Mediterranean Journal of Pharmacy and Pharmaceutical Sciences
https://app.periodikos.com.br/journal/medjpps/article/doi/10.5281/zenodo.6780506

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Original article

Pattern of drug prescribed and drug related problems among hospitalized elderly patients

Mustafa A. Alssageer, Fathi M. Sherif, Esraa S. Mohammed, Soaad A. Abd Alsalm

http://dx.doi.org/10.5281/zenodo.6780506 Mediterr J Pharm Pharm Sci, vol.2, n2, p.66-78, 2022
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Abstract

Prescribing drugs for elderly patients is not an easy task since elderly patients are frequently with comorbid conditions. In Libya, there are no guidelines for the management of medications used in elderly patients and no specialized geriatric health institutions. The aim of this study is to assess the pattern of medication use among hospitalized elderly patients in Sebha Medical Centre and the drug-related problems associated with these patterns. This report is descriptive and retrospective cross-sectional study that is conducted at Sebha Medical Center during 2021. Potential drug-related problems were assessed based on the classification of Hepler and Strand. In this study, out of 195 participants, most of the patients have been given antibiotics (92.0%). The majority of patients have been prescribed anti-gastric agents, vitamins and anti-thrombotic agents which accounted for 75.0%, 62.0% and 55.0%, respectively. To less extent, anti-hypertensive agents, analgesics and anti-hyperlipidemics were reported by 45.0%, 43.0% and 38.0%, correspondently. Almost all the patients have at least one event of drug-related problem and more than three-quarters of the patients had more than one event of drug-related problems. The highest rate was untreated indications which were reported for 77.0% then followed by drug use without indication nearly a half of the events 48.0%. To fewer extent rates were reported: “in improper drug selection”, “drug interaction” and “adverse effects” which were reported for 25.0%, 23.0% and 18.0% of the total events, respectively. Almost all elderly patients have been prescribed antibiotics, analgesics and vitamins. Drug-related problems are predominant prevalent in the clinical practice at the center. This study highlights the importance of activation of clinical pharmacist interventions at hospitals which can contribute to reducing the chance of risk of drug-related problems events among hospitalized elderly patients and ensuring rational drug prescribing in the geriatric clinical settings.

