Medication Review in Turkish Older Adults at Community Pharmacy: A Pilot Study by Using Medication Appropriateness Index

Year 2022, Volume: 12 Issue: 3, 725 - 729, 28.09.2022

Şefika Dal Nazlıcan Uçar Öznur Altıparmak Mesut Sancar Betül Okuyan

https://doi.org/10.33808/clinexphealthsci.1012114

Abstract

Objective: The study aimed to evaluate medication review in older adults (≥65 years) at a community pharmacy by identifying the prevalence of potentiality inappropriate medication and calculating medication appropriateness index.

Methods: This descriptive study was carried out in a community pharmacy for six months. The older adults (≥65 years) using one or more medications were included. During clinical pharmacist-led medication review; the medication appropriateness index was calculated for each medication of older adults. Potentially inappropriate medications were evaluated according to the 2019 American Geriatrics Society Beers Criteria®.

Result: Among a hundred older adults, 46.0% were female. The median age of the patients was 75.5 (IQR, 68.0-78.8). The median number of medications was 9.0 (7.0-10.0). Polypharmacy has been detected in 97.0% of the patients. At least one potentially inappropriate medication was detected in 63.0% of them. The median score of medication appropriateness index score was 53.0 (IQR: 38.6-67.9).

Conclusion: To best our knowledge, this is the first study of clinical pharmacist-led medication review by calculating the medication appropriateness index carried out at a community pharmacy in Turkey. There was a high rate of potentially inappropriate medication with a higher score of medication appropriateness in older adults. This study highlights the importance of medication review led by the clinical pharmacist at community pharmacy to optimize medication usage in older adults.

Keywords

Older adults, clinical pharmacist, medication appropriateness index, potentially inappropriate medication

References

• [1] Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005;17(4):123-32.
• [2] Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49(2):200-9.
• [3] Bahat G, Tufan F, Akin S, Tufan A, Erten N, Karan M. Rational drug use in the elderly. J Gerontol Geriatr Res. 2012;1(1):1-8.
• [4] Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716-24.
• [5] Awad A, Hanna O. Potentially inappropriate medication use among geriatric patients in primary care setting: A cross- sectional study using the Beers, STOPP, FORTA and MAI criteria. PLoS One. 2019;14(6):e0218174.
• [6] Nyborg G, Brekke M, Straand J, Gjelstad S, Romøren M. Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria. BMC Geriatr. 2017;17(1):220.
• [7] 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.e1-9.
• [8] Alhawassi TM, Alatawi W, Alwhaibi M. Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatr. 2019;19(1):154
• [9] Roux B, Sirois C, Simard M, Gagnon ME, Laroche ML. Potentially inappropriate medications in older adults: a population-based cohort study. Fam Pract. 2020;37(2):173-9.
• [10] Gibert P, Cabaret M, Moulis M, Bosson JL, Boivin JE, Chanoine S, Allenet B, Bedouch P, Gavazzi G. Optimizing medication use in elderly people in primary care: Impact of STOPP criteria on inappropriate prescriptions. Arch Gerontol Geriatr. 2018;75:16-9.
• [11] Curtis LH, Østbye T, Sendersky V, Hutchison S, Dans PE, Wright A, Woosley RL, Schulman KA. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621-5.
• [12] Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57- 65.
• [13] By 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):674-94.
• [14] 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):213-8.
• [15] Tommelein E, Petrovic M, Somers A, Mehuys E, van der Cammen T, Boussery K. Older patients’ prescriptions screening in the community pharmacy: development of the Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP(3)S) tool. J Public Health (Oxf). 2016;38(2):e158-70.
• [16] Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045- 51.
• [17] Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R, León-Ortiz M. 2012 American Geriatrics Society Beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person’s Potentially Inappropriate Prescriptions. J Am Geriatr Soc. 2014;62(7):1217-23.
• [18] Brown JD, Hutchison LC, Li C, Painter JT, Martin BC. Predictive Validity of the Beers and Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States. J Am Geriatr Soc. 2016;64(1):22-30.
• [19] Demirer Aydemir F, Oncu S, Yakar NM, Utkugun GA, Gokmen N, Comert B, Ucku R, Gelal A. Potentially inappropriate medication use in elderly patients treated in intensive care units: A cross- sectional study using 2019 Beers, STOPP/v2 Criteria and EU(7)- PIM List. Int J Clin Pract. 2021;75(11):e14802.
• [20] 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):320-5.
• [21] Bulloch MN, Olin JL. Instruments for evaluating medication use and prescribing in older adults. J Am Pharm Assoc (2003). 2014;54(5):530-7.
• [22] O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437-52.
• [23] Castelino RL, Bajorek BV, Chen TF. Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the medication appropriateness index. Ann Pharmacother. 2010;44(12):1922-9.
• [24] Olsson IN, Runnamo R, Engfeldt P. Medication quality and quality of life in the elderly, a cohort study. Health Qual Life Outcomes. 2011;9:95.
• [25] Grimes TC, Deasy E, Allen A, O’Byrne J, Delaney T, Barragry J, Breslin N, Moloney E, Wall C. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Qual Saf. 2014;23(7):574-83.
• [26] Chrischilles EA, Carter BL, Lund BC, Rubenstein LM, Chen- Hardee SS, Voelker MD, Park TR, Kuehl AK. Evaluation of the Iowa Medicaid pharmaceutical case management program. J Am Pharm Assoc (2003). 2004;44(3):337-49.
• [27] Garcia J, Vaz M, Poggi M. Estimated prevalence of contraindicated, severe and moderate interactions in ambulatory patients with polypharmacy in a healthcare provider in Uruguay. Clin Ther. 2015;37(8):e145.
• [28] Patton D, Cadogan C, Gormley GJ, Passmore P, Francis J, Kerse N, Hughes C. Using the Theoretical Domains Framework (TDF) to explore barriers and facilitators to adherence to prescribed medicines in community-based older adults. Int J Pharm Pract. 2015;23:11-2.
• [29] Ziere G, Dieleman J, Hofman A, Pols HA, Van Der Cammen T, Stricker BC. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61(2):218-23.
• [30] Bahat G, Tufan F, Bahat Z, Tufan A, Aydin Y, Akpinar TS, Nadir S, Erten N, Karan MA. Comorbidities, polypharmacy, functionality and nutritional status in Turkish community-dwelling female elderly. Aging Clin Exp Res. 2014;26(3):255-9.
• [31] Rollason V, Vogt N. Reduction of Polypharmacy in the Elderly. Drugs Aging. 2003;20(11):817-32.
• [32] Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2012(5):CD008165.
• [33] Sayın Z, Sancar M, Özen Y, Okuyan B. Polypharmacy, potentially inappropriate prescribing and medication complexity in Turkish older patients in the community pharmacy setting. Acta Clin Belg. 2020:1-7.
• [34] Memiş S, Sancar M, Varlıklı O, Akçay B, Varol H, Söylemez SL, Medisoglu MS, Okuyan B. A pilot study of clinical pharmacistled medication review in older adults on polypharmacy and receiving home health care servıces. The Turkish Journal of Geriatrics. 2020;23(4):515-23.
• [35] Bregnhøj L, Thirstrup S, Kristensen MB, Bjerrum L, Sonne J. Prevalence of inappropriate prescribing in primary care. Pharm World Sci. 2007;29(3):109-15.
• [36] Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996;100(4):428- 37.