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Drug Burden Index and Potentially Inappropriate Medications in Community-Dwelling Older People

The Impact of Home Medicines Review

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Abstract

Background

A significant problem in older people (aged ≥65 years) is the use of potentially inappropriate medications (PIMs), including those with sedative and anticholinergic properties. However, effective intervention strategies have yet to be identified. The Drug Burden Index (DBI) is an evidence-based tool that measures a person’s total exposure to medications with sedative and anticholinergic properties and has been shown to be independently associated with impairment in cognitive and physical function.

Objective

The main aim of the study was to investigate whether Home Medicines Review (HMR) services by pharmacists for community-dwelling older people would lead to an improvement in the use of medications, as measured by a decrease in the DBI score. The study also aimed to investigate the (i) distribution of DBI scores and PIMs among older people living in the community, and (ii) impact of pharmacists’ recommendations on DBI scores and PIMs.

Methods

A retrospective analysis of medication reviews was performed for 372 community-dwelling older people (aged ≥65 years) who received an HMR service from the pharmacist. The main outcome measure was the total DBI score at baseline and post-HMR. The data were also examined to determine the extent of PIM use (2003 Beers’ criteria), and the number and nature of pharmacists’ recommendations.

Results

Overall, medications contributing to the DBI (i.e. medications with sedative or anticholinergic properties) and PIMs were identified in 60.5% (n = 225) and 39.8% (n=148) of the patients, respectively. Following pharmacist recommendations during the HMR service, medications contributing to the DBI were identified in 51.6% (n = 192) of the patients. A statistically significant reduction in the sum total of DBI scores for all patients was observed following pharmacists’ recommendations during the HMR service (206.9 vs 157.3, p < 0.001). Pharmacists’ recommendations also led to a decrease in the use of PIMs, which were identified in 28.2% (n= 105) of the patients following the HMR service.

Conclusion

When the DBI is used for evaluation, pharmacists’ recommendations during HMR services, if acted upon, may effect changes in the prescribing of sedative and anticholinergic medications, thereby substantially reducing the patient’s drug burden. Future studies should focus on whether such a decrease may translate into functional improvements. The study also showed a positive influence of HMR services on the prescribing of PIMs.

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The author acknowledges the Australian Association of Consultant Pharmacy and the seven accredited pharmacists for providing access to de-identified medication reviews used in this study. Associate Professor Sarah Hilmer holds an international patent for the Drug Burden Index. The other authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Faculty of Pharmacy, The University of Sydney, Pharmacy Building A15, Sydney, New South Wales, 2006, Australia

    Ronald L. Castelino, Beata V. Bajorek, Prasad Nishtala & Timothy F. Chen

  2. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia

    Sarah N. Hilmer & Beata V. Bajorek

  3. Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia

    Sarah N. Hilmer

Authors
  1. Ronald L. Castelino
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  2. Sarah N. Hilmer
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  4. Prasad Nishtala
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  5. Timothy F. Chen
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Corresponding author

Correspondence to Ronald L. Castelino.

Appendix

Appendix

Examples of pharmacists’ recommendations to the general practitioner that impacted on the Drug Burden Index score and potentially inappropriate medications are shown in table AI.

Table AI
figure Tab7

Examples of pharmacists’ recommendations to the general practitioner that impacted on the Drug Burden Index (DBI) score and potentially inappropriate medications (PIMs)

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Castelino, R.L., Hilmer, S.N., Bajorek, B.V. et al. Drug Burden Index and Potentially Inappropriate Medications in Community-Dwelling Older People. Drugs Aging 27, 135–148 (2010). https://doi.org/10.2165/11531560-000000000-00000

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