Inappropriate medication prescribing in community-dwelling elderly people living in Iran

Azoulay, Laurent; Zargarzadeh, Amir H.; Salahshouri, Zeinab; Oraichi, Driss; Bérard, Anick

doi:10.1007/s00228-005-0036-4

Cited by 40 publications

(52 citation statements)

References 31 publications

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“…Our finding is relatively agreeable and lower than the various similar other studies reported from India (23.59%), Nigeria (25.5%), USA (27.5%) and Iran (27.6%), 10,12,22,23 but higher than the study from Croatia (2.2%) and Turkey (9.8%) respectively. 24,25 In this study, 7.75% of total drugs prescribed were PIMs, which are in agreement with a study from India (7.45%) and Nigeria (7.88%) respectively.10,12 Among the 3 different categories in Beers criteria, in category 1 which is medications to be avoided in elderly, forms a major category of inappropriate use of drugs. From our study almost 18 different drugs were prescribed to these patients from category 1.…”

Section: Discussionsupporting

confidence: 88%

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Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: a prospective study from a tertiary care hospital

Vij

Malaviya²,

Kumar

2015

Int J Res Med Sci

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Background: To investigate the prevalence of potentially inappropriate medications (PIMs) using updated Beers criteria 2012 and drug utilization study among the elderly patients attending the various outpatient departments (OPDs) of a tertiary care hospital at Pondicherry in India. Methods: This prospective, observational study involving patients aged 65 years and above, was planned and conducted over a period of six months, who attended the various OPDs were included in the study. Prescriptions were collected from the consulting rooms and pharmacy. Results: A total of 600 patients aged 65 years and above were involved in our study. Majority (61.83%) were in the age group of 65-70 years. There was a male preponderance (61.83%). Total of 1769 drugs were prescribed, giving an average of 2.98 drugs per person (range 1 to 9). Polypharmacy (≥ 5drugs) were observed in 99 patients. Of the total 748 disease conditions, cardiovascular diseases were the most prevalent (29.33%) among the elderly patients. Almost 114 patients had comorbid conditions. General medicine department was the highest (28.83%) visited patients. Frequently prescribed drugs belong to the category of analgesic and anti-inflammatory agents (16.50%). Fixed Dose Combination (FDC) was 31%. Almost 110 patients received PIMs from Beers list; majority were belonging to category 1. NSAIDs (30.66%) were the highest PIMs prescribed to musculoskeletal disorders. With regard to WHO indicator, 377(21.31%) drugs were prescribed by generic name. Utilization from Indian national list of essential medicine was 76.82%. Percentage of encounters in which an antibiotic and injections was prescribed to 23.5% and 26.33% respectively. Conclusions: Study has shown the prevalence of disease pattern, comorbidity, drug usage in elderly. PIMs, polypharmacy and FDC were high among the elderly. Prescribers need to be educated about Beers criteria and encouraged for rational prescription.

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Section: Discussionsupporting

confidence: 88%

“…12 An Iranian study by Azoulay et al showed that antihistamines were the most common PIMs, followed by NSAIDs and benzodiazepines. 25 In our study the PIMs were not prescribed with other comorbidity disease conditions, which comes under the category 2 of Beers criteria. Similar study by Veena et al from India also confirms our findings.…”

Section: Discussionmentioning

confidence: 96%

Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: a prospective study from a tertiary care hospital

Vij

Malaviya²,

Kumar

2015

Int J Res Med Sci

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“…Other drugs like indomethacine and piroxicam, non -steroidal anti-inflammatory drugs; chlorzoxazone; muscle relaxant; amiodarone, a class III antiarrhythmic, amitryptyline, an antidepressant drug with sedative property and diazepam, a long acting sedative hypnotic were prescribed. When compared to the study from India, 6 our findings showed higher percentage for most of the drugs such as antihistamines 10.7%, dicyclomine 3.1%, diazepam 0.7% and amiodarone 0.7% while lower from the study in Iran 16 where antihistamines 29%, Non-steroid anti-inflammatory drugs (NSAIDs) 23% and benzodiazepine 16% were prescribed. In a study from Japan had reported the prevalence of PIM for different drugs like antihistamines (1.4%), antispasmodic (0.1%), amitriptyline (0%), and long acting benzodiazepines (0.1%).…”

