Drug Utilization Pattern and Potentially Inappropriate Medications among Elderly Inpatients in a Tertiary Care Hospital in Western Nepal (original) (raw)
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Asian Journal of Pharmaceutical and Clinical Research
Objective: The current study aims to evaluate prescribing pattern and potentially inappropriate medicine (PIM) among elderly patients in a tertiary care hospital of western Nepal. Methods: A prospective cross-sectional study was conducted in the outpatient department of Manipal Teaching Hospital of Western Nepal. The World Health Organization prescribing indicators and Beers’ 2015 updated criteria were assessed to analyze the result. Results: The mean±standard deviation of the age was 73.47±6.42 years and the majority of patients were in the age group 65–74 (58.81%). Male preponderance (male: female=1.20:1) was found. The value of prescribing indicator includes the average number of drug per prescription (4.91), percentage of generic name prescription (3.40%), percentage of antimicrobials prescribed (19.40%), percentage of injections prescribed (2.70%), and percentage of the drug from essential drug list of Nepal (42.22%). At least one PIM was prescribed to 87 (21.6%) patients. Non-...
PATTERN OF MEDICATION USE AMONG ELDERLY INPATIENTS IN A TERTIARY CARE HOSPITAL OF NORTHEAST INDIA
Asian Journal of Pharmaceutical and Clinical Research, 2021
Objectives: The objective of the present study was to assess the pattern of medication use among elderly inpatients of internal Medicine Wards and to evaluate inappropriate prescribing with the help of Beers criteria 2019. Methods: It was a retrospective hospital data-based study. Data were obtained from treatment charts of elderly inpatients stored in the Medical Records Department. Total 236 treatment record charts of patients ≥60 years of either sex was obtained from the period of July 2015 to December 2015 and the information were noted in predesigned pro forma. Results: The mean±SD age of the patients was 69.07±7.72 years with male preponderance (58.5%). Maximum number of patients were having respiratory disorders (57.6%), followed by kidney diseases (20.8%), cardiovascular diseases (18.6%), and so on. A total of 2683 drugs were prescribed with average number of 10.68±4.74 drugs per prescription. Only 363 formulations were prescribed by their generic names and 29.1% drugs were prescribed as fixed dose combinations. Polypharmacy was seen in 91.5% and 39%, respectively, in hospital stay and during discharge. About 60.5% drugs were prescribed from the National list of essential medicine. Total 57 drugs were found to be potentially inappropriate. About 22% patients received at least one drug which was potentially inappropriate according to Beers criteria and around 14% drugs were prescribed inappropriately. Conclusion: This study suggests that use of potentially inappropriate medications is common in elderly patients, some of them associated with high degree of risk in terms of worsening of the co-morbidity or drug-drug interactions. There is a need for nationwide assessment and strategies that may reduce or overcome such high prevalence.
International Journal of Scientific Reports, 2016
In Nepal, the older population accounts for about seven percent of the total population with majority in their sixties. 1 This population is frequent consumer of medications due to the high prevalence of chronic disease and are at particular risk for drug-related problems (DRP) due to physiologic changes that occur with aging and ABSTRACT Background: Evaluate prescribing pattern, polypharmacy, and prescribing potentially inappropriate medicine (PIM) in elderly population to contribute in awareness towards rational use of drugs. Methods: A retrospective cross-sectional and observational study was done in hospitalized geriatric patients in Nepal. The World Health Organization (WHO) "core prescribing indicators" and Beers' 2012 updated criteria were used to assess prescribing pattern and inappropriate prescribing respectively. The drug-drug interactions were checked using Medscape drug interaction checker. In addition, disease prevalence and the most commonly prescribed drugs were also assessed where diseases and drugs were classified according to International Classification of Diseases-10 (ICD-10) and the Anatomical Therapeutic Chemical (ATC) classification respectively. Results: Out of 225 patients, 118 (52.4%) were males and most of the patients were in the age group 65-74 years (125, 55.6%). The diseases of circulatory system were more prevalent (135, 60%) and the average number of drugs was 8.19±3.50. Generic name prescribing was 8.51% and 77.33% of prescription contained antibiotic(s). Injection(s) prescribed were 80%, and drugs prescribed from national essential drug list and WHO essential drug list were 52.55% and 46.15% respectively. Medicines for alimentary tract and metabolism (215, 95.55%) and cardiovascular system (155, 68.89%) were most frequently prescribed. Polypharmacy (≥5 drugs) was found in 195 (86.66%) patients and was significant (P= 0.001). The potentially inappropriate medicines (PIMs) prescribed were 133 (7.21%) and at least one PIM was prescribed to 78 (34.67%) patients. Almost half numbers of patients (48.9%) were detected with at least one potential drug-drug interaction (DDI). Conclusions: Majority of hospitalized elderly patients received polypharmacy with drugs which may have serious drug-drug interactions. Thus, less number of drugs per prescription with minimum potential of drug-drug interaction and inappropriate medicines for elderly can be reinforced by implementing proper system of recording and analysing the therapy.
