Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Keywords: Inappropriate Prescribing, Potentially Inappropriate Medication List, Outpatients, Primary Health Care, Polypharmacy, Electronic Health Records, Cross-Sectional Studies, Multivariate Analysis, Thailand


Objective: The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors.

Methods: This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors.

Results: A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs.

Conclusions: PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.


Download data is not yet available.


Kim J, Parish AL. Polypharmacy and Medication Management in Older Adults. Nurs Clin North Am. 2017;52(3):457-468. https://doi.org/10.1016/j.cnur.2017.04.007

Maher RL, Hanlon JT, Hajjar ER. Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517/14740338.2013.827660

Projovic I, Vukadinovic D, Milovanovic O, Jurisevic M, Pavlovic R, Jacovic S, Jankovic S, Stefanovic S. Risk factors for potentially inappropriate prescribing to older patients in primary care. Eur J Clin Pharmacol. 2016;72(1):93-107. https://doi.org/10.1007/s00228-015-1957-1

The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227-2246. https://doi.org/10.1111/jgs.13702

O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213-218. https://doi.org/10.1093/ageing/afu145

do Nascimento MMG, de Melo Mambrini JV, Lima-Costa MF, Firmo JOA, Peixoto SWV, de Loyola Filho AI. Potentially inappropriate medications: predictor for mortality in a cohort of community-dwelling older adults. Eur J Clin Pharmacol. 2017;73(5):615-621. https://doi.org/10.1007/s00228-017-2202-x

Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: a systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014;70(1):1-11. https://doi.org/10.1007/s00228-013-1575-8

The 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. https://doi.org/10.1111/jgs.15767

Oliveira MG, Amorim WW, de Jesus SR, Heine JM, Coqueiro HL, Passos LC. A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care. J Eval Clin Pract. 2015;21(2):320-325.

Novaes PH, da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G. Comparison of four criteria for potentially inappropriate medications in Brazilian community-dwelling older adults. Geriatr Gerontol Int. 2017;17(10):1628-1635. https://doi.org/10.1111/ggi.12944

Morin L, Laroche ML, 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(9):862. https://doi.org/10.1016/j.jamda.2016.06.011

Moriarty F, Hardy C, Bennett K, Smith SM, Fahey T. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open. 2015;5(9):e008656. https://doi.org/10.1136/bmjopen-2015-008656

Winit-Watjana W, Sakulrat P, Kespichayawattana J. Criteria for high-risk medication use in Thai older patients. Arch Gerontol Geriatr. 2008;47(1):35-51. https://doi.org/10.1016/j.archger.2007.06.006

Pannoi T, Chapman RS, Panza A. Prevalence of potentially inappropriate medication (PIM) and factors associated with PIM in elderly outpatient prescriptions at a district hospital in the southern region of Thailand. J Health Res. 2014;28(2):101-108.

Prasert V, Akazawa M, Shono A, Chanjaruporn F, Ploylearmsang C, Muangyim K, Wattanapongsatit T, Sutin U. Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use. Res Social Adm Pharm. 2018;14(5):451-458. https://doi.org/10.1016/j.sapharm.2017.05.012

Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71(12):1415-1427. https://doi.org/10.1007/s00228-015-1954-4

Blanco-Reina E, Garcia-Merino MR, Ocana-Riola R, Aguilar-Cano L, Valdellós J, Bellido-Estévez I, Ariza-Zafra G. Assessing potentially inappropriate prescribing in community-dwelling older patients using the updated version of STOPP-START criteria: A comparison of profiles and prevalences with respect to the original version. PLoS One. 2016;11(12):e0167586. https://doi.org/10.1371/journal.pone.0167586

Pérez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ. 2018;363:k4524. https://doi.org/10.1136/bmj.k4524

Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, Tully MP, Wass V. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. London: General Medical Council; 2009.

Scarpignato C, Gatta L, Zullo A, Blandizzi C; SIF-AIGO-FIMMG Group; Italian Society of Pharmacology, the Italian Association of Hospital Gastroenterologists, and the Italian Federation of General Practitioners. Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression. BMC Med. 2016;14(1):179. https://doi.org/10.1186/s12916-016-0718-z

Freedberg DE, Kim LS, Yang YX. The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology. 2017;152(4):706-715. https://doi.org/10.1053/j.gastro.2017.01.031

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. https://doi.org/10.1093/eurheartj/ehy339

Chou R, Huffman LH; American Pain Society; American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2007;147(7):505-514. https://doi.org/10.7326/0003-4819-147-7-200710020-00008

Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014;78(4):738-747. https://doi.org/10.1111/bcp.12386

Obreli Neto PR, Nobili A, Marusic S, et al. Prevalence and predictors of potential drug-drug interactions in the elderly: a cross-sectional study in the brazilian primary public health system. J Pharm Pharm Sci. 2012;15(2):344-354.

Miller GE, Sarpong EM, Davidoff AJ, Yang EY, Brandt NJ, Fick DM. Determinants of Potentially Inappropriate Medication Use among Community-Dwelling Older Adults. Health Serv Res. 2017;52(4):1534-1549. https://doi.org/10.1111/1475-6773.12562

Johansson T, Abuzahra ME, Keller S, Mann E, Faller B, Sommerauer C, Höck J, Löffler C, Köchling A, Schuler J, Flamm M, Sönnichsen A. Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(2):532-548. https://doi.org/10.1111/bcp.12959

Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications Included in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug–Disease Interactions in the Elderly Quality Measures. J Am Geriatr Soc. 2015;63(12):e8-e18. https://doi.org/10.1111/jgs.13807

Payne RA, Avery AJ, Duerden M, Saunders CL, Simpson CR, Abel GA. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol. 2014;70(5):575-581. https://doi.org/10.1007/s00228-013-1639-9

How to Cite
Vatcharavongvan P, Puttawanchai V. Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria. Pharm Pract (Granada) [Internet]. 2019Aug.24 [cited 2020Jul.11];17(3):1494. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/1494
Original Research