INAPPROPRIATE PRESCRIBING PATTERN AMONG ELDERLY PATIENTS TREATED IN THE TERTIARY LEVEL HOSPITAlS / Монголын эм зүй, эм судлал

ABSTRACT

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce the health care costs.Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system.Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct a retrospective study on inappropriate prescribing pattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals of Ulaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 – 2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.Results: The mean age of the participants was 67.38±0.24 and 54.6% of participants were male and 44.4% were female.The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total use drug per patients were from standard therapeutic guideline.The most common inappropriately used drugs were as follows amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital), dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medical conditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used to elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.