Drug utilisation among older inpatients in a teaching hospital in Western Nepal
Singapore medical journal, 2010
The proportion of the elderly population in Nepal, though low, is steadily increasing. Studies on drug utilisation among geriatric patients in Western Nepal, a region with the highest proportion of the elderly in all of Nepal, are lacking. The present study was carried out at the Manipal Teaching Hospital, a 700-bed teaching hospital in Pokhara, Western Nepal. The study was carried out from June 1, 2005 to May 31, 2006 using case records of discharged patients aged 60 years and older. This was an observational study that utilised a retrospective case notes review methodology. The microorganisms isolated on culture and their antibiotic sensitivity patterns were studied. Drug consumption was measured by the defined daily dose (DDD) per 100 bed-days. The mean cost of the drugs was calculated. The percentage of drugs prescribed by generic name and the percentages of fixed-dose combinations used were noted. The basic demographic information of older inpatients, drug utilisation patterns,...
International journal of Pharmacy and Pharmaceutical Sciences, 2014
Objective: To assess the prevalence and associated factors of potentially inappropriate medications (PIMs) use in the elderly population attending Gondar University Hospital (GUH). Methods: A two years (2011-2012) retrospective cross sectional analysis was conducted in Gondar University Hospital (GUH). Elderly patients, aged ≥65 years treated with prescription drugs were included in the study. Updated Beers criteria (2012 version) independent of diagnosis was employed to determine the appropriateness of each medication prescribed and SPSS (version16.0) was used for data analysis. P-value < 0.05 was considered as significant association indicator between the variables. Results: A total sample of 1252 patients were used in the study, of whom 347(27.72%) were received at least one potentially inappropriate medication. The mean age of the participants was 71.15 ± 6.18. The most commonly used medications were immediate release nifedipine (53.89%), diclofenac (22.19%), ibuprofen (7.78%) and indomethacin (5.19%). PIM use and our variables were not associated with the prevalence of PIM use among the elderly. Conclusion: PIMs prescriptions for elderly population attending GUH are common with no association with any of our demographic or any other variables we set, which implies to work on improving the availability of updated medical information and knowledge for prescribers and to involve in careful monitoring and optimal use of drug regimens of elderly patients attending GUH.
Introduction: Quality and safety of prescribing in older people remains a global healthcare concern. Inappropriate prescribing in the elderly population is now considered a major public health issue because of its direct association to morbidity, mortality and wastage of health resources. The study was initiated to study the prevalence of potentially inappropriate medications (PIMs) in elderly patients coming to seek health care in a tertiary care teaching hospital in Odisha. Materials and Methods: 2012 AGS Beers Criteria was used to analyse the inappropriateness of the prescriptions in 700 new as well as old patients of either sex who had completed 65 years of age as on 30th September 2013. Data obtained was analyzed with the help of SPSS version 20.0. Multivariate logistic regression was applied to find out the predictors of PIM. Results: 21.86% patients were prescribed at least one potentially inappropriate medication. Most of the drug use was seen in the age group of 65-74 years. Multivariate logistic regression analysis showed that increased number of concurrent medications use (OR: 1.95, CI: 1.19 – 3.01, P = <0.01) was the predictor of inappropriate medication use as per 2012 AGS Beers Criteria. Age, gender and co-morbidity did not influence the use of inappropriate drugs. Conclusion: Inappropriate prescribing to elderly patients is influenced by the total number of drugs prescribed to an elderly patient. There is a need to improve the prescribing pattern in elderly. This will reduce the occurrence of adverse drug reactions, cost of treatment, and increase compliance in elderly patients.
