Tropical Journal of Pharmaceutical Research

Original Research Article | OPEN ACCESS

Influence of hospitalization on potentially inappropriate prescribing among elderly patients in a Malaysian community

Muhammad Eid Akkawi , Mohamad Haniki Nik Mohamed

Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia;

For correspondence:- Muhammad Akkawi Email: mhdeidak@gmail.com Tel:+60186675232

Accepted: 7 October 2017 Published: 31 January 2018

Citation: Akkawi ME, Mohamed MH. Influence of hospitalization on potentially inappropriate prescribing among elderly patients in a Malaysian community. Trop J Pharm Res 2018; 17(1):151-160 doi: 10.4314/tjpr.v17i1.21

© 2018 The authors.
This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited..

Abstract

Purpose: To compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) on admission and discharge of patients, and to determine the associated predictors.

Methods: This was a prospective observational study conducted in the multidisciplinary medical and surgical units of Hospital Tengku Ampuan Afzan (HTAA), Malaysia. The medications of patients who had been admitted to the hospital from community-dwelling settings were reviewed to identify PIMs/PPOs using version 2 of STOPP/START criteria. A logistic regression model was applied to detect the risk factors associated with PIM or PPO at discharge.

Results: Among the 300 patients involved in the study, the prevalence of PIMs was 27 % upon admission, which decreased to 22.3 % at discharge (p = 0.014) with PIMs pertaining to increasing the risk of physical falls in elderly people being the most common for pre- and post-hospitalization. The prevalence of PPOs was 47.6 % upon admission, which increased to 48 % at discharge (p = 0.99), with the omission of musculoskeletal medications being the most common PPOs at admission and discharge. Having a PIM at discharge was associated with the number of discharge medications and the history of falls, whereas having a high comorbidity index score or history of falls was associated with having a PPO at discharge.

Conclusion: Hospitalization significantly reduces the prevalence of PIMs, but not PPOs or polypharmacy, among elderly patients. The number of discharge medications and the history of falls are predictors of discharge PIM, whilst high comorbidities and the history of falls were the predictors of discharge PPO. Improving the knowledge of hospital practitioners regarding geriatric pharmacotherapy is required to optimize prescribing in elderly patients during hospitalization

Keywords: Hospitalization, STOPP criteria, START criteria, Inappropriate prescribing, Co-morbidity, Polypharmacy, Elderly patients