Abstract
The European Commission’s 2019 report regarding the state of health profiles highlighted the fact that Romania is among the countries with the lowest life expectancy in the European Union. Therefore, the objectives of the present study were to assess the current prescription habits of general physicians in Romania related to medicines taken by the elderly population for chronic conditions in both urban and rural setting and to discuss/compare these practices with the current international recommendations for the elderly (American—Beers 2019 criteria and European—STOPP/START v.2, 2015 criteria). A total of 2790 electronic prescriptions for chronic pathologies collected from 18 community pharmacies in the western part of Romania (urban and rural zones) were included. All medicines had been prescribed by general physicians. We identified the following situations of medicine overuse: 15% of the analyzed prescriptions involved the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for >2 weeks, 12% involved the use of a proton-pump inhibitor (PPI) for >8 weeks, theophylline was the bronchodilator used as a monotherapy in 3.17% of chronic obstructive pulmonary disease cases, and zopiclone was the hypnotic drug of choice for 2.31% of cases. Regarding the misuse of medicines, 2.33% of analyzed prescriptions contained an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) for patients with renal failure in addition to vitamin K antagonists (AVKs) and NSAIDs in 0.43% of cases. Prescriptions for COX2 NSAIDs for periods longer than 2 weeks for patients with cardiovascular disorders accounted for 1.33% of prescriptions, and trihexyphenidyl was used as a monotherapy for patients with Parkinson’s disease in 0.18% of cases. From the included medical prescriptions, 32.40% (the major percent of 2383 prescriptions) had two potentially inappropriate medications (PIMs). Rural zones were found to be risk factor for PIMs. Decreasing the chronic prescription of NSAIDs and PPIs, discontinuing the use of hypnotic drugs, and avoiding potentially harmful drug–drug associations will have long term beneficial effects for Romanian elderly patients.
Highlights
The European Commission’s 2019 report regarding the state of health profiles highlighted the fact that Romania is among the countries with the lowest life expectancy in the European Union (EU) (75.3 years in Romania versus 80.9 years in the EU), with large discrepancies between individuals of different genders and education levels [1]
We identified the following situations of medicine overuse: 15% of the analyzed prescriptions involved the use of nonsteroidal antiinflammatory drugs (NSAIDs) for >2 weeks, 12% involved the use of a proton-pump inhibitor (PPI) for >8 weeks, theophylline was the bronchodilator used as a monotherapy in 3.17% of chronic obstructive pulmonary disease cases, and zopiclone was the hypnotic drug of choice for 2.31% of cases
Study Design, Setting, and Data Collection. This cross-sectional study included a total of 2790 electronic medical prescriptions for chronic pathologies collected from 18 community pharmacies in the western part of Romania between January 2018 and June 2019, all written by general physicians
Summary
The European Commission’s 2019 report regarding the state of health profiles highlighted the fact that Romania is among the countries with the lowest life expectancy in the European Union (EU) (75.3 years in Romania versus 80.9 years in the EU), with large discrepancies between individuals of different genders and education levels [1]. Some of the causes of increased mortality involve behavioral risk factors (smoking, obesity, alcohol consumption, low physical activity, and poor nutrition in the form of excessive consumption of salt and sugar and low intake of fruits and vegetables), having a lower number of doctors and nurses per inhabitant, and having much lower health care costs compared with other EU countries (both per patient—1029 versus 2884 EUR/patient in the EU and per percent of gross domestic product (GDP)—5 versus 9.8% in the EU) [1] It seems that the main causes of death are preventable and treatable pathologies, with diseases of the circulatory system (ischemic heart diseases and stroke) being the primary cause (58.2%), followed by cancer (lung, breast, or colorectal) and respiratory diseases [3]. Regarding the COVID-19 mortality rate in other European countries, data published at the beginning of February 2021 by the WHO Coronavirus Disease Dashboard showed the following: 3.51% in Hungary, 3.46% in Italy, 2.73% in Germany, 2.54% in Romania, 2.41% in France, and 2.09% in Spain (number of deaths/total number of reported cases) [9]
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