DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20160087

Prescribing pattern, polypharmacy and potentially inappropriate prescribing in hospitalized elderly patients: a retrospective study in a teaching hospital in Nepal

Sangharshila Basnet, Keshab Raj Paudel, Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Sandeep Adhikari, Sony Shrestha

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.

Keywords


Elderly, Prescribing pattern, Inappropriate prescribing, Polypharmacy, Drug- interaction

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References


Yadav RK. Ageing population in Nepal: Challenges and management. Academic Voices A Multidisciplinary Journal. 2012;2(1).

Owens NJ, Fretwell MD, Willey C. Distinguishing between the fit and frail elderly, and optimizing pharmacotherapy. Drugs & Aging. 1994;4:47-55.

Giron MST, Claesson C, Thorslund M, Oke T, Winblad B, Fastbom J. Drug Use Patterns in a Very Elderly Population: A Seven-Year Review. Clin. Drug Invest. 1999;17(5):389-8.

Classen DC, Pestotnik SL, Evans RS. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277:301-6.

Beijer HJM, De Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24:46-54.

Brennan TA, Leape LL, Laird NM. Incidence of adverse drug events and negligence in hospitalized patients: results of Harvard Medical Practice Study I. N Engl J Med. 1991;324:370-6.

Krishnaswamy K, Kumar BD, Radhaiah G. A drug use survey- precepts and practice. Eur J ClinPharmacol. 1985;29:363-70.

Pradhan SC, Shewade DG, Shashindran CH, Bapna JS. Drug utilization studies. Natl Med J India. 1988;1:185-9.

World Health Organization. How to investigate drug use in health facilities. Selected drug use indicators WHO/DAP/93.1. Geneva: WHO; 1993.

The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, J Am Geriatr Soc. 2012;60(4):616-31.

International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10 online version: 2015). Available from: http://www.who.int/classifications/icd/en/.

Guidelines forATC classification and DDD assignment ATC. Available from: www.whocc.no/filearchive/publications/1_2013guidelines.pdf.

WHO. How to investigate drug use in health facilities: Selected drug use indicators. Geneva: World Health Organization; 1993. WHO/DAP. 1993;1:1-87.

WHO model list of essential medicines, 18th edition (April 2013) [cited 2015 March10]. Availablefrom:http://www.who.int/medicines/publications/essentialmedicines/18th_EML_Final_web_8Jul13.pdf.

National List of Essential Medicines, 2011 - Nepal [cited 2015 March10]. Available from:http://apps.who.int/medicinedocs/documents/s18826en/s18826en.pdf

Prevalence of non-communicable disease in Nepal hospital based study, First Edition: Dec, 2010 [cited 2015 March 10]. Available from: http://www.ncf.org.np/upload/files/611_en_Non_Communicable_diseases.pdf.

Ghosh R, Neogi JN, Srivastava BS, Sen P. Prescribing Trends in A Teaching Hospital in Nepal, JNMA J Nepal Med Assoc. 2003;42:346‐9.

Sapkota S, Pudasaini N, Singh C. Drug prescribing pattern and prescription error in elderly: a retrospective study of inpatient record. Asian J Pharm Clin Res. 2011;4(3):129-32.

Ansari KU, Singh S, Pandey RC. Evaluation of prescribing pattern of doctors for rational drug therapy. Indian J Pharmacol. 1998;30:43-6.

Benet LZ. Principles of prescription order writing & patient compliance instructions. In: Hardman JG, Limbard LE, Molinoff PB, Ruddon RW, Gilman AG, editors. Goodman & Gilman's the pharmacological basis of Therapeutics. 9th ed. New York: McGraw Hill; 1996:1697-706.

World Health Organization. The selection of essential drugs, Technical report series no-615, Report of a WHO expert committee. Geneva; WHO; 1977.

Hartmann M, Huber R, Bliesath H, Steinijans VW, Koch HJ, Wurst W, et al. Lack of interaction between pantoprazole and digoxin at therapeutic doses in man. Int J Clin Pharmacol Ther. 1995;33(9):481-5