Abstract
Background: Prescription and use of inappropriate medications have been identified as a major cause of morbidity among the elderly. Several screening tools have been developed to identify inappropriate medications prescribed for elderly patients. There is dearth of information about the knowledge of Nigerian physicians regarding these screening tools and appropriate prescribing for the elderly in general. The primary objective of this study was to assess the knowledge of Nigerian physicians about these screening tools and appropriate prescribing of medications for the elderly. Methods: The study was a cross-sectional questionnaire-based study conducted among physicians working in Family Medicine and Internal Medicine departments of four tertiary health care facilities in Nigeria. The questionnaire consisted of sections on general characteristics of respondents and their knowledge of four selected screening tools for inappropriate medications in the elderly. Ten clinical vignettes representing different therapeutic areas (using the best option type questions) about medicine use in the elderly were included with a score of 1 and 0 for correct and wrong answers, respectively. The knowledge of respondents was classified as (total score, over 10): poor (score, < 5), average (score, 5-6), and good (score, 7-10). Results: One hundred and five physicians returned completed questionnaires. Twenty percent of respondents knew about Beers criteria, whereas 15.6% were familiar with the STOPP criteria. Majority (83; 84.7%) of the respondents were confident of their ability to prescribeappropriately for elderly patients. The mean knowledge score was 5.3 ± 2.0 with 32 (30.5%), 41 (39%), and 32 (30.5%) having low, average, and good scores, respectively. The association between the knowledge score, duration of practice, and seniority was statistically significant (OR, 3.6, p = .004 and OR, 3; p = .012), respectively. Conclusion: There are significant gaps in the knowledge of Nigerian physicians about screening tools for inappropriate medications. There is a need for stakeholders involved in the care of elderly Nigerian patients to develop new strategies to improve services being offered. These may include introduction of modules on appropriate prescribing in the curriculum of undergraduate and postgraduate medical education and the routine use of some screening tools for inappropriate medications in daily clinical practice.
Highlights
Drug treatment of elderly patients is associated with potential adverse drug reactions (ADRs) with prescription and use of inappropriate medications being responsible in many cases (Dormann et al, 2013; Oscanoa et al, 2017)
The sources of drug information used by respondents were the British National Formulary (BNF), consultations with colleagues, and online sources (Figure 1)
Regarding respondents’ knowledge about screening tools for inappropriate medications, 20.4% and 22.7% of them knew about Beers criteria and Medication Appropriateness Index (MAI), while 15.6% were familiar with the STOPP criteria
Summary
Drug treatment of elderly patients is associated with potential adverse drug reactions (ADRs) with prescription and use of inappropriate medications being responsible in many cases (Dormann et al, 2013; Oscanoa et al, 2017). Several tools/criteria have been developed over time to address the problem of inappropriate prescribing for elderly patients and these include the Beers criteria, Screening Tool of Older Persons’ potentially inappropriate Prescription (STOPP) criteria, Medication Appropriateness Index (MAI), and the Zhan criteria (Beers et al, 1991; Hanlon et al, 1992; Zhan et al, 2001; Gallagher et al, 2008). Its latest update was in 2015 by the American Geriatric Society (AGS), and most of the newer tools were developed using it as a model (American Geriatrics Society, 2015) Negative patient outcomes, such as falls and delirium, have been associated with some of the drugs listed in the Beers criteria (Rothberg et al, 2013; Bazargan et al, 2018). The primary objective of this study was to assess the knowledge of Nigerian physicians about these screening tools and appropriate prescribing of medications for the elderly
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