Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Bhagavathula, Akshaya Srikanth; Seid, Mohammed Assen; Adane, Aynishet; Gebreyohannes, Eyob Alemayehu; Brkić, Jovana; Fialová, Daniela

doi:10.3390/ph14090844

Cited by 19 publications

(26 citation statements)

References 46 publications

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“… 30 Our study revealed that 90.1% of patients had potential mild to major DDIs, which lies in the recent systematic review finding (DDIs: 80.5–90.5%). 31 However, it is higher than Bhagavathula et al (2.8%) 22 and Assefa et al (84.3%) studies. Of all the DDIs, enalapril and spironolactone interactions (73%) were the most frequent DDI like de Oliveira et al study result.…”

Section: Discussionmentioning

confidence: 70%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Adem¹,

Tegegne²

2022

CIA

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Background Appropriate prescribing is often challenging in geriatric patients due to age-related pharmacokinetic and pharmacodynamic alterations. Elderly patients with cardiovascular diseases are frequently prescribed multiple medications. Hence, it is imperative to investigate medication appropriateness, polypharmacy, and drug-drug interactions in these groups of patients. Objective To assess medication appropriateness using the 2019 American Geriatric Society Beers and Medication Appropriateness Index criteria, polypharmacy and drug-drug interactions among elderly ambulatory patients with cardiovascular diseases at Tikur Anbessa Specialized Hospital. Methods A hospital-based retrospective cross-sectional study was conducted among 384 elderly (60 years and older) ambulatory patients with cardiovascular diseases between May 01-August 30, 2021. Data was collected from the patient’s medical record using a data abstraction tool. The data were entered and analyzed using the SPSS program. Descriptive and logistic regression models were used to present the findings. Results The most frequent diagnosis was hypertension (78.4%) followed by ischemic heart disease (31.3%). Averagely, 4.4 ± 2 medications were prescribed per patient. More than half of (53.1%) the patients received polypharmacy. According to Beer’s and medication appropriateness index criteria, over one-third (28.1%) and the majority (95.1%) of the patients were prescribed potentially inappropriate medications, respectively. In addition, 53.1% and 90.1% of patients had polypharmacy, and were exposed to potential drug-drug interactions ranging from mild to major interactions, respectively. Further, polypharmacy was significantly associated with inappropriate medication prescribing. Conclusion The study found that more than half of the patients got one or more potentially inappropriate medications in both criteria. The medication appropriateness index tool identified more potentially inappropriate medication than the Beers criteria. In addition, more than half of the patients got polypharmacy and had potential drug-drug interactions. Further, polypharmacy was significantly associated with inappropriate medication prescriptions. These findings highlight the need for interventions to improve appropriate prescribing practice among elderly patients.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Adem¹,

Tegegne²

2022

CIA

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“…In our study, major polypharmacy (3%) was lower, whereas total polypharmacy (71%) was higher than in similar studies in other settings. Polypharmacy (the use of five or more drugs) was found to be 24.1% in an older patient polypharmacy study in western Ethiopia [ 31 ]. A recent meta-analysis of the elderly Ethiopian population found 33% polypharmacy [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…The reason why antibiotics use was high at the Edna Adan University was unclear and beyond the scope of this study. Studies in selected public hospitals in eastern Ethiopia also revealed that antibiotic use was more widespread [ 31 ]. This suggests that the abuse and indiscriminate use of antibiotics is a common trend and the regulatory system is loose in the East Africa.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Polypharmacy, Drug Use Patterns, and Associated Factors at the Edna Adan University Hospital, Hargeisa, Somaliland

Sidamo

Deboch²,

Abdi

et al. 2022

Journal of Tropical Medicine

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Polypharmacy is the use of multiple drugs by a patient at the same time and is common in the elderly. To our knowledge, drug use patterns in Somaliland are rarely studied. The purpose of this study was to evaluate polypharmacy, drug use patterns, and their predictors at the Edna Adan University Hospital in Hargeisa, Somaliland. A retrospective cohort analysis of 1140 medical records and prescriptions over a year from August 28, 2019, to August 27, 2020, was reviewed. The data completeness and consistency were checked and entered with the SPSS version 25.0. The association between total polypharmacy and different variables was analyzed using multivariable binary logistic regression and expressed as an odds ratio (OR) and 95% confidence interval (CI). In addition, the World Health Organization’s core drug use and facility indicators were used to assess the drug use patterns. The overall polypharmacy in this study was 71%. Statistically significant association was observed between the polypharmacy and variables such as age ( P = 0.01 ; OR = 3.4, 95% CI = 1.9–6.1), chronic illness ( P = 0.01 , OR = 8.6, 95% CI = 5.1–14.7), and comorbidity ( P = 0.01 , OR = 5.2, 95% CI = 2.1–12.9). However, the ward admitted/visited and gender did not have a statistically significant association with polypharmacy. There was overuse of brand drugs (63.9%) and antibiotics (55.2%), while the use of injectables (19.9%) was within the acceptable range. Polypharmacy and overuse of brand drugs and antibiotics were prevalent in the study setting. Essential drugs list, formularies, and treatment and regulatory guidelines are needed in place to ensure appropriate drug use.

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Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Tian,

Chen,

Zeng

et al. 2023

JAMA Netw Open

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ImportanceThe use of potentially inappropriate medications (PIMs) is widespread yet continues to receive little attention in outpatient services.ObjectiveTo estimate the overall prevalence of PIM use in outpatient services.Data SourcesPubMed, Embase, and Web of Science were searched to identify relevant studies published from January 1, 1990, to November 21, 2022.Study SelectionObservational studies that reported the prevalence of PIM use among older patients in outpatient services were screened.Data Extraction and SynthesisTwo reviewers independently selected eligible articles, extracted data, and assessed the risk of bias. A random-effects meta-analysis was conducted to pool the prevalence estimates.Main Outcomes and MeasuresThe global patterns in the prevalence of PIM use among older patients in outpatient services were estimated, and the temporal trends and regional differences in PIM use were investigated.ResultsA total of 94 articles with 132 prevalence estimates were analyzed, including nearly 371.2 million older participants from 17 countries. Overall, the pooled prevalence of PIM use was 36.7% (95% CI, 33.4%-40.0%). Africa had the highest prevalence of PIM use (47.0%; 95% CI, 34.7%-59.4%), followed by South America (46.9%; 95% CI, 35.1%-58.9%), Asia (37.2%; 95% CI, 32.4%-42.2%), Europe (35.0%; 95% CI, 28.5%-41.8%), North America (29.0%; 95% CI, 22.1%-36.3%), and Oceania (23.6%; 95% CI, 18.8%-28.8%). In addition, the prevalence of PIM use is highest in low-income areas. Use of PIMs among older patients has become increasingly prevalent in the past 2 decades.Conclusions and RelevanceThis study of patterns of PIM use by different groups, such as geographic regions and World Bank countries, suggests noticeable geographic environment and economic income differences in the burden of PIMs in outpatient services. Furthermore, the high prevalence trend in the past 2 decades indicates that the global burden of PIM use continues to be worthy of attention.

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Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Cited by 19 publications

References 46 publications

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

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

Assessment of Polypharmacy, Drug Use Patterns, and Associated Factors at the Edna Adan University Hospital, Hargeisa, Somaliland

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

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