Keywords

Drug related problem, elderly, hospitalized patient, pattern drug prescribing

References

  1. Vinks THAM, de Koning FHP, de Lange TM, Egberts TCG (2006) Identification of potential drug-related problems in the elderly: the role of the community pharmacist. Pharmacy World Science. 28 (1): 33-38. doi:10.1007/s11096-005-4213-4
  2. Alssageer MA, Mohammed ES, Abd-Alsalm SA (2022) Prevalence of comorbidity and polypharmacy among hospitalized elderly patients. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2 (1): 55-64. doi.org/10.5281/zenodo.6399521
  3. Sera L, Uritsky T (2016) Pharmacokinetic and pharmacodynamic changes in older adults and implications for palliative care. Progress in Palliative Care. 24 (5): 255-261. doi:10.1080/09699260.2016.1192319
  4. Van Spall HGC, Toren A, Kiss A, Fowler RA (2007) Eligibility criteria of randomized controlled trials published in high-impact  general medical journals: a systematic sampling review. The Journal of the American Medical Association. 297 (11): 1233-1240. doi:10.1001/jama.297.11.1233
  5. Pedone C, Lapane KL (2003) Generalizability of guidelines and physicians’ adherence. Case study on the Sixth Joint National Commitee’s guidelines on hypertension. BMC Public Health. 3: 24. doi:10.1186/1471-2458-3-24
  6. Leendertse AJ, Egberts ACG, Stoker LJ, van den Bemt PMLA (2008) Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Archives of Internal Medicine. 168 (17): 1890-1896. doi:10.1001/archinternmed.2008.3
  7. Pirmohamed M, James S, Meakin S, Green C, Scott Ak, Walley T, Farrar K, Park BK, Preckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of  18 820 patients. British Medical Journal. 329 (7456): 15-19. doi:10.1136/bmj.329.7456.15
  8. Mangoni AA, Jackson SHD (2004) Age-related changes in pharmacokinetics and pharmacodynamics: basic principles  and practical applications. British Journal of Clinical  Pharmacology. 57 (1): 6-14. doi:10.1046/j.1365-2125.2003.02007.x
  9. Simonson W, Feinberg JL (2005) Medication-related problems in the elderly: defining the issues and identifying  solutions. Drugs Aging. 22 (7): 559-569. doi:10.2165/00002512-200522070-00002
  10. Hajjar ER, Gray SL, Slattum Jr PW, Hersh LR, Naples JG, Hanlon JT (2017) Geriatrics. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, Eds. Pharmacotherapy: A pathophysiologic approach, 10e. McGraw-Hill Education. ISBN 978-1-260-11681-6
  11. Pharmaceutical Care Network Europe (PCNE) (2006) PCNE Classification for drug related problems. Revised 01-
  12. Hepler CD, Strand LM (1990) Opportunities and responsibilities in pharmaceutical care. American Journal of Hospital Pharmacy. 47 (3): 533-543. PMID: 2316538
  13. Elyamani M, Sherif FM (2021) Assessment of drug prescribing pattern and prescription errors in elderly patients. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 1 (2): 46-50. doi.org/10.5281/zenodo.5171325.
  14. de With K, Bergner J, Bühner R, Dörje F, Gonnermann C, Haber M, Hartmann M, Rothe U, Strehl E, Steib-Bauert M, Kern W (2004) Antibiotic use in German university hospitals 1998-2000 (Project INTERUNI-II). International Journal of Antimicrobial Agents. 24 (3): 213-218. doi:10.1016/j.ijantimicag.2004.03.015
  15. Palacios-Ceña D, Hernández-Barrera V, Jiménez-Trujillo I, Serrano-Urrea R, Fernández-de-las-Peñas C, Carrasco-Garrido P (2017) Time trends in antibiotic consumption in the elderly: Ten-year follow-up of the Spanish National Health Survey and the European Health Interview Survey for Spain (2003-2014). PLoS One. 12 (11): e0185869. doi.org/10.1371/journal.pone.0185869
  16. Shi S, Klotz U (2008) Proton pump inhibitors: an update of their clinical use and pharmacokinetics. European Journal of Clinical Pharmacology. 64 (10): 935-951. doi:10.1007/s00228-008-0538-y
  17. Hollingworth S, Duncan EL, Martin JH (2010) Marked increase in proton pump inhibitors use in Australia. Pharmacoepidemiology and Drug Safety. 19 (10): 1019-1024. doi:10.1002/pds.1969
