Prevalence of potentially inappropriate medications in older adults in Argentina using Beers criteria and the IFAsPIAM List.

Background Medications in which the risk of adverse events exceeds the expectations of clinical benefits are called potentially inappropriate medications (PIMs). To identify the use of PIMs in elderly patients, the most commonly used tool are the Beers criteria, developed for the population of the United States. Recently, a consensus panel of Argentine experts developed the first Latin American tool, called the IFAsPIAM List. Objective The present study aimed to identify PIM prescriptions in elderly outpatients, to estimate the prevalence of PIMs, and to evaluate their possible relation with polypharmacy and gender and age of the patients. Also, we aimed to compare the results obtained by using the Beers criteria and the IFAsPIAM List. Setting Ten community pharmacies of Rosario, Santa Fe, Argentina. Methods A cross-sectional observational study was conducted between February and September 2015. Data were acquired from 56,952 prescriptions prescribed to 2231 patients aged 65 years old or older. To detect the use of PIMs, we used two tools: the Beers criteria and the IFAsPIAM List. Main outcome measure The prevalence of PIM use according to the Beers criteria and the IFAsPIAM List. Results The monthly average of medications dispensed per patient was 4.35 ± 2.18 and 42.27% of the patients presented major polypharmacy. The prevalence of PIMs was 72.75% according to the Beers criteria and 71.13% according to the IFAsPIAM List (Kappa coefficient k = 0.72), and was significantly higher in patients with major polypharmacy, older than 75 years old, and females. The most frequent PIMs prescribed were anxiolytics, analgesics and antipsychotics. Conclusions The IFAsPIAM List is an effective tool to evaluate the prescription of PIMs in the elderly. The results showed a high prevalence of PIMs with a multicausal origin and directly associated with polypharmacy. As clarified by the authors of the IFAsPIAM List, the criteria specified in the list do not substitute the clinical evaluation of each patient.

Assessment of polypharmacy in elderly patients by using data from dispensed medications in community pharmacies: analysis of results by using different methods of estimation.

Background Estimating the prevalence of polypharmacy is essential for the evaluation of public health. Many different methodologies are used to determine the number of drugs used by a patient. Objective To analyse and compare three different methods (simultaneous, cumulative and continuous medication) to determine the number of drugs used by a patient, to estimate the prevalence of polypharmacy and to evaluate the possible association between polypharmacy and the gender and age of patients. Method Cross-sectional observational study carried out between April and September 2015. Data were acquired from prescriptions corresponding to 3972 patients aged 65 years old or older in ten community pharmacies in Argentina. Results The prevalence of polypharmacy varied significantly according to the method used. Major polypharmacy (use of five or more drugs) was detected in 20.5-47.1% of the patients. The association between gender, age and polypharmacy was statistically significant only when using the continuous medication method. The prevalence of minor polypharmacy (use of two to four drugs) was similar with the three methods. Conclusion These results contribute to deciding which is the best method to determine polypharmacy according to the objective of future studies and considering the advantages and disadvantages of each of them.

Estudio de prevalencia de medicación potencialmente inapropiadas en adultos mayores / Prevalence study of potentially inappropriate medication in older adults

INTRODUCCIÓN La población adulta mayor es un grupo de riesgo asociado con la pluripatología, con la polifarmacia y mayor riesgo de efectos adversos. La medicación potencialmente inapropiada (PIM) es aquella en la que el riesgo de eventos adversos es superior a los beneficios clínicos. Existen diferentes métodos para medir prescripciones PIMs, los más utilizados son Criterios de Beers; de STOPP y el Indice de Medicación Apropiada (MAI). OBJETIVO Evaluar la prevalencia de prescripciones PIM en una población de adultos mayores que reciben su medicación en centros de atención primaria de la salud de Rosario. MATERIAL Y MÉTODOS Estudio retrospectivo observacional de corte transversal de 106 pacientes mayores de 65 años de una muestra aleatoria de seis centros de salud. RESULTADOS Se analizaron 492 prescripciones, encontrándose una prevalencia de PIM de 35.85% según Beers, 45.28% según STOPP y 76.00% con el índice MAI. Solo se halló asociación estadísticamente significativa entre prescripciones PIM y polimedicación mayor con los criterios STOPP. Las PIMs más frecuentemente observadas correspondieron a los grupos farmacológicos de los antiulcerosos, AINES, glibenclamida, benzodiacepinas y antipsicóticos. A través del índice MAI, los pacientes con PIM presentaron para cada uno de los criterios diferentes prevalencias, siendo las más frecuentes; el uso de medicamento inapropiado por la edad o no tenían diagnóstico 76.00%, interacciones fármaco-fármaco; 44.00% interacciones fármacos-enfermedad 24.00% y las duplicaciones innecesarias 4.00%., se encontró que el 76% fueron interacciones fármaco-fármaco, 44% fármaco-enfermedad y hubo un 4% de duplicaciones innecesarias. DISCUSIÓN Los resultados obtenidos muestran una alta prevalencia de PIM utilizando todos los criterios y están en concordancia a la escasa literatura nacional. De los criterios explícitos los de STOPP mostraron una mejor adaptación para ser utilizados en la estimación de PIM en nuestra población