Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

Khusnul Fitri Hamidah; Mahardian Rahmadi; Farah Meutia; Prihatma Kriswidyatomo; Firman Suryadi Rahman; Zamrotul Izzah; Bambang Subakti Zulkarnain; Leopold N Aminde; Christopher Paul Alderman; Yulistiani; Budi Suprapti

doi:10.18549/PharmPract.2022.4.2735

Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

Pharm Pract (Granada). 2022 Oct-Dec;20(4):2735. doi: 10.18549/PharmPract.2022.4.2735. Epub 2022 Nov 8.

Affiliations

¹ Department of Pharmacy, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia. khusnul.fitri.hamidah-2018@ff.unair.ac.id.
² Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. mahardianr@ff.unair.ac.id.
³ Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Airlangga Surabaya, Indonesia. farah.meutia-2020@ff.unair.ac.id.
⁴ Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Emergency Department, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia. prihatma.kriswidyatomo@staf.unair.ac.id.
⁵ Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia. firman.suryadi.rahman-2018@fkm.unair.ac.id.
⁶ Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. zamrotulizzah@ff.unair.ac.id.
⁷ Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. bambang-s-z@ff.unair.ac.id.
⁸ School of Medicine, Griffith University, Gold Coast, QLD, Australia. l.aminde@griffith.edu.au.
⁹ Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia. Chris.Alderman@unisa.edu.au.
¹⁰ Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. yulistiani@ff.unair.ac.id.
¹¹ Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. budi-s@ff.unair.ac.id.

Abstract

Background: Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED).

Objective: To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED.

Methods: A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January - June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively.

Results: A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 - 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 - 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 - 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 - 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 - 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 - 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 - 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 - 5.401) were associated with higher medication complexity.

Conclusion: In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.

Keywords: beers criteria; elderly; medication regimen complexity index; medication-related problem; polypharmacy.