Skip to main content

Advertisement

SpringerLink
Log in

Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To examine the association between potentially inappropriate medications (PIMs) use and the hospitalization rate in elderly Thai patients.

Methods

In this retrospective cohort study, we collected the electronic medical data of elderly patients aged 60 years and older who visited the outpatient department (OPD) at Thammasat University Hospital in Thailand in 2015. The patients were categorized into PIM and non-PIM users according to the Beers 2019 criteria. We calculated descriptive statistics for demographic variables. We also examined the association between PIM use and various different factors with hospitalization rate during follow-up using log-binomial regression. We calculated the relative risk for association between PIM use and other factors with the hospitalization rate.

Results

We collected data for a total of 32,261 patients. The majority of participants were female (59.65%) and had a mean age of 70.21 years (SD = 7.88). Overall, 63.98% of the patients (n = 20,641) were PIM users and 49.45% (n = 15,952) received polypharmacy (≥ 5 medications). The most common PIM prescription was proton-pump inhibitors, which were 27.51% of all medications prescribed. We found that PIM use increased the risk of hospitalization by 1.31 times (adjusted RR = 1.31, 95% CI: 1.21–1.41, p-value < 0.001). Other factors associated with a higher rate of hospitalizations included older age, male gender, polypharmacy, and a higher number of OPD visits.

Conclusion

PIMs were commonly prescribed to the elderly in the OPD, and were significantly associated with subsequent hospitalization. The provision of an alternative drug list can help physicians avoid prescribing PIMs to the elderly. If PIMs prescription is unavoidable, physicians should closely monitor patients for drug-related problems and deprescribe PIMs when they are no longer indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and material

Available upon request.

References

  1. Anantanasuwong D (2021) Population ageing in Thailand: critical issues in the twenty-first century. In: Narot P., Kiettikunwong N. (eds) Education for the elderly in the Asia Pacific. Springer, Singapore. Education in the Asia-Pacific Region: Issues, Concerns and Prospectsvol 59. https://doi.org/10.1007/978-981-16-3326-3_3

  2. Mangoni AA, Jackson SH (2004) Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 57(1):6–14. https://doi.org/10.1046/j.1365-2125.2003.02007.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Fick DM, Mion LC, Beers MH, Waller J (2008) Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health 31(1):42–51. https://doi.org/10.1002/nur.20232

  4. Onda M, Imai H, Takada Y, Fujii S, Shono T, Nanaumi Y (2015) Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ Open 5(8):e007581. https://doi.org/10.1136/bmjopen-2015-007581

    Article  PubMed  PubMed Central  Google Scholar 

  5. The 2019 American Geriatrics Society Beers Criteria® (2019) Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67(4):674–694. https://doi.org/10.1111/jgs.15767

  6. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P (2015) Stop/start criteria for potentially inappropriate prescribing in older people: version 2 [published correction appears in Age Ageing 47(3):489]. Age Ageing 44(2):213–218. https://doi.org/10.1093/ageing/afu145

  7. Wang F, Ma Z, Liu M, Wu X (2020) Potentially inappropriate medications at admission and discharge in older adults: a comparison of the Beers 2019 and 2015 criteria. Int J Clin Pharmacol Ther 58(6):299–309. https://doi.org/10.5414/CP203638

    Article  PubMed  Google Scholar 

  8. Sharma R, Bansal P, Garg R, Ranjan R, Kumar R, Arora M (2020) Prevalence of potentially inappropriate medication and its correlates in elderly hospitalized patients: a cross-sectional study based on Beers Criteria. J Family Community Med 27(3):200–207. https://doi.org/10.4103/jfcm.JFCM_175_20

  9. Gorzoni ML, Rosa RF (2020) Beers 2019 criteria in very old hospitalized patients. Rev Assoc Med Bras 66(7):918–923. https://doi.org/10.1590/1806-9282.66.7.918

  10. Albert SM, Colombi A, Hanlon J (2010) Potentially inappropriate medications and risk of hospitalization in retirees: analysis of a US retiree health claims database. Drugs Aging 27(5):407–415. https://doi.org/10.2165/11315990-000000000-00000

    Article  PubMed  PubMed Central  Google Scholar 

  11. Varga S, Alcusky M, Keith SW, Hegarty SE, Del Canale S, Lombardi M, Maio V (2017) Hospitalization rates during potentially inappropriate medication use in a large population-based cohort of older adults. Br J Clin Pharmacol 83(11):2572–2580. https://doi.org/10.1111/bcp.13365

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lo AX, Flood KL, Biese K, Platts-Mills TF, Donnelly JP, Carpenter CR (2017) Factors associated with hospital admission for older adults receiving care in U.S. emergency departments. J Gerontol A Biol Sci Med Sci 72(8):1105–1109. https://doi.org/10.1093/gerona/glw207

  13. Inouye SK, Zhang Y, Jones RN, Shi P, Cupples LA, Calderon HN, Marcantonio ER (2008) Risk factors for hospitalization among community-dwelling primary care older patients: development and validation of a predictive model. Med Care 46(7):726–731. https://doi.org/10.1097/MLR.0b013e3181649426

