Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment

Abstract

Background: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country.
 Objective: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI).
 Methods: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population.
 Results: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)].
 Conclusions: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.

Prevalence of Drug–Drug Interactions in Older Community-Dwelling Individuals: A Systematic Review and Meta-analysis

“…Table 1 presents the main characteristics of the 33 studies included in this systematic review. The majority of studies were conducted in Europe ( n = 13) [ 20 , 46 , 49 , 53 , 54 , 56 , 61 , 64 , 69 , 70 , 74 – 76 ], ten were conducted in North America [ 47 , 48 , 51 , 52 , 57 , 58 , 60 , 65 , 67 , 72 ], four in South America [ 59 , 62 , 63 , 68 ], three in Asia [ 50 , 66 , 71 ], two in Australia [ 22 , 55 ] and one in Africa [ 73 ]. Most studies ( n = 23) used a cross-sectional design.…”

“…Most studies ( n = 23) used a cross-sectional design. Studies ranged in size from a small cross-sectional study of 175 community-dwelling individuals in Albania [ 53 ] to a large population-based cohort study of 14.32 million community-dwelling Medicare beneficiaries in the USA [ 65 ]. Twenty-four studies [ 22 , 46 – 52 , 55 , 57 – 61 , 64 , 65 , 67 , 70 – 76 ] reported sex for 16,026,598 community-dwelling individuals aged ≥ 65 years, of whom 8,851,384 (55.2%) were female.…”

“…Eighteen studies [ 20 , 22 , 49 , 52 , 54 – 56 , 58 , 61 , 64 – 70 , 75 , 76 ] were rated as being of high methodological quality, and 15 studies [ 46 – 48 , 50 , 51 , 53 , 57 , 59 , 60 , 62 , 63 , 71 – 74 ] were judged to have moderate methodological quality. A full description of the JBI methodological quality assessment, and rating justification, for each of the 33 studies included in this review is provided in Appendices 3–5 of the ESM.…”

“…Most studies (n = 23) used a cross-sectional design. Studies ranged in [20,22,46,[48][49][50][51][52][53][54][55][56][57][58][59][60][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] reported DDI prevalence estimates using study participants as the unit of analysis, one study [75] also reported DDI prevalence using the total number of prescriptions as the unit of analysis, and one study [64] also reported DDI prevalence using the total number of drugs as the unit of analysis. One study [61] only reported the total number of drug combinations potentially leading to serious DDIs, and one study [47] only reported the proportion of PIMs that were due to DDIs.…”

“…A description of the numerator and denominator extracted and used to estimate DDI prevalence for each study is presented in Appendix 7 of the ESM. Across 31 studies using study participants as the unit of analysis, DDI prevalence estimates varied, ranging from 0.8% in Albania [53] to 90.6% in Croatia [46] (Table 1…”