engleski

Potentially inappropriate medicines in elderly hospitalised patients

Introduction: Potentially inappropriate medicines (PIMs) may pose more risks than benefits to a patient, and frequently are linked to increased drug-related morbidity and mortality, prevalence of adverse drug events and high cost to public health system [1]. Since the introduction of the first criteria for inappropriate drug use by Dr. Mark Beers in 1991 [2], various new criteria, both implicit and explicit, have been defined and validated for the purpose of minimizing inappropriate prescribing in older people [3]. However, to the best of our knowledge, until now, EU(7)-PIM list has not been compared to any widely used criteria for detecting PIMs. Aim: The aim of this study was to determine prevalence of PIMs in elderly hospitalised patients by using the EU(7)-PIM list [4], STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) version 2 criteria [5] and the new comprehensive protocol [6]. Methods: A prospective observational study was conducted during the 15-month period at the Department of Internal Medicine, University Hospital Dubrava. Patients older than 65 years, acutely and electively admitted who signed the Informed consent were included in the study. Age, gender, diagnoses, medication history and medicines at discharge were recorded by a careful review of patient’s discharge documents, hospital record, and through the interview with the patient or patient’s family member or a caregiver, if needed. PIMs were identified by using the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Results: Two hundred and seventy six patients were included in the study with a median age (range) of 74 (65-92) years. On average patients used 7 (1-17) medications and had 7 (2-20) comorbidities. According to the STOPP version 2 criteria, 1.42 ± 1.46 PIMs per patient were identified among 69% of patients. EU(7)-PIM list identified 1.20 ± 1.15 PIMs per patient in 67% of patients, while 0.49 ± 0.76 PIMs per patient were found according to the comprehensive protocol and were distributed among 37% of patients. STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (P<0.001). Gender (P=0.002), glomerular filtration rate (P=0.039) and number of comorbidities (P=0.001) were associated with the proportion of PIMs for the STOPP version 2 criteria only. According to all three protocols, benzodiazepines were the most prevalent prescribed PIMs, followed by proton pump-inhibitors and tramadol according to the EU(7)-PIM list and STOPP version 2 criteria only. Conclusion: Depending on the tool used for identification, between one and two thirds of older hospitalized patients had at least one PIM at discharge. STOPP version 2 criteria identified significantly more PIMs than the EU(7)-PIM list and the comprehensive protocol, and was found as a more sensitive tool for PIM detection.

potentially inappropriate medicines, elderly, hospitalised patients

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