Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria
Pasitpon Vatcharavongvan1★, Viwat Puttawanchai1★ Corresponding author
- 1Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, Pathum-Thani, Thailand.
CORRESPONDENCE
Pasitpon Vatcharavongvan
MD, PhD. Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University, Pathum-Thani, Thailand.
Received: 15-03-2019; Accepted: 05-08-2019.
Volume 17, Issue 3 · pp. 1494 · PUBLISHED Jul-Sep 2019 · DOI: 10.18549/PharmPract.2019.3.1494
ABSTRACT
Objective: The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors. Methods: This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors. Results: A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs. Conclusions: PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.
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Vatcharavongvan, P., & Puttawanchai, V. (2019). Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria. Pharmacy Practice, 17(3), 1494. https://doi.org/10.18549/PharmPract.2019.3.1494