Monitoring medication problems in the elderly and strategies for their reduction.

Although the elderly population are known to be at risk of iatrogenic illness, there were surprisingly few studies which investigated both medication-related morbidity and preventability issues in this group of the population. Determining the incidence of hospital admissions related to the use of medications could provide an indication of the more serious drug-induced morbidity in the community. The present study measured the incidence of medication-related hospital admissions in the elderly and assessed their preventability. Subsequently, preventive measures were determined and implemented in an attempt to reduce the incidence of those medication-related admissions which had been shown to be a serious threat to patients’ health. Eight hundred and forty-two elderly patient admissions to hospitals in Aberdeen were examined. An independent expert panel review was employed for evaluation of medication-related problems (MRPs). The incidence of admissions considered as being ‘definitely’ or ‘probably’ medication-related was 7% (57/842). Of all 57 medication-related admissions, nonsteroidal anti-inflammatory drugs (NSAIDs) were responsible in a quarter (24.5%, 14/57). The incidence of MRPs estimated against frequency of prescribing of each medication group was also highest with NSAIDs (17.6%, 18/102). Among groups of medication associated with MRPs, the percentage of MRPs contributing to admission remained highest with NSAIDs (83.3%, 15/18). All of the 14 NSAID-related admissions were considered to be preventable. Nine of the 14 NSAID-related admissions were rated as ‘severe’ or ‘life-threatening’ in condition. Preventive measures thus targeted NSAIDs. Studies of intervention strategies affecting prescribing were reviewed. Preventive strategies in the study were developed in response to the results of a questionnaire which sought the target groups’ opinions on proposed preventive strategies. Educational materials for general medical practitioners (GPs) and community pharmacists, as well as a patient information leaflets were then produced and distributed to GPs and to community pharmacies throughout Grampian. The first and second reminders were sent at two month intervals. The incidence of NSAID-related hospital admissions and NSAID prescriptions were re-measured in a further 1522 elderly patient admissions, following the preventive strategies. The overall incidence of NSAID-related admissions and NSAID prescriptions in the second study population did not drop. However, amongst those identified with NSAID-related problems, all NSAID-related admissions, admissions due to NSAID-induced gastrointestinal (GI) adverse effects, and overall NSAID-induced gastrointestinal (GI) adverse effects dropped significantly (P= 0.0207, 0.0096, and 0.046, respectively). More intensive strategies, possibly with local health board/authority involvement, would seem to be necessary in order to achieve a significant reduction in unnecessary NSAID prescribing, increased monitoring of patient and drug therapy, and thus a reduction in NSAID-related hospital admissions in the elderly population.

Author dc:creator

• Pongwecharak, Juraporn

Advisor dc:contributor.advisor

• R.M.E. Richards, J.A. Cromarty and S.P. Wilkinson

• Medication‑related hospital admissions
• Elderly patients
• Preventable adverse drug reactions
• Nonsteroidal anti‑inflammatory drugs (NSAIDs)
• Prescribing practices
• Drug safety and prevention

Language dc:language

en

Identifier

oai:rgu-repository.worktribe.com:2807533
https://doi.org/10.48526/rgu-wt-2807533

OAI identifier oai:identifier

oai:rgu-repository.worktribe.com:2807533