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The analysis of the use of potentially inappropriate medications in elderly in the Slovak Republic

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Abstract

Background The prevalence of potentially inappropriate medications (PIM) using explicit criteria has been well documented in European countries, however, there is a lack of evidence in the Slovak Republic. There are no specific guidelines and there is a lack of geriatricians in Slovakia. Higher use of PIM leads to greater healthcare services use as well as increases healthcare costs. Objective The aim of this study was to perform an evaluation of the availability and the actual use of PIM by geriatric patients in the nursing homes in Slovakia. Setting Together 459 residents ≥ 65 years living in nursing homes in the Slovak Republic were included for analysis of their drug therapy. Methods Retrospective analysis of medical records of patients’ therapy for evaluation of PIM use. Identification of PIM was based on the Renom-Guiteras EU7 PIM list published in 2015. Main outcome measure Potentially inappropriate medications use. The presence of polypharmacy in patients. Results Inappropriate drug use according to EU7 PIM list was identified in 90.60% (416) patients. The mean number of PIM was 2.34 ± 0.07 PIM/patient/day. Polypharmacy (use of ≥ 5 drugs by patient daily) was found in 83% of all patients. The mean number of prescribed drugs was 8.32 ± 0.17 drugs/patient/day. Out of all 282 PIM listed in EU7 PIM list, there are 150 (53.19%) available on the Slovak market and 86 (30.50%) were used in patients. Patients using at least one PIM took two times more drugs compared to patients without PIM (8.77 ± 0.17 vs. 3.98 ± 0.39 drugs/patient/day, p < 0.001). The most common PIM were PPI (36% of patients), piracetam (17.2%) and alprazolam (16.80%). Conclusions The risk of PIM was almost 9.5 times higher if polypharmacy was present in geriatric patients (OR 9.51, 95% CI, 4.86 – 18.61, p < 0.001). There was a strong, positive correlation (ρ = 0.65) between the number of drugs and the number of PIM (p < 0.01). There was neither association between age/gender of patient and polypharmacy; nor age/gender of patient and presence of PIM. The lack of geriatricians and national guidelines for inappropriate prescribing results in alarmingly high use of PIM in the Slovak Republic.

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References

  1. Ranci C, Pavolini E, editors. Reforms in long-term care policies in europe: investigating institutional change and social impacts [Internet]. New York: Springer; 2013 [cited 2019 Apr 15]. Available from: https://www.springer.com/us/book/9781461445012.

  2. World Population Prospects 2017_KeyFindings. Ageing. 2016 [cited 2019 Jan 25]. Available from: http://www.un.org/en/sections/issues-depth/ageing/.

  3. Extended tables of basic SR data. [Internet]. [cited 2019 Jan 25]. Available from: http://www.infostat.sk/vdc/sk/index.php?option=com_content&view=category&layout=blog&id=13&Itemid=58.

  4. Shelton PS, Fritsch MA, Scott MA. Assessing medication appropriateness in the elderly: a review of available measures. Drugs Aging. 2000;16:437–50.

    PubMed  CAS  Google Scholar 

  5. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet Lond Engl. 2007;370:173–84.

    Google Scholar 

  6. Karandikar YS, Chaudhari SR, Dalal NP, Sharma M, Pandit VA. Inappropriate prescribing in the elderly: a comparison of two validated screening tools. J Clin Gerontol Geriatr. 2013;4:109–14.

    Google Scholar 

  7. Mangin D, Bahat G, Golomb BA, Mallery LH, Moorhouse P, Onder G, et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): position statement and 10 recommendations for action. Drugs Aging. 2018;35:575–87.

    PubMed  PubMed Central  Google Scholar 

  8. Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71:861–75.

    PubMed  PubMed Central  Google Scholar 

  9. Chutka DS, Takahashi PY, Hoel RW. Inappropriate medications for elderly patients. Mayo Clin Proc. 2004;79:122–39.

    PubMed  CAS  Google Scholar 

  10. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA division of geriatric medicine. Arch Intern Med. 1991;151:1825–32.

    PubMed  CAS  Google Scholar 

  11. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157:1531–6.

    CAS  Google Scholar 

  12. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;2015(63):2227–46.

    Google Scholar 

  13. Campanelli CM. American geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616–31.

    PubMed Central  Google Scholar 

  14. Wawruch M, Fialova D, Zikavska M, Wsolova L, Jezova D, Kuzelova M, et al. Factors influencing the use of potentially inappropriate medication in older patients in Slovakia. J Clin Pharm Ther. 2008;33:381–92.

    PubMed  CAS  Google Scholar 

  15. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr [Internet]. 2017 [cited 2018 Aug 14];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/.

  16. ŠÚKL: Slovenská verzia [Internet]. [cited 2017 Jun 27]. Available from: http://www.sukl.sk/.

