The Prevalence And Related Factor Analysis Of Potentially Inappropriate Medication Among Elderly Outpatients

OBJECTIVETo analyze the prevalence of potential inappropriate medications(PIMs)among the elderly outpatients in the Second Affiliated Hospital,Zhejiang University School of Medicine,and evaluate the distribution and risk factors of PIMs among different departments and diseases,and then provide information for the clinical rational drug useMETHODSThe prescriptions for the elderly outpatients aged 65 years and over were collected from the database from January 2016 to June 2016 in the Second Affiliated Hospital,Zhejiang University School of Medicine,and the PIMs were evaluated according to the Beers Criteria 2015 version.The PIMs among different departments and diseases were statistically analyzed by EXCEL and SPSS.The ?2 testing and multivariate logistic regression analysis were conducted to reveal the risk factors of PIMsRESULTS?A total of 182,431 prescriptions were collected.There were 24,374(13.36%of total)PIM prescriptions,which were mainly from the Department of Cardiology,the Department of Neurology,and the Department of Psychiatry(68.77%of total).The highest incidence of PIMs(92.70%)was found in the Department of Psychiatry.while there was none PIM found in the Department of Ophthalmology.?The most common drug of PIMs were diuretics(34.57%.8,425 prescriptions),benzodiazepines(27.77%,6,769 prescriptions)and SSRIs(14.90%,3,631 prescriptions).But the incidences of PIMs of these three drugs in different departments varied differently.?The data of PIMs from different departments was also analyzed,and it was found that the occurrence of PIMs was positively or negatively correlated with gender,age and the number of diseases,while the occurrence of PIMs was positively correlated with the number of drugs.As the number of drugs increased,the odds ratio of PIMs in the Department of Psychiatry was maximal increased by 114.7%,which is 4.5-time folds when compared to the Department of General Medicine(25.4%).?Among the prescriptions with single disease(over 100 prescriptions),the kinds of diseases with highest incidence of PIMs were mental disorders(anxiety disorders,sleep disorders,etc),neurological diseases(neuralgia,etc),cardiovascular diseases(atrial fibrillation,essential hypertension,etc),and hypertension.The incidence of PIMs for the first nine mental disorders was 93.55%?for the top two neurological diseases was 5 1.08%,for the top three cardiovascular diseases was 32.9 1%and for hypertension was 37.3 1%?The statistical results showed that the occurrence of PIMs was positively correlated with the number of drugs used under different diagnostic conditions,while the occurrence of PIMs was positively or negatively correlated with gender and age.As the number of drugs increased,the odds ratios of PIMs in angina,hypertension with hyperlipidemia and hypertension with coronary atherosclerosis(stenosis)were all increased significantly,exceeding 100%.However,the odds ratios of PIMs in trigeminal neuralgia and essential hypertension with coronary atherosclerotic heart were increased least,less than 30%CONCLUSIONThe distribution of PIMs in elderly outpatients varied greatly among different departments and diseases.The occurrence of PIMs was correlated with many factors,among which the number of drugs was positively correlated with the occurrence of PIMs.The clinicians and pharmacists should pay more attention to the departments and diseases with higher incidence of PIMs.Moreover,they need to evaluate the potential risk of drug use,and then promote clinical rational drug use.