  18. Gupta R, Garg P, Kottoor R, Munoz JC, Jamal MM, Lambiase LR, Vega KJ (2010) Overuse of acid suppression therapy in hospitalized patients. Southern Medical Journal. 103 (3): 207-211. doi:10.1097/SMJ.0b013e3181ce0e7a.
  19. Gamelas V, Salvado V, Dias L (2019) Prescription pattern of proton pump inhibitors at hospital admission and discharge. GE - Portuguese Journal of Gastroenterology. 26 (2): 114-120. doi:10.1159/000488506
  20. Bauer J, Biolo G, Cederholm T, Cesari M, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips S, Sieber C,  Stehle P, Teta D, Visvanathan R, Volpi E, Boirie Y (2013) Evidence-based recommendations for optimal dietary protein intake in older  people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association. 14 (8): 542-559. doi:10.1016/j.jamda.2013.05.021
  21. Aslam F, Haque A, Lee LV, Foody J (2009) Hyperlipidemia in older adults. Clinical Geriatric Medicine. 25 (4): 591-606, vii. doi:10.1016/j.cger.2009.08.001
  22. Rubin SM, Sidney S, Black DM, Browner WS, Hulley SB, Cummings SR (1990) High blood cholesterol in elderly men and the excess risk for coronary heart disease. Annals of Internal Medicine. 113 (12): 916-920. doi:10.7326/0003-4819-113-12-916
  23. Yazdanyar A, Newman AB (2009) The burden of cardiovascular disease in the elderly: morbidity, mortality, and  costs. Clinical Geriatrics Medicine. 25 (4): 563-577, vii. doi:10.1016/j.cger.2009.07.007
  24. Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group (1998) Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. New England Journal of Medicine. 339 (19): 1349-1357. doi:10.1056/NEJM199811053391902
  25. Sever PS, Dahlof B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Nieminen M, O'Brien E, Ostergren J (2003) Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomi. The Lancet. 361 (9364): 1149-1158. doi:10.1016/S0140-6736(03)12948-0
  26. Silva C, Ramalho C, Luz I, Monteiro J, Fresco P (2015) Drug-related problems in institutionalized, polymedicated elderly patients:  opportunities for pharmacist intervention. International Journal of Clinical Pharmacy. 37 (2): 327-334. doi:10.1007/s11096-014-0063-2
  27. Gurwitz J, Monane M (1995) The Brown University long-term care quality letter. (Providence, RI, ed.). Brown University, 1995. OCLC: 423566923
  28. Chan D-C, Chen J-H, Kuo H-K, We C-J, Lu I-S, Chiu L-S, Wu S-C (2012) Drug-related problems (DRPs) identified from geriatric medication safety review  clinics. Archives of Gerontology and Geriatrics. 54 (1): 168-174. doi:10.1016/j.archger.2011.02.005
  29. Hailu BY, Berhe DF, Gudina EK, Gidey K, Getachew M (2020) Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatrics. 20 (1): 13. doi:10.1186/s12877-020-1413-7
  30. Nielsen TRH, Andersen SE, Rasmussen M, Honoré PH (2013) Clinical pharmacist service in the acute ward. International Journal of Clinical Pharmacy. 35 (6): 1137-1151. doi:10.1007/s11096-013-9837-1
  31. Naples JG, Hanlon JT, Schmader KE, Semla TP (2016) Recent literature on medication errors and adverse drug events in older adults. The Journal of American Geriatric Society. 64 (2): 401-408. doi:10.1111/jgs.13922
  32. Salvi F, Marchetti A, D’Angelo F, Boemi M, Lattanzio F, Cherubini A (2012) Adverse drug events as a cause of hospitalization in older adults. Drug Safety. 35 (1S): 29-45. doi:10.1007/BF03319101
  33. Koh Y, Kutty FBM, Li SC (2005) Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Therapeutic and Clinical Risk Management. 1 (1): 39-48. doi:10.2147/tcrm.1.1.39.53597
  34. Adepu R, Adusumilli PK (2016) Assessment of drug related problems in patients with chronic diseases through health status survey in a South Indian rural community setting. Indian Journal of Pharmaceutical Science. 78: 537-541. doi: 10.4172/pharmaceutical-sciences.1000149
  35. Gottlieb T, Nimmo GR (2011) Antibiotic resistance is an emerging threat to public health: an urgent call to  action at the Antimicrobial Resistance Summit 2011. The Medical Journal of Australlia. 194 (6): 281-283. doi:10.5694/j.1326-5377.2011.tb02973.x
  36. Organization WH (2014) Antimicrobial resistance: global report on surveillance. World Health Organization. WHO, pp. 256. ISBN: 9789241564748
  37. Allen Maycock CA, Muhlestein JB, Horne BD, Carlquist JF, Bair TL, Pearson RR, Li Q, Anderson JL (2002) Statin therapy is associated with reduced mortality across all age groups of  individuals with significant coronary disease, including very elderly patients. Journal of American College of Cardiology. 40 (10): 1777-1785. doi:10.1016/s0735-1097(02)02477-4
  38. Aronow WS (2015) Lipid-lowering therapy in older persons. Archives of Medical Sciences. 11 (1): 43-56. doi:10.5114/aoms.2015.48148
  39. Mao W, Vu H, Xie Z, Chen W, Tang S (2015) Systematic review on irrational use of medicines in China and Vietnam. PLoS One. 10 (3): e0117710. doi:10.1371/journal.pone.0117710
  40. Tigabu BM, Daba D, Habte B (2013) Factors associated with unnecessary drug therapy and inappropriate dosage in jimma university specialised hospital, south west Ethiopia. World Journal of Pharmaceutical Sciences. 1 (14): 93-98
  41. Haider N, Mazhar F, Ahmed M (2017) Drug use without indication in elderly hospitalized patients. Journal of Postgraduate Medicine. 63 (2): 138-139. doi:10.4103/jpgm.JPGM_675_16
  42. Coleman EA, Smith JD, Frank JC, Eilertsen TB, Thiare JN, Kramer AM (2002) Development and testing of a measure designed to assess the quality of care transitions. International Journal of Integr Care. 2:e02. doi:10.5334/ijic.60
  43. Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchechells EE (2005) Unintended medication discrepancies at the time of hospital admission. Archives of Internal Medicine. 165 (4): 424-429. doi:10.1001/archinte.165.4.424
  44. Maton PN, Orlando R, Joelsson B (1999) Efficacy of omeprazole versus ranitidine for symptomatic treatment of poorly responsive acid reflux disease-a prospective, controlled trial. Alimentary Pharmacology and Therapeutics. 13 (6): 819-826. doi:10.1046/j.1365-2036.1999.00527.x
  45. Revicki DA, Sorensen S, Maton PN, Orlando RC (1998) Health-related quality of life outcomes of omeprazole versus ranitidine in poorly responsive symptomatic gastroesophageal reflux disease. Digestive Diseases. 16 (5): 284-291. doi:10.1159/000016878
  46. Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC (2012) Interventions to improve the appropriate use of polypharmacy for older people. The Cochrane Database of Systematic Reviews. (5): CD008165. doi:10.1002/14651858.CD008165.pub2
  47. Mira JJ (2019) Medication errors in the older people population. Expert Review of Clinical Pharmacology. 12(6): 491-494. doi:10.1080/17512433.2019.1615442
  48. Tulner LR, Frankfort S V, Gijsen GJPT, van Campen JPCM, Koks CHW, Beijnen JH (2008) Drug-drug interactions in a geriatric outpatient cohort: prevalence and  relevance. Drugs Aging. 25 (4): 343-355. doi:10.2165/00002512-200825040-00007
  49. Hamilton RA, Briceland LL, Andritz MH (1998) Frequency of hospitalization after exposure to known drug-drug interactions in a  Medicaid population. Pharmacotherapy. 18 (5): 1112-1120.
  50. Shad MU, Marsh C, Preskorn SH (2001) The economic consequences of a drug-drug interaction. Journal of Clinical Psychopharmacology. 21 (1): 119-120. doi:10.1097/00004714-200102000-00027
  51. Hansen ML, Sørensen R, Clausen MT, Fog-Petersen ML, Raunsø J, Gadsbøll N, Gislason GH, Folke F, Andersen SS, Schramm TK, Abildstrøm SZ, Poulsen HE, Køber L, Torp-Pedersen C (2010) Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and  clopidogrel in patients with atrial fibrillation. Archives of Internal Medicine. 170 (16): 1433-1441. doi:10.1001/archinternmed.2010.271
  52. Connolly SJ, Eikelboom JW, BoschJ, Dagenais G, Dyal L, Lanas F, Metsarinne K  M,  Dans AL, Ha JW, Parkhomenko AN, Avezum AA, Lonn E, Lisheng L, Torp Pedersen C, Widimsky P, Maggioni AP, Felix C, Keltai K, Hori M, Yusoff K, Guzik TJ, Bhatt DL, Branch KRH, Burns NC, berkowitz SD, Anand SS, Varigos JD, Fox KAA, Yusf S (2018) Rivaroxaban with or without aspirin in patients with stable coronary artery  disease: an international, randomised, double-blind, placebo-controlled trial. The Lancet. 391 (10117): 205-218. doi:10.1016/S0140-6736(17)32458-3
