Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan

Saqib, Anum; Atif, Muhammad; Scahill, Shane

doi:10.1111/jphs.12220

Cited by 9 publications

(4 citation statements)

References 50 publications

(92 reference statements)

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“…Another study conducted in Karachi, Pakistan had revealed that at least 1 PIM was prescribed to more than half (64%) of the older population [ 46 ]. It is suggested that many of the PIMs like antihistaminic agents (e.g., diphenhydramine), proton pump inhibitors (e.g., omeprazole and esomeprazole) and analgesics (e.g., aspirin and non-steroidal anti-inflammatory drugs (NSAIDS)) are more frequently used by older people than any other age group [ 47 , 48 , 49 ]. This might be attributable to the reason that old age people mostly suffer from insomnia, heart burn, acid reflex, headache, muscle pain, and joint pain due to multiple co-morbidities and the physicians in developing countries like Pakistan are usually inefficient in diagnosing the underlying cause [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

2018

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Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

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Section: Discussionmentioning

confidence: 99%

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

2018

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“… 37 It is estimated that antihistaminic agents (eg, diphenhydramine), proton pump inhibitors (eg, omepra-zole and esomeprazole), and analgesics (eg, aspirin and nonsteroidal anti-inflammatory drugs) are more frequently used by elderly people than by any other age groups. 38 – 40 This is probably due to the reason that old age people mostly suffer from insomnia, heart burn, acid reflex, headache, muscle pain, and joint pain due to multiple comorbidities and the physicians in developing countries such as Pakistan are usually inefficient in diagnosing the underlying cause. 41 , 42 Also, there is no clinical guideline available in Pakistan for the diagnosis and management of diseases among geriatric patients.…”

Section: Discussionmentioning

confidence: 99%

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

Sarwar¹,

Dar²,

Mahar³

et al. 2018

CIA

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Background and objectivesDue to physiological and pharmacological variations, geriatrics are at high risk of experiencing life-threatening outcomes related to the use of potentially inappropriate medications (PIMs). Thus, the present study aims to evaluate prescribing practices of PIMs among elderly patients who may lead to unplanned hospitalization and associated risk factors.MethodsA cross-sectional study was conducted in different hospitals of Lahore, Pakistan. The study population consisted of geriatric patients aged ≥65 years. Data were collected from the medical records of geriatric patients, who attended these selected hospitals between December 1, 2017, and February 28, 2018. Data were analyzed using SPSS (IBM SPSS Statistics for Windows, Version 21.0) and Microsoft Excel (MS Office 2010).ResultsThe records of 385 geriatric patients were investigated. More than half (60.8%) of the patients were subjected to polypharmacy, which can be defined as the utilization of 5–9 drugs by the patient at the same time, whereas 36.4% were prescribed with one PIM and 56.4% were hospitalized due to PIMs. Majority of them were prescribed with PIMs including N02BA01 (aspirin, 32.4%), A02BC01 (omeprazole, 23.6%), A10AB02 (insulin, 17.4%), A02BC05 (esomeprazole, 8.5%), C08CA01 (amlodipine, 8.3%), and R06AA02 (diphenhydramine, 5.9%). Results of regression analysis revealed that patients exposed to polypharmacy (OR=2.556, 95% CI=1.579–4.135, P-value≤0.001) and excessive polypharmacy (OR=37.828, 95% CI=4.754–300.9, P-value≤0.001) were significantly associated with unplanned hospitalization, whereas factors such as age 75–84 years (OR=0.343, 95% CI=0.156–0.756, P-value=0.008) and polypharmacy (OR=2.480, 95% CI=1.219–5.048, P-value=0.012) were significantly correlated with PIMs.ConclusionThe utilization of PIMs listed in Beers criteria among geriatric population can cause unplanned hospitalization. As the patients receiving polypharmacy are at high risk of unplanned hospitalization, so caution must be exercised in prescribing PIMs for elderly people.

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“…It is due to multifaceted issues in the establishment of healthcare system and the use of e-mails and video conferencing in the management of chronic diseases. In a country like Pakistan, where almost half of the population is illiterate and over two thirds (67%) of the population reside in rural areas [27], lack of education and poor socioeconomic status serve as contributing factors towards decreased capacity and willingness to use information technologies. Thus, the objective of this study is to assess the capacity and willingness of patients to use information technology for managing chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

Capacity and willingness to use information technology for managing chronic diseases among patients: A cross-sectional study in Lahore, Pakistan

et al. 2019

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Background and objectivesThe information technology is a pivotal source of communication between patients and healthcare providers for managing chronic diseases. The objective of this study is to assess the capacity and willingness of patients to use information technology for managing chronic diseases.MethodsA descriptive, cross-sectional study design was employed. Study was conducted in six tertiary care hospitals of Lahore, Pakistan. The study population consisted of patients aged ≥18 years and diagnosed with a minimum of one chronic non-communicable disease. A structured questionnaire was administered to the study participants for data collection. SPSS was used for data analysis.ResultsAmong the 400 respondents, hypertension (39.5%) was the leading chronic condition followed by diabetes (27.5%). Majority of the patients owned a cell phone (90.7%) and had internet access (66.2%). Almost half of the respondents (51.0%) were willing to use text messages; whereas 78.5% and 75.7% of the respondents were reluctant to use video conference and e-mail as a source of communication with healthcare providers. Reason for unwillingness to use e-mail was the patients’ desire to be directly examined by the doctor; whereas unfamiliarity with the use of text message and video conference was the major reason for not using these technologies. Logistic regression analysis revealed that interest in using e-mail to interact with specialist was more among those participants who had good self-reported health (OR = 2.579, 95%CI = 1.276–5.212, p = .008), access to internet (OR = 5.416, 95%CI = 2.777–10.564, p < .001), and those who owned a cell phone (OR = 12.944, 95%CI = 1.751–95.704, p = .012). Interest in using text messages to interact with specialist was more among participants with middle-income group (OR = 2.303, 95%CI = 1.389–3.818, p < .001), residency in close proximity to healthcare professional (OR = 3.529, 95%CI = 2.333–5.339, p < .001), access to internet (OR = 3.253, 95%CI = 2.102–5.033, p < .001) and among those who owned a cell phone (OR = 46.709, 95%CI = 6.335–344.377, p < .001). Interest in using video conference to interact with specialist was more among those participants who had access to internet (OR = 5.840, 95%CI = 2.825–12.069, p < .001) and among those who owned a cell phone (OR = 11.177, 95%CI = 1.510–82.725, p = .018).ConclusionThis study concluded that nearly half of the respondents were willing to use text messages; whereas, majority was reluctant in using video conference and e-mail as a source of communication with healthcare providers. Most of the respondents who were located farther from the health care provider were willing to use video conferencing in case it could save more than 60 minutes of their time.

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Drug utilization evaluation among an elderly population: a retrospective cross-sectional study in a tertiary care hospital in Pakistan

Cited by 9 publications

References 50 publications

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

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

Capacity and willingness to use information technology for managing chronic diseases among patients: A cross-sectional study in Lahore, Pakistan

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