Evaluation of risk factors for potentially inappropriate prescription (PIP)

in hospitalized geriatric patients with pulmonary disease

Joowon Chung^o, Hwewon Han, Jae Yeon Kim

Department of Pharmacy, Asan Medical Center center

[Purpose]

 Geriatric patients are at high risk of potentially inappropriate prescription (PIP), causing adverse drug reaction (ADR), and unintentional hospitalization.

[Methods]

 We included participants aged ≥ 65 years from pulmonary elderly patients admitted for at least 2 days in a large teaching hospital. PIP was identified using Beers, STOPP+StART criteria. Clinically significant drug ADRs and DRPs during hospitalization were assessed by a pharmacist and confirmed by the staff physician. Risk factors for PIP were analyzed using multivariate binomial regression adjusting for confounders using statistical software SPSS (Version 21.0).

[Results]

 Of the 194 patients, 113 (58%) received a total of 168 PIPs by Beer’s criteria (9.6% of total prescriptions), 118 by STOPP (6.8% of total prescriptions), 74 by START (4.2% of total prescriptions) at admission. The most common PIP was “1st antihistamines” (27%, n=45) by Beer’s, “Use of aspirin and warfarin in combination without H2 receptor antagonist” (22%, n=26) by STOPP, and “Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease” (28%, n=21) by START criteria. Patients receiving PIP showed higher occurrence of ADR (67.3% vs 29.6%, p<0.001), and longer hospital stay (mean,17.9 vs 8.9 days, p=0.003). On logistic regression, taking more than 10 medications at admission (OR 2.4, 95% CI 1.25-4.75, p=0.009) by Beers criteria; underlying cardiovascular disease (OR 4.4, 95% CI 2.03-9.51, p<0.001) and diabetes (OR 4.6, 95% CI 2.07-10.2, p<0.001) by STOPP+START criteria were significant risk factors for PIP.

[Conclusion]

 PIP in hospitalized elderly patients with pulmonary disease was common, especially in patients receiving >10 medications and with diabetes/cardiovascular diseases. Based on these results, pharmacist-guided intervention within the multidisciplinary team would be helpful to improve medication use in elderly patients.

[KeyWords]

potentially inappropriate prescription (PIP), STOPP, START, Beers, geriatric