  53. Delafuente JC (2003) Understanding and preventing drug interactions in elderly patients. Critical Review in Oncology / Hematology. 48 (2): 133-143. doi:10.1016/j.critrevonc.2003.04.004
  54. Gurwitz JH, Soumerai SB, Avorn J (1990) Improving medication prescribing and utilization in the nursing home. Journal of American Geriatric Society. 38 (5): 542-552. doi:10.1111/j.1532-5415.1990.tb02406.x
  55. Patel H, Bell D, Molokhia M, Srishanmuganathan J, Patel M, Car J, Majeed A (2007) Trends in hospital admissions for adverse drug reactions in England: analysis of  national hospital episode statistics 1998-2005. BMC Clinical Pharmacology. 7: 9. doi:10.1186/1472-6904-7-9
  56. Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, benser MBates DW,  (2001) Risk factors for adverse drug events among nursing home residents. Archives of Internal Medicine. 161 (13): 1629-1634. doi:10.1001/archinte.161.13.1629
  57. Fulton MM, Allen ER (2005) Polypharmacy in the elderly: a literature review. Journal of the American Academy of Nurse Practice. 17 (4): 123-132. doi:10.1111/j.1041-2972.2005.0020.x
  58. British Geriatrics Society (2014) Fit for Frailty.British Geriatrics Society, Marjory Warren House 31 St John’s Square LONDON EC1M 4DN. ISBN No. 978-0-9929663-1-7
  59. Duerden M, Payne R, Avery T (2013) Polypharmacy and medicines optimisation. King’s Fund Report, November 2013. doi:10.13140/RG.2.1.1597.0726
  60. Lindeman RD (1995) Renal and urinary tract function. In: Masoro EJ, Ed. Handbook of Physiology. Oxford, Oxford University Press. 1995: 485-503. ISBN: 978-0195077223
  61. Klein-Schwartz W, Oderda GM (1991) Poisoning in the elderly. Epidemiological, clinical and management  considerations. Drugs Aging. 1 (1): 67-89. doi:10.2165/00002512-199101010-00008
  62. Goldstein JL, Scheiman JM, Fort JG, Whellan DJ (2016) Aspirin use in secondary cardiovascular protection and the development of  aspirin-associated erosions and ulcers. Journal of Cardiovascular Pharmacology. 68 (2): 121-126. doi:10.1097/FJC.0000000000000387
  63. McQuaid KR, Laine L (2006) Systematic review and meta-analysis of adverse events of low-dose aspirin and  clopidogrel in randomized controlled trials. American Journal of Medicine. 119 (8): 624-638. doi:10.1016/j.amjmed.2005.10.039
  64. Zeraatchi A, Talebian M-T, Nejati A, Dashti-Khavidaki S (2013) Frequency and types of the medication errors in an academic emergency department in Iran: The emergent need for clinical pharmacy services in emergency departments. Journal of Research and Pharmacy Practice. 2 (3): 118-122. doi:10.4103/2279-042X.122384
  65. Wilcox CS (2002) New insights into diuretic use in patients with chronic renal disease. Journal of American Society of Nephrology. 13 (3): 798-805. doi:10.1681/ASN.V133798
  66. Sellors J, Kaczorowski J, Sellors C, Dolovich L, Woodward C, Willan A, Goeree R, Cosby R, Trim K, Sebaldt R, Howard M, Hardcastke L, Poston J (2003) A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients. Canadian Medical Association Journal. 169 (1): 17-22. PMID: 12847034
  67. Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR (1996) A randomized, controlled trial of a clinical pharmacist intervention to improve  inappropriate prescribing in elderly outpatients with polypharmacy. American Journal of Medicine. 100 (4): 428-437. doi:10.1016/S0002-9343(97)89519-8
  68. Abukhalil AD, Shaloudi AY, Shamasneh NM, Aljamal AM (2021) Awareness of Beers criteria and potentially inappropriate medications among physicians and pharmacists in Palestine. Journal of Pharmacy Practice Reserach. 51 (5): 381-389. doi.org/10.1002/jppr.1728
  69. Jamal I, Amin F, Jamal A, Saeed A (2015) Pharmacist’s interventions in reducing the incidences of drug related problems in any practice setting. International Current Pharmaceutical Journal. 4 (2): 347-352. doi.org/10.3329/ icpj.v4i2.21483

Submitted date:
05/04/2023

Reviewed date:
06/06/2023

Accepted date:
06/10/2023

Publication date:
10/21/2023

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