Tzu-Chueh Wang
ABSTRACT
Potentially inappropriate medication (PIM) is defined as medication which may result in higher than expected risk when used by elderly patients. Its risk of occurrence may be increased through the effects of drug interactions, adverse drug reactions (ADR), adverse drug effects (ADE), and so on. At the commencement of this study, we hypothesized that: 1. After the release of a revised version of the Beers Criteria, the number of medications prescribed that are inappropriate under these guidelines would decline. 2. Polypharmacy would lead to increased potentially inappropriate use of medication. 3. More PIM would be prescribed at hospitals than at local clinics. To test these hypotheses, we analyzed prescriptions that had been issued by physicians at local hospitals and clinics and dispensed at a community pharmacy in Kaohsiung City, from 2009 to 2015. We found that the overall rate of prescription of PIM for elderly patients was 50.8% from 2009-2012, compared with 37.6% from 2013-2015. The largest number of prescriptions filled at the pharmacy was for the 'young-old', while the smallest number was for the 'oldest-old'. Prior to the introduction of the guidelines, the incidence of PIM was highest among the 'oldest-old', while after their introduction, PIM was highest among the 'aged'. In terms of prescribing institutions, physicians in hospitals were more likely to prescribe PIM than those in clinics. In terms of polypharmacy, inappropriate medications were most likely to be prescribed when ten or more medications were being used simultaneously. After the release of the guidelines, the rate of PIM among patients using ten kinds of medication or more exceeded that of those using one to four medications by a factor of six. This study involved only a retro-analysis of prescriptions dispensed at a community pharmacy. In the future, if pharmacists can discuss the appropriateness of prescriptions with physicians after medications have been prescribed, it is likely that the rate of PIM can be reduced, thus contributing to an improved quality of life for elderly patients.
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Index Terms
- Potentially Inappropriate Medication Prescription in Elderly Outpatients
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