Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Population
2.2. Data Analysis
2.3. Statistical Analysis
3. Results
3.1. Study Population Characteristics
3.2. Overall Medication Prescribed
3.3. Prevalence of PIM Prescription
3.4. Most Prescribed PIM at Admission and at Discharge
3.5. Factors Related to Changes in PIMs
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Medication Outcome | Measure | Admission n = 6481 | Discharge n = 7239 |
---|---|---|---|
Number of medicines | median (Q1–Q3) range (min-max) | 10 (8–13) 0–27 | 11 (9–14) 1–27 |
Polypharmacy (≥5 meds) | no yes | 29 (4.7%) 587 (95.3%) | 18 (2.9%) 598 (97.1%) |
PIMs Beers criteria (at least one) | no yes | 119 (19.3%) 497 (80.7%) | 79 (12.8%) 537 (87.2%) |
PIMs STOPP criteria (at least one) | no yes | 312 (50.6%) 304 (49.4%) | 233 (37.8%) 383 (62.2%) |
PIMs EU (7)-PIM list (at least one) | no yes | 300 (48.7%) 316 (51.3%) | 183 (29.7%) 433 (70.3%) |
n—number of medicines |
Frequency of PIMs | Tool | |||||
---|---|---|---|---|---|---|
Beers 2019 Criteria | STOPP v2 Criteria | EU (7)-PIM List | ||||
Admission | Discharge | Admission | Discharge | Admission | Discharge | |
0 | 119 (19.3%) | 79 (12.8%) | 312 (50.6%) | 233 (37.8%) | 300 (48.6%) | 183 (29.7%) |
1 | 238 (38.6%) | 190 (30.8%) | 174 (28.2%) | 190 (30.8%) | 204 (33.1%) | 205 (33.2%) |
2 | 147 (23.8%) | 162 (26.3%) | 88 (14.3%) | 119 (19.3%) | 80 (13.0%) | 152 (24.6%) |
3 | 68 (11.0%) | 116 (18.8%) | 30 (4.9%) | 44 (7.1%) | 24 (3.9%) | 50 (8.1%) |
4 | 28 (4.5%) | 47 (7.6%) | 7 (1.1%) | 24 (3.9%) | 5 (0.8%) | 19 (3.1%) |
≥5 | 16 (2.6%) | 22 (3.6%) | 5 (0.8%) | 6 (1.0%) | 3 (0.5%) | 7 (1.2%) |
Variation Type | Beers 2019 | STOPP v2 | EU (7)-PIM List | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Drug | PIMs Admission (n) | PIMs Discharge (n) | PIMs Variation | Drug | PIMs Admission (n) | PIMs Discharge (n) | PIMs Variation | Drug | PIMs Admission (n) | PIMs Discharge (n) | PIMs Variation | |
Increase | Metoclopramide | 105 | 148 | 43 | Quetiapine | 36 | 66 | 30 | Bisacodyl | 30 | 95 | 65 |
Quetiapine | 36 | 66 | 30 | Hydroxyzine | 13 | 40 | 27 | Metoclopramide | 105 | 148 | 43 | |
Sertraline | 6 | 33 | 27 | Haloperidol | 84 | 109 | 25 | Sitagliptin | 7 | 42 | 35 | |
Hydroxyzine | 13 | 40 | 27 | Morphine | 3 | 24 | 21 | Hydroxyzine | 13 | 40 | 27 | |
Haloperidol | 84 | 109 | 25 | Butylscopolamine | 3 | 15 | 12 | Haloperidol | 84 | 109 | 25 | |
Decrease | Acetylsalicylic acid | 58 | 50 | 8 | Captopril | 46 | 37 | 9 | Propranolol | 6 | 4 | 2 |
Sulfamethoxazole and Trimethoprim | 5 | 0 | 5 | Tiapride | 10 | 8 | 2 | Amiodarone | 17 | 16 | 1 | |
Tiapride | 10 | 8 | 2 | Valsartan | 4 | 2 | 2 | Clemastine | 2 | 1 | 1 | |
Clemastine | 3 | 2 | 1 | Enalapril | 2 | 0 | 2 | Phenytoin | 1 | 0 | 1 | |
