RESUMO
OBJECTIVE: In 2019, a regional survey of potentially inappropriate prescriptions (PIP) of psychotropic drugs in elderly psychiatric inpatients was carried out highlighting their inappropriate use in this population. The aim of this study was to assess the clinical relevance - defined as the provision of an appropriate and necessary treatment, chosen from other alternatives as being the most likely to produce the expected results for a given patient - of these prescriptions considered inappropriate according to current established criteria. MATERIAL AND METHOD: Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities ) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant). RESULTS: Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant. CONCLUSION: This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.
RESUMO
BACKGROUND: Potentially inappropriate prescribing (PIP) in elderly patients is highly prevalent and is associated with an increased risk of adverse drug events, morbidity, and mortality. Accordingly, this study aimed to evaluate the PIP encountered in a geriatric setting and to highlight the role of the clinical pharmacists in this context. METHOD: A retrospective observational study was conducted during March and April 2018 in an elderly daycare in Beirut area. Patients' files were screened to evaluate each patient's clinical status using a developed tool that included the Medication Appropriateness Index. Statistical analysis was performed using SPSS (version 20). The results were considered significant at P<0.05. RESULTS: The results showed a high incidence of hypertension, schizophrenia, and diabetes among the studied sample with percentages of 41.7%, 35.3%, and 26.6%, respectively. As for the PIP, drug therapy duration and cost were the most encountered problems followed by medication indication, dosage, and drug-drug interaction. Moreover, PIP increased with the number of prescribed medications (P<0.05). Proton pump inhibitors, low dose aspirin, and antidiabetic medications' users had a significantly higher Medication Appropriateness Index score as compared to non-users. CONCLUSION: As a conclusion, suboptimal care is proved in this study empowering the collaboration between clinical pharmacists and physicians in minimizing the PIPs in elderly daycares.