Potentially Inappropriate Medication at a Private Hospital

potentiall(a)y remote medicine at a Private HospitalAbstractThe mathematical function of certain medicines in geriatrics when potential risks come forwardweigh the potential benefit and an effective election is available is called as potentially Inappropriate medicinal dose. Beca exercise geriatrics argon more(prenominal) sensitive towards wayward effects of medications. Beers criteria which is updated and reviewed by American Geriatric hostelry list out 53 medications/therapeutic classes of drugs to be avoided in geriatrics. methodological analysis A prospective observational theatre of ope proportionalityns was conducted for 9 months in a 650 bed private corporate hospital, South India. All geriatric uncomplainings admitted in the hospital during the issue period was included. Beers Criteria 2013 were social functiond to identify potentially out or keeping(p) medications. Result The prevalence of PIM call (52%) was significantly higher in drive universe. An avg of 10 drugs were taken by the cogitation community. A total of 215 medications were identify as PIMs. Among them 195(90%) medications should be avoided by the geriatrics independent of their particularise ( family I). 66(60%) of the discover population had economic consumptiond more than iodin(a) PIMs. 91(83%) of the PIM users had at least(prenominal) unrivalled DRPs and the mean DRPs determine of the PIM users were 1.591.3. Conclusion High prevalence of PIMs in the battleground population signifies the bespeak of monitoring geriatric prescriptions.Key words PIMs, Beers Criteria, GeriatricsIntroductionIn recent years proportion of geriatric hospital access with comorbidity and polypharmacy has been increase continuously (1, 2). unbecoming drug events (ADRs) argon the or so common intellectual for hospital admission, but some time its not identified. Medication errors (MEs) or conventional adverse drug reactions (ADRs) are the common reason for adverse drug events which e nds in clinical symptoms. Overall, elderly patients need greater oversight to drug therapy and safety parameters (1, 3-5).Greater attention is needed for geriatric population due to eld related pharmacodynamics and pharmacokinetic changes. But appropriate pharmaceutical burster for elderly are determined on the basis of clinical psychometric test conducted with adult population.(6) The burden of harm military issueing due to the use of multiple drugs in geriatric populations is a major health related problem in developed countries. A research study reveals that around one in four geriatrics admitted to hospitals are confident(p) with at least one remote medication and potentially preventable adverse drug reactions accounts for close 20% of all inpatient deaths (7).The perspicacity of potentially foreign medication (PIM) in geriatric is a challenging organise and there is a need for considering many factors which influences the prescribing as wellhead as outcome. Eight we ll known tools are available to identify the PIMs and studies reports that Beers criteria is the best and easy one to assess the PIMs. Beers criteria also has the advantage over others because it is periodically updated (8).This study thereof aimed to investigate the prevalence of PIM use on geriatric population utilize Beers criteria 2012 and its connection with medicine Related Problems (DRPs) .MethodologyStudy Site The work entitled A study on prevalence and impact of Potentially Inappropriate Medication use in geriatrics at a private corporate hospital was carried out in a 640 supply private corporate hospital, South India.Study Design Prospective observational study.Study Period Nine months.Inclusion criteria Patients above age of 65 yrs.Exclusion criteria The patients who are un forgeting to participate in the study and out patientsMETHOD A regular ward rounds was carried out in all the wards of General medicine. Each patients medication profile was reviewed. Patients wh o met the inclusion criteria were briefed on the project with the help of patient information form and if they are willing to participate in the study their