PRESCRIBING PATTERN AND APPROPRIATENESS OF PRESCRIPTION AMONG ELDERLY PATIENTS IN A TERTIARY CARE HOSPITAL OF WESTERN NEPAL – A PROSPECTIVE CROSSSECTIONAL STUDY

SAGARANANDA GIRI; GULAM MUHAMMAD KHAN

doi:10.22159/ajpcr.2020.v13i4.36843

Authors

SAGARANANDA GIRI Department of, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal.
GULAM MUHAMMAD KHAN Department of, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal.

DOI:

https://doi.org/10.22159/ajpcr.2020.v13i4.36843

Keywords:

Beers Criteria, Elderly patients, Polypharmacy, Potentially inappropriate medicine, Prescribing pattern

Abstract

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-cyclooxygenase-selective nonsteroidal anti-inflammatory drugs (44%) and anticholinergics (18%) were the most frequently prescribed PIMs.

Conclusions: Polypharmacy, PIMs, and potential drug-drug interaction were prevalent in this study. It is recommended that all the doctors, pharmacists, other concerned health-care professionals, patients, policymakers, and all other stakeholders must be aware of these situations and a multidisciplinary approach must be developed for the promotion of rational use of drugs.

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References

UNFPA. Ageing in the Twenty First Century: Report. A Celebration and Challenges; 2012. Available from: https://www.unfpa.org/publications/ ageing-twenty-first-century. [Last accessed on 2018 Nov ???].

United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing (ST/ESA/SER. A/390); 2015. Available from: https://www.un.org/en/development/desa/population/ publications/pdf/ageing/wpa2015_report.pdf. [Last accessed on 2018 Nov ???].

Central Bureau of Statistics. National Population and Housing Census 2011. Vol. 1. Kathmandu, Nepal: Central Bureau of Statistics; 2012. Available from: https://www.unstats.un.org/unsd/demographic-social/ census/documents/nepal/nepal-census-2011-vol1.pdf. [Last accessed on 2018 Nov ???].

World Health Organization. Definition of an Older or Elderly Person. Geneva: World Health Organization; 2013. Available from: https:// www.who.int/healthinfo/survey/ageingdefnolder/en/. [Last accessed on 2018 Nov ???].

Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther 2007;32:113-21.

Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: Misleading, but manageable. Clin Interv Aging 2008;3:383-9.

Romana A, Kamath L, Sarda A, Muraraiah S, Jayanthi CR. Polypharmacy leading to adverse drug reactions in elderly in a tertiary care hospital. Int J Pharma Bio Sci 2012;3:218-24.

Khandeparkar A, Rataboli PV. A study of harmful drug-drug interactions due to polypharmacy in hospitalized patients in Goa Medical College. Perspect Clin Res 2017;8:180-6.

Pavani V, Shravani K, Prabhakar RV. Study of prescribing pattern for evaluation of rational drug therapy in Warangal. Indian J Pharm Pract 2011;4:77-9.

Basnet S, Paudel KR, Sah AK, Jha RK, Sah P, Adhikari S, et al. Prescribing pattern, polypharmacy and potentially inappropriate prescribing in hospitalized elderly patients: A retrospective study in a teaching hospital in Nepal. Int J Sci Rep 2016;2:7-12.

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

Hill‐Taylor B, Sketris I, Hayden J, Byrne S, O’sullivan D, Christie R. Application of the STOPP/START criteria: A systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther 2013;38:360-72.

Galli TB, Reis WC, Andrzejevski VM. Potentially inappropriate prescribing andthe risk of adverse drug reactions in critically ill older adults. Pharm Pract (Granada) 2016;14:1-7.

Pasina L, Djade CD, Tettamanti M, Franchi C, Salerno F, Corrao S, et al. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: Results from the REPOSI Study. J Clin Pharm Ther 2014;39:511-5.

World Health Organization. International Statistical Classification of Diseases and Related Health Problems: 10th Revision (ICD-10). Geneva: World Health Organization; 2018. Available from: http://www.who.int/ classifications/apps/icd/icd.1992. [Last accessed on 2018 Nov ???].

World Health Organization. Anatomical Therapeutic Chemical (ATC) Classification. Geneva: World Health Organization; Available from: https://www.who.int/medicines/regulation/medicines-safety/toolkit_ atc/en/. [Last accessed on 2018 Nov ???].

World Health Organization. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators. Geneva: World Health Organization; 1993.

National List of Essential Medicines, Nepal; 2016. Available from: http://www.apps.who.int/medicinedocs/documents/s23537en/ s23537en.pdf. [Last accessed on 2018 Nov ???].

The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015;63:2227-46.

Sah AK, Jha RK, Sah P, Basnet S. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department. J Coll Med Sci Nepal 2017;13:197-202.

Rakesh KB, Chowta MN, Shenoy AK, Shastry R, Pai SB. Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital. Indian J Pharmacol 2017;49:16-20.

Mainuddin AK, Begum HA, Rawal LB, Islam A, Islam SS. Women empowerment and its relation with health seeking behavior in Bangladesh. J Family Reprod Health 2015;9:65-73.

Kanagasanthosh K, Topno I, Aravindkumar B. Prevalence of potentially inappropriate medication use and drug utilization pattern in elderly patients: A prospective study from a tertiary care hospital. Int J Res Med Sci 2015;3:2062-72.

Sharifnia SH, Mohammadzadeh M, Arzani G, Salamzadeh J, Abolfazli SA, et al. Main factors affecting physicians’ prescribing decisions: The Iranian experience. Iran J Pharm Res 2018;17:1105-15.

Ay P, Akici A, Harmanci H. Drug utilization and potentially inappropriate drug use in elderly residents of a community in Istanbul, Turkey. Int J Clin Pharmacol Ther 2005;43:195-202.

Marzi MM, Diruscio VA, Núñez MH, Pires MS, Quaglia NB. Analysis of medication prescription in an Argentinian geriatric hospital. Rev Med Chil 2013;141:194-201.

Abraham FE, Varughese GL, Mathew JC, John PM, Sam GK. Drug utilization pattern among geriatric patients in a tertiary care teaching hospital. Asian J Pharm Clin Res 2015;8:191-4.

Atif M, Sarwar MR, Azeem M, Umer D, Rauf A, Rasool A, et al.Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan. J Pharm Policy Pract 2016;9:1-8.

Taskeen M, Anitha N, Ali SR, Bharath R, Khan AB. A study on rational drug prescribing pattern in geriatric patients in Hyderabad metropolitan. J Drug Deliv Ther 2012;2:109-13.

Eze UI, Olowu AO. Prescribing patterns and inappropriate use of medications in elderly outpatients in a tertiary hospital in Nigeria. Trop J Pharm Res 2011;10:19-25.

Joshi MP, Sugimoto T, Santoso B. Geriatric prescribing in the medical wards of a teaching hospital in Nepal. Pharmacoepidemiol Drug Saf 1997;6:417-21.

Slabaugh SL, Maio V, Templin M, Abouzaid S. Prevalence and risk of polypharmacy among the elderly in an outpatient setting: A retrospective cohort study in the Emilia-Romagna region, Italy. Drugs Aging 2010;27:1019-28.

Van Der Hooft CS, Jong GW, Dieleman JP, Verhamme KM, Van Der Cammen TJ, Stricker BH, et al. Inappropriate drug prescribing in older adults: The updated 2002 Beers criteria-a population‐based cohort study. Br J Clin Pharmacol 2005;60:137-44.