Amiodarone | 17 | 16 | 1 | Ramipril | 25 | 23 | 2 | - | - | - | - |
PIM Tool | Variable | Adjusted OR (95%CI) Category | |
---|---|---|---|
PIMs Increase | PIMs Decrease | ||
Beers 2019 criteria | Females | 0.93 (0.55−1.57) | 1.58 (1.07−2.33) * |
Total medicines per patient | 1.14 (1.09−1.19) * | 1.09 (1.05−1.13) * | |
I00-I99, diseases of the circulatory system | 1.30 (1.08−1.57) * | 1.15 (0.99−1.33) | |
K00-K95, diseases of the digestive system | 2.05 (1.31−3.2) * | 1.49 (1.03−2.17) * | |
STOPP v2 criteria | Total medicines per patient | 1.12 (1.06−1.17) * | 1.1 (1.06−1.13) * |
K00-K95, diseases of the digestive system | 1.54 (1.01−2.36) * | 1.02 (0.71–1.47) | |
R00-R99, abnormal symptoms, signs, and clinical and laboratory findings not classified elsewhere | 1.14 (0.76−1.7) | 1.33 (1.01−1.73) * | |
EU(7)-PIM list | Females | 1.21 (0.66−2.2) | 1.48 (1.01−2.18) * |
Total medicines per patient | 1.14 (1.08–1.2) * | 1.11 (1.07−1.15) * | |
N00-N99, diseases of the genitourinary tract | 0.97 (0.67−1.4) | 0.75 (0.59−0.97) * |
PIMs Tool | Variable | Adjusted RR(95%CI) | p-Value |
---|---|---|---|
Beers 2019 criteria | Polypharmacy | 1.83 (1.18–3.02) | 0.0111 |
F00-F99, mental, behavioral, and neurodevelopment disorders | 1.18 (1.04–1.33) | 0.0077 | |
I00-I99, diseases of the circulatory system | 1.09(1.05–1.14) | <0.0001 | |
STOPP v2 criteria | 75 to 84 years | 0.77 (0.6–0.98) | 0.0363 |
I00-I99, diseases of the circulatory system | 1.07 (1.01–1.14) | 0.0195 | |
V00-Y99, external causes of morbidity | 1.47 (1.05–2.03) | 0.0231 | |
EU (7)-PIM list | 85 years or older | 0.77 (0.63–0.94) | 0.0095 |
Polypharmacy | 3.34 (1.69–7.89) | 0.0018 | |
D50-D89, blood and blood-forming organs diseases involving immunological mechanism | 1.19 (1.04–1.36) | 0.0096 | |
I00-I99, diseases of the circulatory system | 1.07 (1.01–1.12) | 0.0149 | |
N00-N99, diseases of the genitourinary tract | 0.88 (0.80–0.97) | 0.0089 |
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Perpétuo, C.; Plácido, A.I.; Aperta, J.; Figueiras, A.; Herdeiro, M.T.; Roque, F. Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal. Int. J. Environ. Res. Public Health 2023, 20, 4955. https://doi.org/10.3390/ijerph20064955
Perpétuo C, Plácido AI, Aperta J, Figueiras A, Herdeiro MT, Roque F. Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal. International Journal of Environmental Research and Public Health. 2023; 20(6):4955. https://doi.org/10.3390/ijerph20064955
Chicago/Turabian StylePerpétuo, Carla, Ana I. Plácido, Jorge Aperta, Adolfo Figueiras, Maria Teresa Herdeiro, and Fátima Roque. 2023. "Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal" International Journal of Environmental Research and Public Health 20, no. 6: 4955. https://doi.org/10.3390/ijerph20064955