Asian Journal of Pharmaceutical and Clinical Research, 2017
Objective: To investigate the drug utilization pattern and the prevalence of potentially inappropriate medications (PIMs) using updated AGS Beers criteria 2012 among the elderly patients who attended the geriatric outpatient departments as well as admitted indoor patients ina tertiary care Hospital at Guwahati, Assam, India.Method: A hospital based prospective, observational and cross sectional study, involving patients aged 65 years and above was planned and conducted over a period of 6 months from January 2016 to June 2016. Patients were visited daily, interviewed and case records were collected. Data were analyzed using Microsoft Office Excel Sheets.Results: A total of 150 patients aged 65 years and above were analyzed. 97 patients (65%) were males and 53 (35%) were females. Majority of the patients (61 numbers, 41%) belonged to the age group of 65-70 years, and least were in the age group of 86-90 years (13 numbers, 9%). Prescription of five or more medications (polypharmacy) w...
Asia Pacific Journal of Medical Toxicology, 2020
Background: Polypharmacy and inappropriate prescriptions are the most highlighted health issues among geriatric population, as they have multiple comorbidities. The objective of this study was to assess prescriptions using the World Health Organization (WHO) core indicators and Beers Criteria to discover polypharmacy and inappropriate prescriptions.Methods: This was a prospective, cross-sectional study of geriatric patients (65 years and above) who were attending the medicine outpatients clinic of a tertiary care teaching hospital hospital from May to December, 2016. World Health Organization (WHO) indicators and updated Beers Criteria were used to assess the drug utilization pattern and the prevalence of potentially inappropriatemedications (PIMs), respectively.Results: The prescriptions of 250 geriatrics patients with a distribution of 57.6% male and 42.4% female were assessed for this study. The total numbers of drugs recorded from the prescriptions were 1635 drugs, with an avera...
International Journal of Basic & Clinical Pharmacology, 2022
Background: Medication use in older people has been increasing as the incidence of chronic diseases increases worldwide. Use of more medicines may increase the chance of prescribing potentially inappropriate medications (PIMs) and may increases the risk of potential drug-drug interactions (pDDIs). The objective of this study was to assess PIMs and pDDIs to improve the rational use of medicationsMethods: In this study data from the older people were obtained from patient visiting medicine, OPD, BPKIHS, Dharan. Demographic and medications information were collected. PIM and pDDIs were evaluated from medication data using the Beer’s criteria for potentially inappropriate medication use in older adults, 2015 and lexicomp application respectively.Results: Among 550 patients 50.9% patients were male. Common diagnosis was systemic hypertension 335 (64.5%) followed by type 2 diabetes mellitus 276 (50.18%). The most commonly prescribed drug was metformin (215) followed by amlodipine (205), a...
Geriatric prescribing in the medical wards of a teaching hospital in Nepal
… and Drug Safety, 1997
Introduction: Evaluation of medication usage pattern is crucial for the better patient care, particularly for the geriatric who often have experience with multiple therapy and problems. This study was conducted to investigate the medication usage in elderly patients through a validated World Health Organization (WHO) indicators. Methods: A retrospective crossectional and non-interventional study was conducted in the geriatric outpatient departments in a teaching hospital (Islamabad, Pakistan). The patients aged ≥60 years visiting the geriatric medical outpatient and emergency department from September 2018 to April 2019 were selected through random systematic sampling technique. The collected information was evaluated according to the WHO recommendations. Results: A total of 3,792 drugs were prescribed (average drug per prescription= 5.2 (Range 4-8) in 720 elderly patients. Out of these, antimicrobials were prescribed in 76.4% (n=550), at least one injectable medication in 63.9% (n=460), generic prescribing in 30% (n=1141) and prescribing from National essential list/hospital formulary in 95.8% (n=3634) of the prescription. A statistically significant difference was observed between prescribing practices and WHO optimal values (P<0.001). The most frequently prescribed class of antimicrobials was cephalosporins (65.3%) and ceftriaxone (41%), ciprofloxacin (13.6%) and cefuroxime (10.7%) were the most commonly used antibiotics. Conclusion: The major problems identified in this study were polypharmacy, low generic prescribing, higher usage of antimicrobials and injectable. A special attention is required by the healthcare authorities for the better care of the geriatric patients.