Abstract
Abstract Objective: to study the main elements of the iatrogenic triad in a group of elderly women with a Chronic Non-Communicable Disease (CNCD) contracted to a health plan. Method: A cross-sectional and descriptive epidemiological study was carried out by analyzing 3,501 medical prescriptions of 725 elderly women aged ≥65 years. The medications were determined to be Potentially Inappropriate Medications (PIM) based on four instruments (AGS Beers 2015, PRISCUS List, EU(7)-PIM, Brazilian Consensus of PIM - CBPIM). In addition, the most prescribed drugs were assessed for possible Drug Interactions (DI) and classified according to degree of severity. Results: the present study revealed that 89.3% of the studied group used at least one element of the iatrogenic triad, and 44.9% of the sample were associated with the use of polypharmacy and PIM. A total of 48.0% were taking at least five continuous use medications. The main DI were omeprazole, simvastatin and levothyroxine, all of which are of significant severity and have potential drug-food interactions. A total of 35.1% of PIM were identified through the four criteria used, 26.6% were identified by the CBPIM, 25.8% by the EU(7)-PIM, and 24.6% and 6.6% by AGS Beers and PRISCUS, respectively. Conclusion: a high index of continuous use medications, PIM and potential DI were identified, mainly enzymatic inhibitors in a group of elderly women at risk due to their clinical characteristics. Old age was associated with the presence of all the elements of the iatrogenic triad. It was also noted that there were no significant differences between the criteria applied, except for the PRISCUS list.
Highlights
The elderly are the most frequent consumers of medications yet at the same time are the most sensitive and exposed to Adverse Drug Related Events (ADRE) such as: prescription or drug cascades; toxic effects; the Iatrogenic triad, defined as the prescription of at least one potentially inappropriate medication (PIM), combined with the continued use of polypharmacy and the presence of potential drug interactions, and adverse drug reactions (ADR)
The present study aimed to investigate the presence of elements of the Iatrogenic Triad (PIM prescription, continuous use of polypharmacy and the presence of the main potential interactions associated with medication) in a group of elderly women participating in a disease management program, who were contracted to a health plan in the city of São Paulo, Brazil
Between September and December 2015, a cross-sectional, descriptive, retrospective study was conducted on the use of drugs by a group of noninstitutionalized elderly women, contracted to a supplementary health plan in the city of São Paulo, and who were part of a chronic disease management program (CDM) provided by a health plan provider (HPP) in that city
Summary
The elderly are the most frequent consumers of medications yet at the same time are the most sensitive and exposed to Adverse Drug Related Events (ADRE) such as: prescription or drug cascades; toxic effects; the Iatrogenic triad, defined as the prescription of at least one potentially inappropriate medication (PIM), combined with the continued use of polypharmacy and the presence of potential drug interactions, and adverse drug reactions (ADR). A variety of drugs sold to and consumed by the elderly are associated with the emergence of several types of drug interactions (DI), namely: drug-drug, drug-disease, drug-laboratory test, drug-food and drug-tobacco interactions. A pharmacological or clinical response where the effects of a drug are altered by the combination of two or more drugs, herbal remedies, food, alcoholic beverages or environmental chemical agents defines the presence of DI3. Antilipidemics, betablockers, anti-inflammatories, digitalis, inhibitors (omeprazole, cimetidine and captopril) and enzyme inducers (phenytoin and carbamazepine) are some of the medicines that frequently cause ADR and are responsible for approximately 25% of resulting hospital admissions, which are mostly caused by an acute reaction[4,5]
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