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Potentially inappropriate prescribing in elderly outpatients in Croatia

European Journal of Clinical Pharmacology volume 70, pages 737–744 (2014)Cite this article

Abstract

Purpose

The purpose of this study was to determine the prevalence of inappropriate prescribing to the elderly and to identify possible gender-related differences in prescribing certain potentially inappropriate medications (PIMs) to outpatients by using large administrative prescription database.

Methods

Medications prescribed for elderly outpatients (≥ 65 years) in Primorsko-Goranska County, Croatia, who received five or more different drugs simultaneously in 2010, were analyzed. The prevalence of potentially inappropriate drugs prescribed to the elderly was assessed using the new comprehensive protocol developed by authors Mimica Matanović and Vlahović-Palčevski.

Results

A total of 62.4 % of patients received at least one medication with unfavorable benefit/risk ratio in the elderly. Female patients were given inappropriate medications in a significantly higher percentage than men (69.3 % vs. 50.5 %; p < 0.001). The average number of prescriptions for PIMs that should have been avoided with certain diseases or conditions was 0.88 per patient in the survey. The most common drug combination potentially leading to serious drug–drug interactions (DDIs) included an angiotensin-converting enzyme (ACE) inhibitor and a potassium supplement.

Conclusions

Our study has shown that every tenth medication prescribed to a patient > 65 years and receiving five or more drugs was potentially inappropriate. Elderly women were prescribed PIMs more often than men. Drugs of concern in female patients were benzodiazepines, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs). In male patients, there was a significantly higher proportion of possible interactions with warfarin, theophylline, and medications affecting the cardiovascular system, such as ACE inhibitors and amiodarone.

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Conflict of interest

None.

Contributions of Authors

Dr. Branislava Popović: Conception and design of the study, analysis and interpretation of data, drafting and revising the article, and final approval of the manuscript.

Dr. Nives Radošević Quadranti: Conception and design of the study, analysis and interpretation of data, drafting and revising the article, and final approval of the manuscript.

Dr. Suzana Mimica Matanović: Conception and design of the study, interpretation of data, critically revising the manuscript, and final approval of the manuscript.

Dr. Ines Diminić Lisica: Interpretation of data, drafting and revising the article, and final approval of the manuscript.

Dr. Aleksandar Ljubotina: Interpretation of data, drafting and revising the article, and final approval of the manuscript.

Dr. Dubravka Pezelj Duliba: Acquisition and interpretation of data, drafting and revising the article, and final approval of the manuscript.

Dr. Vera Vlahović-Palčevski: Conception and design of the study, acquisition of data, analysis and interpretation of data, drafting and critically revising the article, and final approval of the manuscript.

Author information

Affiliations

  1. Department of Family Medicine, University of Rijeka Medical Faculty, Braće Branchetta 20, 51000, Rijeka, Croatia

    Branislava Popović, Ines Diminić Lisica & Aleksandar Ljubotina

  2. Department of Pharmacology, University of Rijeka Medical Faculty, Braće Branchetta 20, 51000, Rijeka, Croatia

    Nives Radošević Quadranti & Vera Vlahović-Palčevski

  3. Clinical Pharmacology Unit, University Hospital Center Osijek, J. Huttlera 4, 31000, Osijek, Croatia

    Suzana Mimica Matanović

  4. Department of Pharmacology, Medical Faculty Osijek, University J.J. Strossmayer Osijek, J. Huttlera 4, 31000, Osijek, Croatia

    Suzana Mimica Matanović

  5. Croatian Health Insurance Fund, Margaretska 3, 10000, Zagreb, Croatia

    Dubravka Pezelj Duliba

  6. Department of Clinical Pharmacology, University Hospital Center Rijeka, Krešimirova 42, 51000, Rijeka, Croatia

    Vera Vlahović-Palčevski

Authors
  1. Branislava Popović
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  2. Nives Radošević Quadranti
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  3. Suzana Mimica Matanović
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  4. Ines Diminić Lisica
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  5. Aleksandar Ljubotina
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  6. Dubravka Pezelj Duliba
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  7. Vera Vlahović-Palčevski
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Corresponding author

Correspondence to Nives Radošević Quadranti.

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Popović, B., Quadranti, N.R., Matanović, S.M. et al. Potentially inappropriate prescribing in elderly outpatients in Croatia. Eur J Clin Pharmacol 70, 737–744 (2014). https://doi.org/10.1007/s00228-014-1667-0

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  • DOI: https://doi.org/10.1007/s00228-014-1667-0

Keywords

  • Inappropriate prescribing
  • Elderly
  • Outpatients
  • Polypharmacy
  • Gender