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Risk of drug interactions and prescription appropriateness in elderly patients

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Abstract

Background

In Europe, adverse drug reactions and drug interactions are the cause of considerable morbidity and mortality. In over 75s, hospital access due to adverse drug reactions can be as high as 1 in every 3.

Aims

To assess the quality of the prescribed polytherapies in the territory, in terms of the risk of drug interactions and of prescription appropriateness, in over 75s.

Methods

Randomly selected patients, over 75s, were analysed among the patients of 3 general practitioners. Their data were analysed with the INTERCheck® software. This software provided the list of drug interactions deriving from the chronic therapies. The program also provided the Beers criteria and the STOPP criteria related to the drugs, highlighting potentially inappropriate drugs.

Results

A total of 188 patients were included in the study. A total of 216 serious or very serious drug interactions have been identified. A total of 92 patients (48.9%) were at risk of at least one serious or very serious interaction. The cut-off of the correlation between the number of drugs taken and the risk of incurring a serious or very serious interaction was found to be 5 (AUC = 0.833, sensitivity = 87%, p < 0.001). Patients on ≥ 4 drugs were at risk of prescriptive inappropriateness with a sensitivity of 84% (AUC = 0.781, p < 0.0001).

Conclusions

Focusing on patients with at least 4 drugs in therapy is the right strategy to reduce the risks associated with polypharmacy.

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References

  1. Mazzola P, Rimoldi SML, Rossi P et al (2016) Aging in Italy: the need for new welfare strategies in an old country. Gerontologist 56:383–390. https://doi.org/10.1093/geront/gnv152

    Article  PubMed  Google Scholar 

  2. European Commission (2018) The 2018 Ageing Report: economic and budgetary projections for the EU member states (2016–2070).

  3. Edwards IR, Aronson JK (2000) Adverse drug reactions: definitions, diagnosis, and management. Lancet 356:1255–1259. https://doi.org/10.1016/S0140-6736(00)02799-9

    Article  CAS  PubMed  Google Scholar 

  4. Hazell L, Shakir SAW (2006) Under-reporting of adverse drug reactions. Drug Saf 29:385–396. https://doi.org/10.2165/00002018-200629050-00003

    Article  PubMed  Google Scholar 

  5. Ribeiro-Vaz I, Santos CC, Cruz-Correia R (2016) Promoting adverse drug reaction reporting: comparison of different approaches. Rev. Saude Publica 50:14. https://doi.org/10.1590/S1518-8787.2016050006122

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chan M, Nicklason F, Vial JH Adverse drug events as a cause of hospital admission in the elderly. Intern Med J 31:199–205

  7. Becker ML, Kallewaard M, Caspers PWJ et al (2007) Hospitalisations and emergency department visits due to drug-drug interactions: a literature review. Pharmacoepidemiol Drug Saf 16:641–651. https://doi.org/10.1002/pds.1351

    Article  PubMed  Google Scholar 

  8. Laursen J, Kornholt J, Betzer C et al (2018) General practitioners’ barriers toward medication reviews in polymedicated multimorbid patients: how can a focus on the pharmacotherapy in an outpatient clinic support GPs? Heal Serv Res Manag Epidemiol 5:2333392818792169. https://doi.org/10.1177/2333392818792169

    Article  Google Scholar 

  9. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63:2227–2246. https://doi.org/10.1111/jgs.13702

    Article  Google Scholar 

  10. Hamilton H, Gallagher P, Ryan C et al (2011) Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 171:1013–1019. https://doi.org/10.1001/archinternmed.2011.215

    Article  PubMed  Google Scholar 

  11. Antoniazzi S, Chiarelli MT, Nobili A et al (2015) The value of software that provides clinically relevant information on drug interactions. Eur J Intern Med 26:e52–e53. https://doi.org/10.1016/j.ejim.2015.07.004

    Article  PubMed  Google Scholar 

  12. Mantelli S, Jungo KT, Rozsnyai Z et al (2018) How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study. BMC Fam Pract 19:169. https://doi.org/10.1186/s12875-018-0856-9

    Article  PubMed  PubMed Central  Google Scholar 

  13. Green JL, Hawley JN, Rask KJ (2007) Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am J Geriatr Pharmacother 5:31–39

    Article  Google Scholar 

  14. Nobili A, Pasina L, Tettamanti M et al (2009) Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther 34:377–386. https://doi.org/10.1111/j.1365-2710.2009.01021.x

    Article  CAS  PubMed  Google Scholar 

  15. Bjerrum L, Andersen M, Petersen G, Kragstrup J (2003) Exposure to potential drug interactions in primary health care. Scand J Prim Health Care 21:153–158. https://doi.org/10.1080/02813430310001806

    Article  PubMed  Google Scholar 

  16. Johnell K, Klarin I (2007) The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf 30:911–918. https://doi.org/10.2165/00002018-200730100-00009

    Article  PubMed  Google Scholar 

  17. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG (2008) Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging 25:1021–1031. https://doi.org/10.2165/0002512-200825120-00004

    Article  PubMed  Google Scholar 

  18. Urzal J, Pedro AB, Oliveira IF et al (2019) Inappropriate prescribing to elderly patients in an internal medicine ward. Acta Med Port 32:141–148. https://doi.org/10.20344/amp.10683

    Article  PubMed  Google Scholar 

  19. Forgacs I, Loganayagam A (2008) Overprescribing proton pump inhibitors. BMJ 336:2–3. https://doi.org/10.1136/bmj.39406.449456.BE

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank Dr. Rinaldi, Dr. Verdi and Dr. Perosino for making their databases, their patients and their work available to the study.

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Authors and Affiliations

  1. ASL Città di Torino, Turin, Italy

    Elisa Petrini

  2. Department of Medical Sciences, Division of Gastroenterology, University of Turin, Turin, Italy

    Gian Paolo Caviglia & Giorgio Maria Saracco

  3. Unit of Gastroenterology, Molinette Hospital, Turin, Italy

    Rinaldo Pellicano

  4. Department of Surgical Sciences, University of Turin, Turin, Italy

    Mario Morino & Davide Giuseppe Ribaldone

Authors
  1. Elisa Petrini
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  2. Gian Paolo Caviglia
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  3. Rinaldo Pellicano
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  4. Giorgio Maria Saracco
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  5. Mario Morino
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  6. Davide Giuseppe Ribaldone
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Corresponding author

Correspondence to Davide Giuseppe Ribaldone.

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Informed consent was obtained from all individual participants included in the study.

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Petrini, E., Caviglia, G.P., Pellicano, R. et al. Risk of drug interactions and prescription appropriateness in elderly patients. Ir J Med Sci 189, 953–959 (2020). https://doi.org/10.1007/s11845-019-02148-8

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  • DOI: https://doi.org/10.1007/s11845-019-02148-8

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