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lohman MC, Scherer EA, Whiteman KL, Greenberg RL, Bruce ML (2018) Factors associated with accelerated hospitalization and re-hospitalization among medicare home health patients. J Gerontol A Biol Sci Med Sci 73(9):1280–1286. https://doi.org/10.1093/gerona/glw335

    Article  PubMed  Google Scholar 

  15. Magalhães MS, Santos FSD, Reis AMM (2019) Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge. Einstein (Sao Paulo) 18:eAO4877. https://doi.org/10.31744/einstein_journal/2020AO4877

  16. Sakunphanit T (2008) Thailand: universal health care coverage trough pluralistic approaches [Internet]. International Labour Organization pp. 12–18. Available from: https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---soc_sec/documents/publication/wcms_secsoc_6612.pdf

  17. Tangcharoensathien V, Suphanchaimat R, Thammatacharee N, Patcharanarumol W (2012) Thailand’s universal health coverage scheme. Economic and Political Weekly 47(8). Available from: https://www.researchgate.net/publication/266590494_Thailand%27s_Universal_Health_Coverage_Scheme [cited 22 April 2021]

  18. World Health Organization (2016) International statistical classification of diseases and related health problems 10th revision version for 2016. Geneva. https://icd.who.int/browse10/2016/en#/XVIII [Accessed 20 April 2021]

  19. Lu WH, Wen YW, Chen LK, Hsiao FY (2015) Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study. CMAJ 187(4):E130–E137. https://doi.org/10.1503/cmaj.141219

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pannoi T, Chapman RS, Panza A (2020) Prevalence of potentially inappropriate medication (PIM) and factors associated with PIM in elderly outpatient prescriptions at a district hospital in the southern region of Thailand. J Health Res 28(2):100–8. Available from: https://he01.tci-thaijo.org/index.php/jhealthres/article/view/92875 [cited 2020 Jun 10]

  21. Diaz-Quijano FA (2012) A simple method for estimating relative risk using logistic regression. BMC Med Res Methodol 15(12):14. https://doi.org/10.1186/1471-2288-12-14

    Article  Google Scholar 

  22. Al-Azayzih A, Alamoori R, Altawalbeh SM (2019) Potentially inappropriate medications prescribing according to Beers Criteria among elderly outpatients in Jordan: a cross sectional study. Pharm Pract (Granada) 17(2):1439.  https://doi.org/10.18549/PharmPract.2019.2.1439

  23. Alhawassi TM, Alatawi W, Alwhaibi M (2019) Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers Criteria. BMC Geriatr 19:154. https://doi.org/10.1186/s12877-019-1168-1

    Article  PubMed  PubMed Central  Google Scholar 

  24. Motallebzadeh N, Jayaprakash G, Mohammadi E (2019) Evaluation of rationality of geriatric patients’ prescription based on Beers Criteria in a tertiary care hospital in India. Open Access Maced J Med Sci 7(6):987–991. https://doi.org/10.3889/oamjms.2019.172

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vatcharavongvan P, Puttawanchai V (2019) Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria. Pharm Pract (Granada) 17(3):1494. https://doi.org/10.18549/PharmPract.2019.3.1494

  26. Alturki A, Alaama T, Alomran Y, Al-Jedai A, Almudaiheem H, Watfa G (2020) Potentially inappropriate medications in older patients based on Beers Criteria: a cross-sectional study of a family medicine practice in Saudi Arabia. BJGP Open 4(1).  https://doi.org/10.3399/bjgpopen20X101009

  27. Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, Rojas-Fernandez C, Walsh K, Welch V, Moayyedi P (2017) Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can Fam Physician 63(5):354–364

    PubMed  PubMed Central  Google Scholar 

  28. Drug and Medical Supply Information Center, Ministry of Public Health (2020) Announced drug policy committee on National List of Essential Medicine 2020. Available from: http://dmsic.moph.go.th/index/dataservice/97/0 [cited 2021 Apr 1]

  29. Drug Informatin Center, Faculty of Pharmacy, Mahidol University (2018) Proton pump inhibitors (PPIs) and it’s unnecessary use.[Internet]. weekly news 3rd week of Oct 2018. Available from: https://www.pharmacy.mahidol.ac.th/dic/news_week_full.php?id=1480 [cited 2020 Apr 30]

  30. Limpawattana P, Kamolchai N, Theeranut A, Pimporm J (2013) Potentially inappropriate prescribing of Thai older adults in an internal medicine outpatient clinic of a tertiary care hospital. Afr J Pharm Pharmacol 7(34):2417–2422

    Article  Google Scholar 

  31. Cashin AG, Folly T, Bagg MK, Wewege MA, Jones MD, Ferraro MC, Leake HB, Rizzo RR, Schabrun SM, Gustin SM, Day R (2021) Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ 374

  32. Chou R, Qaseem A, Snow V, Casey D, Cross Jr JT, Shekelle P, Owens DK and Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147(7):478–491