consent was obtained. The data from medical examination chart were recorded in customized data entry form.The confirming drugs were evaluated and PIMs use were identified with the help of Beers criteria. The drugs which are identified as PIM are categorized into followingPotentially inappropriate medications /classes to avoid in geriatrics,Potentially inappropriate medications /classes to avoid in geriatrics with certain ghoulish condition that the listed PIM use can exacerbateMedications to be used with carefulness in geriatrics.ADRs associated with PIMs use were assessed. do drugs interaction and ADR was monitored and inform. DRPs and drug Risk Ratio (DRR) were metric for PIMs. DRPs were the sum of ADR, drug interaction and drug allergy.DRR was calculated as the count of DRPs in relation to how often the drug was used (DRPS/ telephone build of times used).Results and DiscussionIn the study period, 212 patients were included in the study as per inclusion criteria and exclusion criteria. 110 (52%) patients were open to be prescribed with PIMs listed in Beers criteria (fig no 01). A similar study conducted by Birader K et al (2013) (9) reported that PIM prevalence were 38% in their study population. Increased anxiolytics use as a prophylaxis for hospital related anxiety might be the reason for high prevalence of PIM than the later study. The total spell of patients in study population were 110. Among them 62(56%) were males and 48(44%) were females.The study direct reveals that PIMs user are generally males. A similar study conducted by Birader K et al (2012) (9) reported that prevalence of PIM use is more among males than females.The age categorization of PIM users was done. The maximum age of PIM users was 93 years and mean age of PIM users was bring to be 70.25.77. The median(prenominal) age for PIM users was 68.5 years.The result indicated that age group of (65-69) were commonly prescribed by PIMs. This results compared with a previous study carried out by Birader K et al (2012) (9) which also reports that PIMs were ofttimes prescribed in the age group of 65-69 years. The societal habit of the PIM users shows that 8(7%) patients were smokers and alcoholics, 14(13%) patients were alcoholics, 21(19%) patients were smokers and 67(61%) patients were teetotalers in PIM users.The comorbidities of the PIM users was analyzed. There were 52 (47%) deplorable from hypertension and 32(29%) were suffering from DM. The results shows that well-nigh of the study group had comorbidities of hypertension followed by DM and CVDs. A similar study conducted by Fouquet A (11) also reported that most common diagnosis among their study population was hypertension and diabetes.The number of drugs prescribed for the PIM users were calculated (fig no 2). The mean number of drugs per presc ription was 9.92 with the maximum of 16 drugs and minimum of 5 drugs prescribed. The above results signifies that all prescriptions were in polypharmacy category. A similar study conducted by Blozik E (12) concluded that one of the principal(prenominal) factor for PIM use is polypharmacy.The number of PIM drugs per prescription in the study population was calculated ( physique no 3). The result reveals that 44(40%) were using one PIM drug, 50(45%) were using both PIMs, 14(13) were using three PIMs, 1(1%) were using 4 PIMs and the maximum of 5 PIMs use were found in 1(1%) of the study population. 66(60%) of the study population consumed more than one PIM. The mean was found to be 1.80.78 and an avg of 2 PIM was used by the study population. A similar study conducted by Dormann H (2013) (13) were reported that 87% of the study population consumed at least one PIM.Among the PIM users the total number of PIM drugs was calculated and it was found to be 215 drugs. PIM users were categor ized into three groups according to Beers criteria. (Table no 2) There were 195(90%) belongs to category I, 12(6%) were in category II and 8(4%) were in category III.The individual categories of PIM was analyzed. It was found that alprazolam 57(52%), clonazepam 17(15%), hyocyamine 10(9%), Lorazepam 10(9%), hydroxyzine 10(9%), zolpidem 10(9%), ketorolac 