Potentially inappropriate medication use among older adult patients on follow-up at the chronic care clinic of a specialized teaching hospital in Ethiopia. A cross-sectional study

Abstract

Background Older adult patients are prone to potentially inappropriate medication use (PIMU); its use has been associated with multiple adverse consequences. As a result, it is crucial to determine the magnitude and factors associated with PIMU. The present study was mainly aimed to determine and assess the magnitude and predictors of potentially inappropriate medication use in older adult patients on follow-up at the chronic care clinic of Jimma medical center. Methods A retrospective cross-sectional study was conducted involving 219 patients aged 65 years and above on treatment follow-up. Data was collected using a checklist. The 2019 updated American Geriatric Society (AGS) Beers Criteria® and Screening Tool of Older People’s Potentially Inappropriate Prescriptions criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) criteria (version 2) were employed to assess PIMU. SPSS IBM (v22) was used for data entry and analysis. Categorical variables were described using frequency and percentage, whereas continuous variables were described using mean with standard deviation (SD) or median with interquartile range (IQR). Logistic regression was conducted to identify predictors of PIMU. Results The average number of medications prescribed per patient was 4.0 (IQR = 2.0). At least one PIMU was identified in 182 (83.1%) and 99 (45.2%) patients, based on Beers and STOPP criteria, respectively. Additionally, potential prescription omission (PPO) was observed in 24 (10.9%) patients. The risk of Beers PIMU was increased with age [AOR = 1.21, p < 0.001], hypertension [AOR = 4.17, p < 0.001], and polypharmacy [AOR = 14.10, p < 0.001], while a decrease in the risk was noted in patients with a diagnosis of ischemic stroke [AOR = 0.133, p = 0.01] and asthma [AOR = 0.03, p < 0.001]. Using STOPP criteria, hypertension [AOR = 2.10, p = 0.04], diabetes mellitus [AOR = 2.26, p = 0.04], ischemic heart disease [AOR = 2.84, p = 0.04], peripheral neuropathy [AOR = 10.61, p < 0.001], and polypharmacy [AOR = 6.10, p < 0.001] significantly increased the risk of PIMU. Conclusions Regardless of the screening tool used to assess, the present study revealed PIMU in the large proportion of the participants. Multiple medication use and certain disease condition had increased the probability of PIMU. Hence, it is imperative to use screening tools for reviewing medications prescribed in older adult patients to ensure safety of medication therapy.

Overuse of medications in low- and middle-income countries: a scoping review

“…resource allocation, staffing and national guidelines; Table 3 ). Only 10 of these studies were from low-income countries, 20 , 77 , 111 , 127 , 129 , 144 , 166 , 183 , 262 , 337 and we did not observe clear associations between country income levels and drivers ( Box 2 ), nor could we observe any geographical variations in the drivers.…”

Medication Appropriateness, Polypharmacy, and Drug-Drug Interactions in Ambulatory Elderly Patients with Cardiovascular Diseases at Tikur Anbessa Specialized Hospital, Ethiopia

“…Our findings showed that 28.1% of the patients received at least one PIM according to the AGS Beers Criteria. Ethiopian studies conducted in geriatric patients at Tirunesh Beijing Hospital, University of Gondar Teaching Hospital chronic care clinic, and Jimma Medical Center reported that 46.9%, 21 47.2%, 22 and 83.1% 23 of older adults were prescribed at least one PIM, respectively. In these studies, medication appropriateness was assessed using Beers criteria in two studies, 22 , 23 while the remaining study 21 used both WHO core prescribing indicators and Beers criteria.…”

“…Ethiopian studies conducted in geriatric patients at Tirunesh Beijing Hospital, University of Gondar Teaching Hospital chronic care clinic, and Jimma Medical Center reported that 46.9%, 21 47.2%, 22 and 83.1% 23 of older adults were prescribed at least one PIM, respectively. In these studies, medication appropriateness was assessed using Beers criteria in two studies, 22 , 23 while the remaining study 21 used both WHO core prescribing indicators and Beers criteria. In addition, our finding was lower than a study done in the United States, with 87.4% of the patients receiving at least one PIM.…”

“…Diuretics (46.3%), antiplatelets (31.5%), and tricyclic antidepressants (5.7%) were the frequently prescribed PIMs in our study. However, angiotensin-converting enzyme inhibitors (ACEIs) (15.6%), a combination of aspirin and Vitamin K Antagonist (14%), and statins (3.16%) were the common PIMs reported by Abegaz et al 27 In addition, Tesfaye et al 23 found diuretics (46.3%), antiplatelets (31.5%) and tricyclic antidepressants were the common PIMs. Further, a study conducted in Serbia showed that proton pump inhibitors (15.7%) were the frequent PIM according to Beers criteria.…”

A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study

“…Only a few studies explored the relationship between chronic diseases and PIMU. An investigation determined and assessed the magnitude and predictors of PIMU in older adult patients at the chronic care clinic in southwest Ethiopia [ 17 ]. According to Beers and STOPP criteria, at least one PIMU was identified in 83.1% and 45.2% of the patients, respectively.…”