    Article  Google Scholar 

  33. Unger T, Borghi C, Charchar F, Khan N, Poulter N, Prabhakaran D et al (2020) International society of hypertension global hypertension practice guidelines. Hypertension 75(6):1334–1357. Available from: https://doi.org/10.1161/HYPERTENSIONAHA.120.15026 [cited 17 April 2021]

  34. Pugh D, Gallacher PJ, Dhaun N (2019) Management of hypertension in chronic kidney disease. Drugs 79(4):365–379. https://doi.org/10.1007/s40265-019-1064-1

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jeon HL, Park J, Han E, Kim DS (2018) Potentially inappropriate medication and hospitalization/emergency department visits among the elderly in Korea. Int J Qual Health Care 30(1):50–56. https://doi.org/10.1093/intqhc/mzx171

    Article  PubMed  Google Scholar 

  36. Reich O, Rosemann T, Rapold R, Blozik E, Senn O (2014) Potentially inappropriate medication use in older patients in Swiss managed care plans: prevalence, determinants and association with hospitalization. PLoS ONE 9(8):e105425. https://doi.org/10.1371/journal.pone.0105425

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Huang CH, Umegaki H, Watanabe Y, Kamitani H, Asai A, Kanda S, Nomura H, Kuzuya M (2019) Potentially inappropriate medications according to STOPP-J criteria and risks of hospitalization and mortality in elderly patients receiving home-based medical services. PLoS ONE 14(2):e0211947. https://doi.org/10.1371/journal.pone.0211947

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Pasina L, Djade CD, Tettamanti M, Franchi C, Salerno F, Corrao S, Marengoni A, Marcucci M, Mannucci PM, Nobili A (2014) REPOSI Investigators. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI study. J Clin Pharm Ther 39(5):511–5. https://doi.org/10.1111/jcpt.12178

  39. Hallgren J, Fransson EI, Kåreholt I, Reynolds CA, Pedersen NL, Dahl Aslan AK (2016) Factors associated with hospitalization risk among community living middle aged and older persons: results from the Swedish Adoption/Twin Study of Aging (SATSA). Arch Gerontol Geriatr 66:102–8. https://doi.org/10.1016/j.archger.2016.05.005

  40. Ruangruitchankul S (2018) Polypharmacy in the elderly. Ramathibodi Nurs J 41(1):95–104. [cited 2020 Apr 29]

  41. Ruangritchankul S, Krairit O, Putthipokin K, Chansirikarnjana S, Assavapokee T, Sraium S (2018) Polypharmacy among older adults in Outpatient Clinic, Internal Medicine Department, Ramathibodi Hospital. Thai J Toxicol 33(1):35–40. Available from: https://li01.tci-thaijo.org/index.php/ThaiJToxicol/article/view/243627 [cited 2021 Feb 28]

  42. Badawy NA, Labeeb SA, Alsamdan MF, Alazemi BF (2020) Prevalence and risk of polypharmacy among community-dwelling, elderly Kuwaiti patients. Med Princ Pract 29(2):166–173. https://doi.org/10.1159/000503298

    Article  PubMed  Google Scholar 

  43. Abdulah R, Insani WN, Destiani DP, Rohmaniasari N, Mohenathas ND, Barliana MI (2018) Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. Ther Clin Risk Manag 4(14):1591–1597. https://doi.org/10.2147/TCRM.S170475

    Article  Google Scholar 

  44. Abe T, Tamiya N, Kitahara T, Tokuda Y (2015) Polypharmacy as a risk factor for hospital admission among ambulance-transported old-old patients. Acute Med Surg 3(2):107–113. https://doi.org/10.1002/ams2.153

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Thammasat University, Pathum Thani, Thailand

    Vorawee Varavithya, Chayanee Tirapat, Penpitcha Rojpibulstit & Panadda Poovichayasumlit

  2. Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Nonthaburi, Thailand

    Vanida Prasert

  3. Thammasat University Research Unit in Physical Anthropology and Health Science, Thammasat University, Pathum Thani, Thailand

    Pasitpon Vatcharavongvan

Authors
  1. Vorawee Varavithya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chayanee Tirapat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Penpitcha Rojpibulstit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Panadda Poovichayasumlit
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vanida Prasert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pasitpon Vatcharavongvan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Vorawee Varavithya: study design, data collection, data analysis, manuscript writing. Chayanee Tirapat: study design, data collection, data analysis, manuscript writing. Penpitcha Rojpibulstit: study design, data collection, data analysis, manuscript writing. Panadda Poovichayasumlit: study design, data collection, data analysis, manuscript writing. Vanida Prasert: study design, data analysis, manuscript writing. Pasitpon Vatcharavongvan: study design, data analysis, manuscript writing.

Corresponding author

Correspondence to Pasitpon Vatcharavongvan.

Ethics declarations

Ethics approval

The Ethical Review Sub-Committee Board for Human Research of Faculty of Medicine, Thammasat University approved this study (MTU-EC-CF-0–221/61).

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Varavithya, V., Tirapat, C., Rojpibulstit, P. et al. Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study. Eur J Clin Pharmacol 78, 847–855 (2022). https://doi.org/10.1007/s00228-021-03269-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-021-03269-9

Keywords

Search

Navigation