we found a worsening health self-assessment, increased frailty, a higher incidence of recurrent falls and prevalence of depression, as well as a higher hospital admission rate, ambulatory medical consultation, and more prescribed medications. We did not find an impact on functional capacity.Conclusions: We validated the negative effects of potentially inappropriate medication in the long run for the health of older people and, therefore, potentially inappropriate medications should be monitored in primary care services to avoid greater risks.

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Section: Discussionsupporting

confidence: 82%

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults

et al. 2021

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“…This may reflect the extensive co-morbidities in the studied patients similar to other studies assessing rates of polypharmacy among patients in Asia including Pakistan with appreciable psychiatric disorders (40,41). However, this will need closer monitoring as polypharmacy is known to increase the rate of adverse drug reactions with associated increases in hospitalisations, morbidity and mortality as well as negatively impact on adherence rates to the medicines prescribed (64)(65)(66)(67)(68). There are a number of initiatives that can subsequently be undertaken to reduce rates of inappropriate prescribing, and we will be looking at these in the future (66,(69)(70)(71).…”

Section: Discussionsupporting

confidence: 54%

Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications

et al. 2020

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Introduction: Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. Methods: Multi-centred, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. Results: 57664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. Conclusions: There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.

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“…Screening tools, such as the Beers criteria, STOPP, MAI, and Zhan criteria, are a group of explicit and sometimes implicit classification of medicines used for elderly patients. Medications on these lists have been found to contribute significantly to morbidity in elderly patients (Price et al, 2014; Sarwar et al, 2018). Only about a fifth of respondents in this study knew about the Beers criteria and the MAI with another 15% having information about the STOPP criteria.…”

Section: Discussionmentioning

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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Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

Cited by 15 publications

References 47 publications

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults

Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications

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

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