Analysis on prevalence and influencing factors of potentially inappropriate medication in elderly patients in outpatient and emergency departments in China

Abstract

Objective To understand the situation and influencing factors of potentially inappropriate medication(PIM) in elderly patients in outpatient and emergency departments in China. Methods Prescriptions for patients aged ≥65 years with complete prescribing information from 79 hospitals in six cities including Beijing, Shanghai, Guangzhou, Tianjin, Hangzhou and Chengdu from February 1st, 2014 to December 31st, 2014 were collected. All prescriptions for elderly patients of 10 working days in each quarter were collected and the basic information (including region, hospital grade, gender, age, department, and major disease/disease status) and medication information (including drug name, drug specification, drug dosage form, drug dose, and the number of combined drugs) were recorded. The situation and influencing factors of PIM in elderly patients based on the Chinese PIM list and 2012 Beers criteria were analyzed. Results A total of 2 962 232 prescriptions were collected, of them, 1 499 201 were for male patients and 1 463 031 ones for female patients. The ages were from 65 to 120 years and the average age was (75±7) years. The number of combined drugs were 1-15 and the average number was 2.2±1.5. According to the Chinese PIM list (Chinese list, including 72 drugs)and 2012 Beers criteria (Beers criteria, including 124 drugs and 100 of them were in the Chinese market), the detection proportion of prescriptions for elderly patients containing PIM in outpatient and emergency departments were 15.81%(468 228/2 962 232)and 9.16% (271 250/2 962 232), respectively (P<0.001); the detection proportion of PIM varieties in prescriptions were 90.28%(65/72)and 70.00% (70/100), respectively (P<0.001); the detection proportion of PIM varieties with high risks or high recommendation and high evidence levels were 85.71% (30/35) and 67.50% (27/40), respectively (P=0.065). The proportion of prescriptions with one inappropriate medication in all PIM prescriptions were 91.83%(429 977/468 228) and 92.79%(251 696/271 250), respectively. The top 10 drugs in PIM prescriptions were clopidogrel, estazolam, alprazolam, doxazosin, nicergoline, zolpidem, diclofenac, insulin, olanzapine, and warfarin according to the Chines PIM list, and estazolam, alprazolam, doxazosin, terazosin, zolpidem, diclofenac, meloxicam, olanzapine, clonazepam, and spironolactone according to 2012 Beers criteria. Multiple logistic regression analysis showed that the cities, hospital grade, gender, age, departments for treatment, the number of combined medica-tions, and disease or disease states were independent risk factors for PIM. The risks of PIM in patients with sleep disorder, depression, coronary heart disease, Alzheimer disease, prostate hyperplasia and arthritis or joint pain were higher than in patients with other diseases or disease status. Conclusions The prevalence of PIM use according to the Chinese PIM list and 2012 Beers criteria in elderly patients in outpatient and emergency departments in China were not optimistic. Risk factors of PIM use in elderly patients in China were the regional distribution, hospital grade, gender, age, the number of combined medications, department for treatment, and disease/disease status. Key words: Potentially inappropriate medication list; Elderly; China