Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan
Received 12 May 2018
Accepted for publication 27 June 2018
Published 28 August 2018 Volume 2018:13 Pages 1485—1495
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Richard Walker
Muhammad Rehan Sarwar,1,2 Abdur-Rehman Dar,2 Saad Yousaf Mahar,2 Tayyab Riaz,2 Usman Danish,2 Sadia Iftikhar2
1Department of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan; 2Department of Pharmacy Practice, Akhtar Saeed College of Pharmaceutical Sciences, Lahore, Pakistan
Background and objectives: Due to physiological and pharmacological variations, geriatrics are at high risk of experiencing life-threatening outcomes related to the use of potentially inappropriate medications (PIMs). Thus, the present study aims to evaluate prescribing practices of PIMs among elderly patients who may lead to unplanned hospitalization and associated risk factors.
Methods: A cross-sectional study was conducted in different hospitals of Lahore, Pakistan. The study population consisted of geriatric patients aged ≥65 years. Data were collected from the medical records of geriatric patients, who attended these selected hospitals between December 1, 2017, and February 28, 2018. Data were analyzed using SPSS (IBM SPSS Statistics for Windows, Version 21.0) and Microsoft Excel (MS Office 2010).
Results: The records of 385 geriatric patients were investigated. More than half (60.8%) of the patients were subjected to polypharmacy, which can be defined as the utilization of 5–9 drugs by the patient at the same time, whereas 36.4% were prescribed with one PIM and 56.4% were hospitalized due to PIMs. Majority of them were prescribed with PIMs including N02BA01 (aspirin, 32.4%), A02BC01 (omeprazole, 23.6%), A10AB02 (insulin, 17.4%), A02BC05 (esomeprazole, 8.5%), C08CA01 (amlodipine, 8.3%), and R06AA02 (diphenhydramine, 5.9%). Results of regression analysis revealed that patients exposed to polypharmacy (OR=2.556, 95% CI=1.579–4.135, P-value≤0.001) and excessive polypharmacy (OR=37.828, 95% CI=4.754–300.9, P-value≤0.001) were significantly associated with unplanned hospitalization, whereas factors such as age 75–84 years (OR=0.343, 95% CI=0.156–0.756, P-value=0.008) and polypharmacy (OR=2.480, 95% CI=1.219–5.048, P-value=0.012) were significantly correlated with PIMs.
Conclusion: The utilization of PIMs listed in Beers criteria among geriatric population can cause unplanned hospitalization. As the patients receiving polypharmacy are at high risk of unplanned hospitalization, so caution must be exercised in prescribing PIMs for elderly people.
Keywords: Beers criteria, geriatrics, potentially inappropriate medications, unplanned hospitalization, polypharmacy
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