Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Pharmacy Practice

  • Pasitpon Vatcharavongvan1Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, Pathum-Thani, Thailand.
  • Viwat Puttawanchai1Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, Pathum-Thani, Thailand.

Volume 17 Issue 3 Pages 1-8

DOI: 10.18549/PharmPract.2019.3.1494

Abstract

Objective: The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors. Methods: This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors. Results: A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs. Conclusions: PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.

Keywords

  • Inappropriate Prescribing
  • Potentially Inappropriate Medication List
  • Outpatients
  • Primary Health Care
  • Polypharmacy
  • Electronic Health Records
  • Cross-Sectional Studies
  • Multivariate Analysis
  • Thailand
Pharmacy Practice

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