  17. WHO| 2. Anatomical Therapeutic Chemical (ATC) Classification [Internet]. WHO. [cited 2019 Sep 24]. Available from: http://www.who.int/medicines/regulation/medicines-safety/toolkit_atc/en/.

  18. Population ages 65 and above (% of total)| Data [Internet]. [cited 2019 Jan 25]. Available from: https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS.

  19. Prados-Torres A, Del Cura-González I, Prados-Torres D, López-Rodríguez JA, Leiva-Fernández F, Calderón-Larrañaga A, et al. Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project). Implement Sci IS. 2017;12:54.

    PubMed  Google Scholar 

  20. Feng X, Tan X, Riley B, Zheng T, Bias T, Sambamoorthi U. Polypharmacy and multimorbidity among medicaid enrollees: a multistate analysis. Popul Health Manag. 2018;21:123–9.

    PubMed  PubMed Central  Google Scholar 

  21. Wastesson JW, Morin L, Laroche M-L, Johnell K. How chronic is polypharmacy in old age? A longitudinal nationwide cohort study. J Am Geriatr Soc. 2018;67(3):455–62.

    PubMed  Google Scholar 

  22. Onder G, Liperoti R, Fialova D, Topinkova E, Tosato M, Danese P, et al. Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci. 2012;67:698–704.

    PubMed  Google Scholar 

  23. Wawruch M, Zikavska M, Wsolova L, Kuzelova M, Tisonova J, Gajdosik J, et al. Polypharmacy in elderly hospitalised patients in Slovakia. Pharm World Sci. 2007;30:235–42.

    PubMed  Google Scholar 

  24. Bronskill SE, Gill SS, Paterson JM, Bell CM, Anderson GM, Rochon PA. Exploring variation in rates of polypharmacy across long term care homes. J Am Med Dir Assoc. 2012;13(309):e15–21.

    Google Scholar 

  25. Dwyer LL, Han B, Woodwell DA, Rechtsteiner EA. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother. 2010;8:63–72.

    PubMed  Google Scholar 

  26. Wauters M, Elseviers M, Azermai M, Vander Stichele R. Availability and actual use in the Belgian market of potentially inappropriate medications (PIMs) from the EU(7)-PIM list. Eur J Clin Pharmacol. 2016;72:243–5.

    PubMed  Google Scholar 

  27. Sönnerstam E, Sjölander M, Gustafsson M. An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU(7)-PIM list. Eur J Clin Pharmacol. 2017;73:735–42.

    PubMed  PubMed Central  Google Scholar 

  28. Colloca G, Tosato M, Vetrano DL, Topinkova E, Fialova D, Gindin J, et al. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study. PLOS One. 2012;7:e46669.

    PubMed  PubMed Central  CAS  Google Scholar 

  29. Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. BMJ. 2011;342:d3514.

    PubMed  Google Scholar 

  30. Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17:862.e1–9.

    Google Scholar 

  31. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.

    PubMed  CAS  Google Scholar 

  32. Laroche M-L, Charmes J-P, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63:725–31.

    PubMed  Google Scholar 

  33. Moriarty F, Cahir C, Bennett K, Fahey T. Economic impact of potentially inappropriate prescribing and related adverse events in older people: a cost-utility analysis using Markov models. BMJ Open. 2019;9:e021832.

    PubMed  PubMed Central  Google Scholar 

  34. Henschel F, Redaelli M, Siegel M, Stock S. Correlation of incident potentially inappropriate medication prescriptions and hospitalization: an analysis based on the PRISCUS list. Drugs Real World Outcomes. 2015;2:249–59.

    PubMed  PubMed Central  Google Scholar 

  35. Dedhiya SD, Hancock E, Craig BA, Doebbeling CC, Thomas J. Incident use and outcomes associated with potentially inappropriate medication use in older adults. Am J Geriatr Pharmacother. 2010;8:562–70.

    PubMed  Google Scholar 

  36. Fick D. Potentially inappropriate medication use in a medicare managed care population: association with higher costs and utilization. J Manag Care Pharm. 2001;7:407–13.

    Google Scholar 

  37. Mann E, Haastert B, Frühwald T, Sauermann R, Hinteregger M, Hölzl D, et al. Potentially inappropriate medication in older persons in Austria: a nationwide prevalence study. Eur Geriatr Med. 2014;5:399–405.

    Google Scholar 

  38. Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.

    PubMed  Google Scholar 

  39. Ma Z, Zhang C, Cui X, Liu L. Comparison of three criteria for potentially inappropriate medications in Chinese older adults. Clin Interv Aging. 2019;14:65–72.

    PubMed  Google Scholar 

  40. Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293:1348–58.

    PubMed  Google Scholar 

  41. Almeida TA, Reis EA, Pinto IVL, Ceccato MD, Silveira MR, Lima MG, et al. Factors associated with the use of potentially inappropriate medications by older adults in primary health care: an analysis comparing AGS Beers, EU(7)-PIM List, and Brazilian Consensus PIM criteria. Res Soc Adm Pharm RSAP. 2018;15(4):370–7.

