Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment
Background: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country.
Objective: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI).
Methods: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population.
Results: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)].
Conclusions: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.
Redston MR, Hilmer SN, McLachlan AJ, Clough AJ, Gnjidic D. Prevalence of Potentially Inappropriate Medication Use in Older Inpatients with and without Cognitive Impairment: A Systematic Review. J Alzheimers Dis. 2018;61(4):1639-1652. https://doi.org/10.3233/jad-170842
Sönnerstam E, Sjölander M, Gustafsson M. An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU(7)-PIM list. Eur J Clin Pharmacol. 2017;73(6):735-742. https://doi.org/10.1007/s00228-017-2218-2
Delgado J, Bowman K, Clare L. Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007. BMJ Open. 2020;10(1):e029172. https://doi.org/10.1136/bmjopen-2019-029172
Johnell K. Inappropriate Drug Use in People with Cognitive Impairment and Dementia: A Systematic Review. Curr Clin Pharmacol. 2015;10(3):178-184. https://doi.org/10.2174/1574884710666150609154741
Joung KI, Kim S, Cho YH, Cho SI. Association of Anticholinergic Use with Incidence of Alzheimer's Disease: Population-based Cohort Study. Sci Rep. 2019;9(1):6802. Published 2019 May 1. https://doi.org/10.1038/s41598-019-43066-0
Hukins D, Macleod U, Boland JW. Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. Eur J Clin Pharmacol. 2019;75(4):467-481. https://doi.org/10.1007/s00228-018-02612-x
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
Hudhra K, Beçi E, Petrela E, Xhafaj D, García-Caballos M, Bueno-Cavanillas A. Prevalence and factors associated with potentially inappropriate prescriptions among older patients at hospital discharge. J Eval Clin Pract. 2016;22(5):707-713. https://doi.org/10.1111/jep.12521
Ilickovic IM, Jankovic SM, Tomcuk A, Djedovic J. Pharmaceutical care in a long-stay psychiatric hospital. Eur J Hosp Pharm. 2016;23(3):177-181. https://doi.org/10.1136/ejhpharm-2015-000718
Stojanović M, Vuković M, Jovanović M, Dimitrijević S, Radenković M. GheOP3 S tool and START/STOPP criteria version 2 for screening of potentially inappropriate medications and omissions in nursing home residents. J Eval Clin Pract. 2020;26(1):158-164. https://doi.org/10.1111/jep.13107
Tahiri Z, Kellici S, Mone I, Shabani D, Qazimi M, Burazeri G. Prevalence and correlates of inappropriate use of benzodiazepines in Kosovo. Int J Clin Pharm. 2017;39(4):669-673. https://doi.org/10.1007/s11096-017-0486-7
Godman B, et al. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin. 2020;36(2):301-327. https://doi.org/10.1080/03007995.2019.1700947
Nejashmikj VR, Stojkovska S, Topuzovska IK, Stavrikj K. Evidence Based Practice in Using Antibiotics for Acute Tonsillitis in Primary Care Practice. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2017;38(2):63-68. https://doi.org/10.1515/prilozi-2017-0023
Vezmar Kovačević S, Simišić M, Stojkov Rudinski S, et al. Potentially inappropriate prescribing in older primary care patients. PLoS One. 2014;9(4):e95536. Published 2014 Apr 24. https://doi.org/10.1371/journal.pone.0095536
Projovic I, Vukadinovic D, Milovanovic O, et al. 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
Harasani K, Xhafaj D, Qipo O. Prevalence and types of potentially inappropriate prescriptions among older and middle-aged community-dwelling Albanian patients. Int J Risk Saf Med. 2020;31(1):5-13. https://doi.org/10.3233/jrs-195052
World Bank. The World Bank in Albania. Available at: https://www.worldbank.org/en/country/albania/overview (accessed Apr 10, 2020).
Carson N, Leach L, Murphy KJ. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry. 2018;33(2):379-388. https://doi.org/10.1002/gps.4756
Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000.
Steinman MA, Fick DM. Using Wisely: A Reminder on the Proper Use of the American Geriatrics Society Beers Criteria®. J Am Geriatr Soc. 2019;67(4):644-646. https://doi.org/10.1111/jgs.15766
Vatcharavongvan P, Puttawanchai V. Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria. Pharm Pract (Granada). 2019;17(3):1494. https://doi.org/10.18549/pharmpract.2019.3.1494
Al-Azayzih A, Alamoori R, Altawalbeh SM. Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study. Pharm Pract (Granada). 2019;17(2):1439. https://doi.org/10.18549/pharmpract.2019.2.1439
Pinto TCC, Machado L, Bulgacov TM, Rodrigues-Júnior AL, Costa MLG, Ximenes RCC, Sougey EB. Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer's Disease (AD) in the elderly?. Int Psychogeriatr. 2019;31(4):491-504. https://doi.org/10.1017/s1041610218001370
Ciesielska N, Sokołowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kędziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016;50(5):1039-1052. https://doi.org/10.12740/pp/45368
Olazarán J, Torrero P, Cruz I, Aparicio E, Sanz A, Mula N, Marzana G, Cabezón D, Begué C. Mild cognitive impairment and dementia in primary care: the value of medical history. Fam Pract. 2011;28(4):385-392. https://doi.org/10.1093/fampra/cmr005
Copyright (c) 2020 Pharmacy Practice and the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.