Section: Discussioncontrasting

confidence: 68%

“…The average age found in this study (76.4 years) is similar to that found in other studies. 15,16 In our study, we found the average number of drugs prescribed was 5. The less number of drugs prescribed in our study compared to studies conducted in other countries might be due to a functional health insurance policy for the elderly in those countries which might have provided easier access to medications.…”

mentioning

confidence: 52%

Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

Sah

Jha

Sah

et al. 2017

J Coll Med Sci-Nepal

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Background & Objectives:Older individuals often suffer fr om multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analysed using Beer's Criteria updated to 2013. Results: In the 869 patients included, the aver age number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly. Key words:Beer 's criteria; elderly; potentially inappropriate medicine Citation: Sah AK, J ha RK, Sah P, Basnet S. Potentially inappr opr iate pr escr ibing in elder ly population: A study in medicine out-patient department. JCMS Nepal. 2017;13(1):197-202. 198 of Bharatpur, Chitwan, Nepal. All the patients who have visited medicine OPD for treatment of diseases; who were aged 65 years and above and consented for study were included. All the new cases were included in the study during the period May 2013 to April 2014. Data were recorded in a performa which includes Patient demographic data, medical histories, current diagnoses and prescribed medications. The study protocol was approved by the institutional review committee. The recorded data were analysed for potentially inappropriate use with the help of Beers criteria 2003. 8,9 According to Beers criteria, drugs which are prescribed inappropriately are classified into one of the following categories: Category A: Drugs that generally should be avoided in older adults. Category B: Drugs that exceed maximum recommended daily dose. Category C: Drugs to be avoided in combination with specific co-morbidity RESULTS A total of 869 patients were included into the study. Of these, 574 (66.1%) were males and 295 (33.9%) were females. In total, 4833 drugs were prescribed to the patients ranging from two to 11 drugs per prescription with mean of 5.56 per patient. Atenolol (24.3%) and amlodipine (23.16%) were the most frequently used medicines. Other commonl...

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“…Other researches show that the prevalence of institutionalized older people who take at least one PIM ranges from 27.6% to 46.2% (Ruggiero et al, 2010;Castellar et al, 2007;Azoulay et al, 2005). The prescription of PIM must follow judicious protocols, since their administration may double the odds of hospitalization of elderly people (Albert et al, 2010), as well as the demand for health services (Fick et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

Varallo

Ambiel

Nanci

et al. 2012

Braz. J. Pharm. Sci.

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The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI); to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients ≥60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.Uniterms: Drugs/interactions. Elderly people/inappropriated use of medicines. Long-term care facility. Medication/errors. Safety management.O presente estudo teve como objetivos estimar a prevalência de idosos em uso de medicamentos potencialmente impróprios (MPI) e com ocorrência de interações medicamentosas potencialmente perigosas (IMPP); identificar os fatores de risco para a prescrição de MPI e avaliar o impacto de intervenção farmacêutica (IF) para a prescrição de alternativas terapêuticas mais seguras. Para tanto, realizou-se estudo transversal em instituição de longa permanência do interior de São Paulo, de dezembro/2010 a janeiro/ 2011. Os prontuários médicos dos pacientes ≥60 anos e que utilizavam pelo menos um medicamento foram consultados para avaliar a segurança farmacoterapêutica das prescrições médicas, identificando-se os MPI e as IMPP, segundo critérios de Beers (2003) e o critério da Organização Mundial da Saúde, respectivamente. A IF constou de carta de orientação ao médico da instituição, com sugestão de equivalentes terapêuticos mais seguros. Aproximadamente 88% dos idosos haviam utilizado pelo menos um medicamento e, para 30% deles, havia pelo menos um MPI prescrito. A maioria dos MPI identificados (53,4%) age no sistema nervoso central. Entre as 13 interações medicamentosas detectadas, 6 são consideradas IMPP. A polimedicação foi detectada c...

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Inappropriate medication prescribing in community-dwelling elderly people living in Iran

Abstract: Our findings indicate a high prevalence of inappropriate prescribing in elderly patients. Given the potential severity of this problem, further steps need to be implemented to prevent this occurrence.

Cited by 40 publications

References 31 publications

Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: a prospective study from a tertiary care hospital

Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: a prospective study from a tertiary care hospital

Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

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