    Google Scholar 

  42. Wawruch M, Zikavska M, Wsolova L, Jezova D, Fialova D, Kunzo M, et al. Perception of potentially inappropriate medication in elderly patients by Slovak physicians. Pharmacoepidemiol Drug Saf. 2006;15:829–34.

    PubMed  CAS  Google Scholar 

  43. Fried TR, Tinetti ME, Iannone L. Primary care clinicians’ experiences with treatment decision making for older persons with multiple conditions. Arch Intern Med. 2011;171:75–80.

    PubMed  Google Scholar 

  44. Grina D, Briedis V. The use of potentially inappropriate medications among the Lithuanian elderly according to Beers and EU(7)-PIM list—a nationwide cross-sectional study on reimbursement claims data. J Clin Pharm Ther. 2017;42:195–200.

    PubMed  CAS  Google Scholar 

  45. Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol. 2010;69:543–52.

    PubMed  PubMed Central  Google Scholar 

  46. Mucalo I, Hadžiabdić MO, Brajković A, Lukić S, Marić P, Marinović I, et al. Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Eur J Clin Pharmacol. 2017;73:991–9.

    PubMed  Google Scholar 

  47. Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ. 2008;336:2–3.

    PubMed  PubMed Central  Google Scholar 

  48. Naunton M, Peterson GM, Bleasel MD. Overuse of proton pump inhibitors. J Clin Pharm Ther. 2000;25:333–40.

    PubMed  CAS  Google Scholar 

  49. Ahrens D, Chenot J-F, Behrens G, Grimmsmann T, Kochen M. Appropiateness of treatment recommendations for PPI in hospital discharge letters. Eur J Clin Pharmacol. 2010;66:1265–71.

    PubMed  PubMed Central  Google Scholar 

  50. Yang Y-X, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296:2947–53.

    PubMed  CAS  Google Scholar 

  51. Choudhry MN, Soran H, Ziglam HM. Overuse and inappropriate prescribing of proton pump inhibitors in patients with Clostridium difficile-associated disease. QJM Mon J Assoc Physicians. 2008;101:445–8.

    CAS  Google Scholar 

  52. Lee C, Lo A, Ubhi K, Milewski M. Outcome after discontinuation of proton pump inhibitors at a residential care site: quality improvement project. Can J Hosp Pharm. 2017;70:215–23.

    PubMed  PubMed Central  Google Scholar 

  53. Gomm W, von Holt K, Thomé F, Broich K, Maier W, Fink A, et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims data analysis. JAMA Neurol. 2016;73:410–6.

    PubMed  Google Scholar 

  54. Goldstein FC, Steenland K, Zhao L, Wharton W, Levey AI, Hajjar I. Proton pump inhibitors and risk of mild cognitive impairment and dementia. J Am Geriatr Soc. 2017;65:1969–74.

    PubMed  PubMed Central  Google Scholar 

  55. Cumming RG, Le Couteur DG. Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs. 2003;17:825–37.

    PubMed  CAS  Google Scholar 

  56. Khong TP, de Vries F, Goldenberg JSB, Klungel OH, Robinson NJ, Ibáñez L, et al. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif Tissue Int. 2012;91:24–31.

    PubMed  PubMed Central  CAS  Google Scholar 

  57. Bakken MS, Engeland A, Engesæter LB, Ranhoff AH, Hunskaar S, Ruths S. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol. 2014;70:873–80.

    PubMed  PubMed Central  CAS  Google Scholar 

  58. Sergi G, De Rui M, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. 2011;28:509–18.

    PubMed  Google Scholar 

  59. Carey IM, De Wilde S, Harris T, Victor C, Richards N, Hilton SR, et al. What factors predict potentially inappropriate primary care prescribing in older people? Analysis of UK primary care patient record database. Drugs Aging. 2008;25:693–706.

    PubMed  Google Scholar 

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Acknowledgements

The authors thank all involved nursing homes and their stuff for their cooperation in data collection, as well as to all data collectors: Romana Bartosova, Dominika Csankova, Ema Milova, Paulina Pilarcikova and Katarina Slosiarova, Dominika Rubintova.

Funding

This project was supported by the grant of Slovenská lekárnická komora (Slovak Pharmacy Chamber) Nos. 204/SLeK/2018, 13/SLeK/2019.

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  1. Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, Bratislava, 832 32, Slovak Republic

    Stanislava Jankyova, Dominika Rubintova & Tatiana Foltanova

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  1. Stanislava Jankyova
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  2. Dominika Rubintova
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Correspondence to Tatiana Foltanova.

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Jankyova, S., Rubintova, D. & Foltanova, T. The analysis of the use of potentially inappropriate medications in elderly in the Slovak Republic. Int J Clin Pharm 42, 100–109 (2020). https://doi.org/10.1007/s11096-019-00944-x

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