Potentially inappropriate prescribing to older patients receiving multidose drug dispensing

Abstract

Background: Multidose drug dispensing (MDD) is an adherence aid that provides patients with machine-dispensed medicines in disposable unit bags, usually for a 14 day period. Previous studies have suggested that the quality of prescribing, with time, is lower for MDD users, compared to patients receiving prescriptions dispensed as usual. This study aimed to examine the quality of prescribing to Norwegian elderly home care service patients receiving MDD. Methods: A cross-sectional study comprising 45,593 MDD patients aged ≥70 years was performed. The proportion of potentially inappropriate medications (PIMs) was assessed using the Norwegian General Practice Criteria, and drug-drug interactions (DDI) were investigated using the Norwegian Medicines Agency database. Results: On average, patients were prescribed 10.6 drugs (SD = 5.0), of which 6.1 were dispensed via MDD. Men used on average fewer drugs than women (10.7 vs 11.1), Twenty-seven percent of patients used at least one PIM. Concomitant use of three or more psychotropic drugs (10.8%), and prescribing of diazepam (6.4%) was the most commonly identified inappropriate prescribing. DDIs affected 59% of the patients, however, only 2.7% had serious interactions. Women were more frequently exposed to both PIMs and DDIs than men, with an odds ratio of 1.50 (95% CI: 1.43-1.58) and 1.43 (95% CI: 1.37-1.50), respectively. Conclusions: Polypharmacy is common in elderly Norwegian patients using MDD. About one-fourth of the patients were exposed to PIMs, and over half were exposed to DDI.

Prevalence of potentially inappropriate medications among old people with major neurocognitive disorder in 2012 and 2017

“…There was also an association between PIM use and using multi-dispensed drugs. This association has been observed in previous studies as well [ 43 ], and PIMs are found to be common among people using multi-dispensed drugs [ 44 , 45 ]. The use of multi-dispensed drugs is believed to reduce medical errors, increase drug adherence and decrease the waste of unused drugs [ 46 ].…”

The Practice Guidelines for Multidose Drug Dispensing Need Revision—An Investigation of Prescription Problems and Interventions

“…However, one can speculate whether the pharmacist should have detected even more medication-related problems for these patients. MDD patients, in general, use many medications, and potentially inappropriate medications are common [ 20 , 38 ]. Pharmacists have access to the complete medication list for these patients; this puts them in a position to review the medication treatment as a whole.…”

Medication Safety in Municipal Health and Care Services

“…The MDD system varies between the countries. In Sweden, Finland and Norway most MDD users are home care clients (Bardage et al, 2014;Josendal et al, 2020;Sinnemäki et al, 2014). In the Netherlands, however, the largest group of MDD users are home-dwelling patients who get MDD directly from the community pharmacy (Cheung et al, 2014).…”