Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study
Abstract Background Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia....
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-024-04949-8 |
| _version_ | 1797209082497597440 |
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| author | Nahla A. Alageel Carmel M. Hughes Monira Alwhaibi Walid Alkeridy Heather E. Barry |
| author_facet | Nahla A. Alageel Carmel M. Hughes Monira Alwhaibi Walid Alkeridy Heather E. Barry |
| author_sort | Nahla A. Alageel |
| collection | DOAJ |
| description | Abstract Background Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia. Therefore, we aimed to estimate the prevalence of PIP and investigate associations between PIP and other patient characteristics among PwD in an ambulatory care setting. Methods A cross-sectional, retrospective analysis was conducted at a tertiary hospital in Saudi Arabia. Patients who were ≥ 65 years old, had dementia, and visited ambulatory care clinics between 01/01/2019 and 31/12/2021 were included. Prescribing appropriateness was evaluated by applying the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria. Descriptive analyses were used to describe the study population. Prevalence of PIP and the prevalence per each STOPP criterion were calculated as a percentage of all eligible patients. Logistic regression analysis was used to investigate associations between PIP, polypharmacy, age and sex; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Analyses were conducted using SPSS v27. Results A total of 287 PwD were identified; 56.0% (n = 161) were female. The mean number of medications prescribed was 9.0 [standard deviation (SD) ± 4.2]. The prevalence of PIP was 61.0% (n = 175). Common instances of PIP were drugs prescribed beyond the recommended duration (n = 90, 31.4%), drugs prescribed without an evidence-based clinical indication (n = 78, 27.2%), proton pump inhibitors (PPIs) for > 8 weeks (n = 75, 26.0%), and acetylcholinesterase inhibitors with concurrent drugs that reduce heart rate (n = 60, 21.0%). Polypharmacy was observed in 82.6% (n = 237) of patients and was strongly associated with PIP (adjusted OR 24.1, 95% CI 9.0–64.5). Conclusions Findings have revealed a high prevalence of PIP among PwD in Saudi Arabia that is strongly associated with polypharmacy. Future research should aim to explore key stakeholders’ experiences and perspectives of medicines management to optimise medication use for this vulnerable patient population. |
| first_indexed | 2024-04-24T09:49:03Z |
| format | Article |
| id | doaj.art-a66cfde947084643854314dbc19c3d35 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-24T09:49:03Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-a66cfde947084643854314dbc19c3d352024-04-14T11:28:42ZengBMCBMC Geriatrics1471-23182024-04-0124111010.1186/s12877-024-04949-8Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational studyNahla A. Alageel0Carmel M. Hughes1Monira Alwhaibi2Walid Alkeridy3Heather E. Barry4Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen’s University BelfastPrimary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen’s University BelfastDepartment of Clinical Pharmacy, College of Pharmacy, King Saud UniversityDepartment of Medicine, College of Medicine, King Saud UniversityPrimary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen’s University BelfastAbstract Background Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia. Therefore, we aimed to estimate the prevalence of PIP and investigate associations between PIP and other patient characteristics among PwD in an ambulatory care setting. Methods A cross-sectional, retrospective analysis was conducted at a tertiary hospital in Saudi Arabia. Patients who were ≥ 65 years old, had dementia, and visited ambulatory care clinics between 01/01/2019 and 31/12/2021 were included. Prescribing appropriateness was evaluated by applying the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria. Descriptive analyses were used to describe the study population. Prevalence of PIP and the prevalence per each STOPP criterion were calculated as a percentage of all eligible patients. Logistic regression analysis was used to investigate associations between PIP, polypharmacy, age and sex; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Analyses were conducted using SPSS v27. Results A total of 287 PwD were identified; 56.0% (n = 161) were female. The mean number of medications prescribed was 9.0 [standard deviation (SD) ± 4.2]. The prevalence of PIP was 61.0% (n = 175). Common instances of PIP were drugs prescribed beyond the recommended duration (n = 90, 31.4%), drugs prescribed without an evidence-based clinical indication (n = 78, 27.2%), proton pump inhibitors (PPIs) for > 8 weeks (n = 75, 26.0%), and acetylcholinesterase inhibitors with concurrent drugs that reduce heart rate (n = 60, 21.0%). Polypharmacy was observed in 82.6% (n = 237) of patients and was strongly associated with PIP (adjusted OR 24.1, 95% CI 9.0–64.5). Conclusions Findings have revealed a high prevalence of PIP among PwD in Saudi Arabia that is strongly associated with polypharmacy. Future research should aim to explore key stakeholders’ experiences and perspectives of medicines management to optimise medication use for this vulnerable patient population.https://doi.org/10.1186/s12877-024-04949-8Ambulatory careDementiaElectronic health recordsInappropriate prescribingPharmacoepidemiologyPolypharmacy |
| spellingShingle | Nahla A. Alageel Carmel M. Hughes Monira Alwhaibi Walid Alkeridy Heather E. Barry Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study BMC Geriatrics Ambulatory care Dementia Electronic health records Inappropriate prescribing Pharmacoepidemiology Polypharmacy |
| title | Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study |
| title_full | Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study |
| title_fullStr | Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study |
| title_full_unstemmed | Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study |
| title_short | Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study |
| title_sort | potentially inappropriate prescribing for people with dementia in ambulatory care a cross sectional observational study |
| topic | Ambulatory care Dementia Electronic health records Inappropriate prescribing Pharmacoepidemiology Polypharmacy |
| url | https://doi.org/10.1186/s12877-024-04949-8 |
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