The Effect of Beers Criteria-Based Training in General Practitioners on Prescribing Potentially Inappropriate Medications in Elderly Patients
Abstract
Background: Pharmacotherapy in elderly patients has become a major concern due to their physiological changes, pharmacokinetic and pharmacodynamics variations and poly-pharmacy. In considering the global trend in population aging, we aim to evaluate the effect of “Beers Criteria” education on prescribing medications for elderly patients by General Practitioners (GPs).
Methods: Thirty GPs with the highest number of prescriptions were included in this pilot study. All prescriptions written over a three-month period were considered, then prescriptions for geriatric patients were selected and evaluated. The GPs were trained using pamphlets and booklets which were prepared based on Beers 2015 explicit criteria. In order to evaluate the effect of education, appropriateness of prescriptions was analyzed before and 1 month following training.
Results: Of 15,447 prescriptions selected during the first step, 1,281 prescriptions were related to geriatric patients in which the prevalence of inappropriate drug prescriptions was 37.3%. The most inappropriate medications identified were Bisacodyl, Alprazolam, and Hyoscyamine. While in the second step 1,055 of 15,154 prescriptions concerned the elderly and inappropriate drug prescription rate was noted as 23.6%. The most common inappropriate medications included Alprazolam, Amitriptyline, and Hyoscyamine. Based on our results, the prevalence of prescribing potentially inappropriate medications (PIMs) for elderly patients is high among GPs and educational interventions that raise awareness about “Beers Criteria” significantly reduce the prescribing PIMs.
Conclusion: Given the importance of GP training programs in reducing inappropriate prescription rates among geriatric patients, it will be necessary for the National Committee of Rational Use of Drugs (NCRUD) to consider undertaking comprehensive educational strategies for reducing the prevalence of inappropriate medication use in elderly people.
2. Bloom DE, Canning D, Lubet A. Global population aging: Facts, challenges, solutions & perspectives Daedalus 2015;144(2):80-92.
3. Hutchison LC, O'Brien CE. Changes in pharmacokinetics and pharmacodynamics in the elderly patient. Journal of Pharmacy Practice 2007;20(1):4-12.
4. Zaveri H, Mansuri S, Patel V. Use of potentially inappropriate medicines in elderly: A prospective study in medicine out-patient department of a tertiary care teaching hospital. Indian J Pharmacol 2010;42(2):95-8.
5. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 2015;175(5):827-34.
6. Sköldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging 2015;32(8):671-8.
7. Azoulay L, Zargarzadeh A, Salahshouri Z, Oraichi D, Bérard A. Inappropriate medication prescribing in community-dwelling elderly people living in Iran. Eur J Clin Pharmacol 2005;61(12):913-9.
8. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 1997;157(14):1531-6.
9. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163(22):2716-24.
10. Campenelli C. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60(4):616-31.
11. Hux JE, Melady MP, DeBoer D. Confidential prescriber feedback and education to improve antibiotic use in primary care a controlled trial. CMAJ 1999;161(4):388-92.
12. Panel AGSBCUE, Fick DM, Semla TP, Beizer J, Brandt N, Dombrowski R, et al. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015;63(11):2227-46.
13. Ghadimi H, Esmaily HM, Wahlstrom R. General practitioners' prescribing patterns for the elderly in a province of Iran. Pharmacoepidemiol Drug Saf 2011;20(5):482-7.
14. Zargarzadeh AH, Sadeghi K, Mirmoghtadaei P. Prescribing of Potentially Inappropriate Medications to Elderly People by Medical Specialists in Isfahan, Iran. Iranian Journal of Pharmaceutical Sciences 2008;4(4):241-6.
15. Vali L, Pour Reza A, Rahimi Foroushani A, Ahmadi B, Akbari Kamrani AA. Analysis of Inappropriate Medication Use in Older Adults Discharged From Hospitals Affiliated With Tehran University of Medical Sciences (TUMS) Using the Beers Criteria in 2010. Iranian Journal of Ageing 2011;6(3):56-65.
16. Heidari S, Aliabadi A, Naebi A, Khoramirad A. Frequency of Use of Potentially Inappropriate Medications and Its Associated Factors in Elderly People in Qom City, 2012, Iran. Qom University of Medical Sciences Journal 2014;8(4):44-52.
17. Raji MA, Ostir GV, Markides KS, Espino DV, Goodwin JS. Potentially inappropriate medication use by elderly Mexican Americans. Ann Pharmacother 2003;37(9):1197-202.
18. Onder G, Landi F, Cesari M, Gambassi G, Carbonin P, Bernabei R. Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly. Eur J Clin Pharmacol 2003;59(2):157-62.
19. Chang CM, Liu PYY, Yang YHK, Yang YC, Wu CF, Lu FH. Potentially Inappropriate Drug Prescribing Among First‐Visit Elderly Outpatients in Taiwan. Pharmacotherapy 2004;24(7):848-55.
20. Cannon KT, Choi MM, Zuniga MA. Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis. Am J Geriatr Pharmacother 2006;4(2):134-43.
21. Koyama A, Steinman M, Ensrud K, Hillier TA, Yaffe K. Ten‐Year Trajectory of Potentially Inappropriate Medications in Very Old Women: Importance of Cognitive Status. J Am Geriatr Soc 2013;61(2):258-63.
22. Oliveira MG, Amorim WW, de Jesus SR, Rodrigues VA, Passos LC. Factors associated with potentially inappropriate medication use by the elderly in the Brazilian primary care setting. Int J Clin Pharm 2012;34(4):626-32.
23. Greenblatt DJ, Shader RI. Dependence, tolerance, and addiction to benzodiazepines: clinical and pharmacokinetic considerations. Drug Metab Rev 1978;8(1):13-28.
Files | ||
Issue | Vol 8, No 2 (Spring 2020) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/jpc.v8i2.3829 | |
Keywords | ||
Potentially Inappropriate Medication General Practitioners Geriatrics |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |