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

Abstract

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.

The knowledge, awareness, and perception of healthcare professionals about appropriate prescribing in the elderly: Findings from Nigeria and South Africa

“…The 2015 AGS‐Beers Criteria were adopted due to a lack of locally available validated criteria for appropriate prescribing to the elderly in Nigeria and South Africa at the time of this study . The correct response for each of the questions was awarded “1” and incorrect response “0” with the highest possible total score being seven.The respondents' knowledge was classified based on the total score as poor (0‐3), fair (4, 5) and good (6, 7) in line with a previous study . The respondents were divided into subgroups based on their socio‐demographics (eg, profession, gender, and length of practice) and differences in their mean knowledge and median scores were determined.…”

“…This finding is, however, surprising considering that hypertension is one of the most common non‐communicable diseases with high morbidity and mortality in elderly Africans and HCPs are expected to be adequately knowledgeable about its pharmacotherapeutics . The finding of this present study, however, contradicts a previous report in Nigeria which indicated that physicians were adequately knowledgeable about the use of centrally acting hypertensives in the elderly …”

“…In this study, although many participants in Nigeria and South Africa claimed awareness of explicit criteria, less than 1% and about 5%, respectively, could name any. This result is in line with studies in Nigeria and the USA and it probably suggests that the HCPs were not applying the Criteria in their clinical practice …”

“…Glibenclamide is a long‐acting sulphonylurea which is recommended to be avoided in the elderly by the AGS‐Beers Criteria due to its prolonged hypoglycemic effect . The result of this present study contradicts a study in Nigeria . The view of this study participants may be due to limited alternatives to this readily available medication in the African drug markets.…”

“…The 2015 AGS‐Beers Criteria applies to elderly people in all clinical settings except palliative care and hospice . Although an American initiative, the Criteria have been applied in many low and middle‐income countries including Nigeria and South Africa, and many clinical settings including primary care . A recent review of interventions to reduce adverse drug reactions in elderly Africans revealed a lack of locally available criteria for appropriate prescribing to this group of patients .…”