10(8%) were prescribed in category I (table no 3). A similar study conducted by Birader K et al (2013) (16) reported that alprazolam and cimetidine were shoply used PIM among their study population. enjoyment of hyocyamine in constipation 3(25%) accounts for the most frequent inappropriate drug use in category II (table no 4). hydroxyzine in constipation 2(17%), cyproheptidine in constipation 2(17%), ketorolac in PUD 2(17%), clonazepam in frequent fall 1(8%), ketorolac in CHF 1(8%) and theophylline in insomnia 1(8%) were other category II inappropriate medication use.Use of escitalapram 3(40%), mirtazapine 2(30%), fluoxetine 1(10%), sertraline 1(10%) and Duloxetine 1(10%) were the category III PIMs (table no5).The DRP among the PIM users were analyzed (fig no . It was found that 19(17%) of the PIM users were free from DRPs. Majority of the study population had at least one drug related problems. The mean hold dear of DRP in the study population was found to be 1.591.3. The minimum observed number of DRP per patient was one and maximum observed number of DRP per patient was six.The ADR use was monitored in the study population. A total number of 40 ADR associated with PIM use (Fig no5) and 14 ADR associated with nonPIM use were identified. The study result reveals that one among three PIM users were found to have at least one ADR. A similar study conducted by N. Nixdorff et al (2008) were also reported that PIM users were found to experience ADR most frequently than nonPIM users.As a part of our study, screening of drug interactions were done. A total number of 131 major drug interactions were identified, in t hat 111 were unique. Among the drug interactions found 16(12%) were PIM-PIM drug interactions, 39(30%) were PIM-other drugs drug interactions and 76(58%) were caused by non PIM drugs (table no 6).do drugs risk ratio were calculated for the study population (table no7). It was observed that prochlorperazine had the highest DRR (4) followed by purple heart (2), digoxine (2), pentazocine (2) and duloxetine (2).The statistical analysis of obtained results has been done using statistical tools. The association of different variables are analyzed using 2 test.On assessment of association between number of comorbidities with number of drugs and number of PIMs (table no8), the result proved that number of comorbidies are statistically associated with the number of drugs at 0.001 aim of significance and number of PIMs at 0.05 take aim of significance. It means that as number of comorbidity increases polypharmac and PIM use also increases.On assessment of association between number of drug s and number of PIMs (table no 9), the result proved that number of drugs are statistically associated with number of PIMs at 0.05 level of significance. This result proves that polypharmacy is one of the reason for PIMs.On assessment of association between number of DRPs with number of drugs and number of PIMs (table no10), the result proved that DRPs are statistically associated with number of PIMs at 0.01 level of significance but not associated with number of drugs at 0.05 level of significance.This result proves that DRPs is more associated with PIMs than polypharmacy which means it not the number of drugs contributing to DRPs but the use of PIMs.ConclusionOur study identified a high prevalence of PIMs use and associated DRPs in the study population. DRPs due to PIMs is preventable. Development and implementation of new criteria or modification of already existing criteria such as Beers criteria, START STOPP criteria which will helps in safe prescribing practice can reduce the PIMs use.ReferencesBudnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011 365 200212.Budnitz DS, Shehab N, Kegler SR, Richards CL Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007 147 75565.Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005 clxv 6874.Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital prospective analysis of 18 820 patients. BMJ 2004 329 159.Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009 57 0006Avorn J, Shrank WH. Adverse drug reactions in elderly people A potent cause of preventable illness. BMJ. 2 0083369567Minimizing Inappropriate Medications in Older Populations A 10-step Conceptual Framework. Ian A. Scott, MBBS, MHA, MEd,a Leonard C. Gray, MBBS, MMed, PhD,b Jennifer H. Martin, MBChB, MA (Oxon), PhD,c Charles A. Mitchell, MBBSdOpondo D. Inappropriateness of Medicationth Prescriptions to Elderly Patients in the Primary supervise Setting A Systematic Review, plos one, aug 2012, volume 7, issue 8Biradar K assessment of potentially inappropriate medication in elderly patients at Basavehwar teaching hospitalIJPP 2012dec, vol 5,issue 4, 73-5Denys TL (2011) Functional Decline Associated With Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults With Dementia, Am J Alzheimers Dis Other Demen. 2011 December 26(8) 60615. inside10.1177/1533317511432734Fouquet A, Zegbeh H, Krolak-Salmon P, Mouchoux C. Detection of potentially inappropriate medication in a French geriatric teaching hospital A comparison study of the French Beers criteria and the imp roved prescribing in the elderly tool. J Eurger 2012 3 326-29Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs aging. 201330561-8Dormann H, Sonst A, Mller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Brkle T, Maas R. Adverse drug events in older patients admitted as an emergency the business office of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013 110(13) 2139. inside 10.3238/arztebl.2013.0213N. Nixdorff et al. Potentially inappropriate medications and adverse drug effects in elders in the ED. AJEM 2008 26 697700Tables and figuresNO. of PIM/prescriptionNumber of patientsN=110 constituent144402504531413411511Table no1 Number of PIM per Prescriptionsl nocategoryno. of PIMspercentage1PIM drugs/classes to be avoid in geriatrics (category I)195902PIM to be avoided in certain pathological cond ition (category II)1263PIMs to be used with caution (category III)84Table no2 Categories of PIMsl noDrugs nary(prenominal) of Patientssl noDrug nary(prenominal) of Patients1Alprazolam57 (29%)16Nitrofurentoin3(1.5%)2Clonazepam17(9%)17Mirtazapine2(1%)3Hyocyamine10(5%)18Cyproheptidine2(1%)4Lorazepam10(5%)19Diazepam2(1%)5Hydroxyzine10(5%)20Piroxicam2(1%)6Zolpidem10(5%)21Prochloperazine2(1%)7Ketorolac10(5%)22Chlorphemiramine2(1%)8Aceclofenac9(4.5%)23Trihexylphenedine2(1%)9propoxyphene8(4%)24Digoxin2(1%)10Diclofenac7(3.5%)25Phenobarbitone1(0.5%)11spironolactone6(3%)26Naproxen1(0.5%)12Prazosin5(3%)27Clinidium-chlordiazepoxide1(0.5%)13clonidine5(3%)28Indomethacin1(0.5%)14Chlordiazepoxide3(1.5%)29Metachlopramide1(0.5%)15 amitriptyline hydrochloride3(1.5%)30Pheniramine1(0.5%)31Pentazocine1(0.5%)Table no 3 kin 1(PIM drugs/classes to be avoid in geriatrics)Sl noDrugDisease no PatientsPercentage1KetorolacCHF182Hydroxyzine befooling2173HyocyamineConstipation3254KetorolacPUD2175CyproheptidineCons tipation2176ClonazepamFrequent Fall187InsomniaTheophyllin18Table no 4 class II (PIM to be avoided in certain pathological condition)sl noDrug noneof Patientspercentage1Mirtazapine2302 fluoxetine1103Sertraline1104Duloxetine1105Escitalapram340Table no 5 Cateegory III (PIMs to be used with caution)NO OF INTERACTION per centumPIM-PIM1612PIM- OTHER DRUGS3930OTHER DRUGS7658Table no6 Categories of Drug InteractionsSl NoDrugDRPsTotalDrug Risk Ratio1PROCLORPERAZINE824.002PHENOBARBITONE212.003DIGOXIN422.004PENTAZOCINE212.005DULOXETINE212.006NAPROXEN212.00Table no.7 Drug Risk RatioSl noVarienceNo. of comorbiditiesChi fashion plate valueP value12 31No. of PIMs15211312.76*0.052101215 3715122No. of drugs6-81316426.77*0.0019-1182517 121719Table no8 tie beam of no. of comorbidities with no. of drugs and PIMs.varienceNo. of DrugsChi squire valueP value6-89-1112-1415No. of PIMs116214321.76*0.0012142484 32554Table no 9 Association of no. drugs and no. PIMsSl noVarienceNo. of DRPsChi squire valueP v alue01231No. of PIMs1112110221.76*0.0012723812 314292No. of drugs6-891511111.770.059-11425612 1268310Table no10 Association of DRPs with no. of drugs and PIMsFig no1 Prevalence of PIMsFig no2 Number of Drugs Prescribed per PatientFig no3 Number of PIM per PrescriptionFig no 4 Adverse Drug Events and Its frequencyFig no5 Adverse Drug Events and Its Frequency