الفهرس | Only 14 pages are availabe for public view |
Abstract Drug use is widespread in elderly patients. It is also complicated by agerelated changes which increase the response to many drugs. These changes with the extensive use of drugs and high prevalence of co -morbidities increase the risk of inconvenient effects of drugs in elderly patients. Inappropriate drug use (IDU) is an imperative health care problem in elderly and it is linked with adverse drug reactions, hospitalization, and mortality. Potentially inappropriate medications (PIMs) use is a chief problem among older people, and may be committed to increase risk of adverse drug effects and to develop drug-drug and drug-disease interactions. Appropriate prescribing can be evaluated by using explicit and implicit criteria. The most commonly used explicit criteria are the Beers criteria and STOPP & START criteria. Although the most commonly used implicit criteria are medication appropriateness index (MAI). These tools include a list of inappropriate drugs that should be avoided in older patients. All of the above stress on the role of the clinical pharmacist in detection of the potentially inappropriate medication through the application of the above tools. This study was conducted to minimize drug related problems in elderly patients after evaluating their occurrence and causes. This was done through four phases: evaluation of the medications related problems in the control group (150 patients) that will be occurred and analysis of them, construction of pharmaceutical care plan to solve these problems, educational intervention for pharmacists, patients, nurses and physicians and finally application of this plan on the intervention group (150 patients). The primary objective of this study is to determine whether the complex intervention would change the quality of medication therapy determined by the explicit criteria by using Beers criteria and STOPP & START criteria in comparison to control group. The intervention focuses on multi-morbid patients receiving polypharmacy. Moreover, medication appropriateness index was done as a secondary measure. In the current study it was found that: The age of participants was in harmony with the general life expectancy of elderly, with relative predominance of female patients. The main cause of morbidity found in our study was hypertension followed by diabetes and ischemic heart diseases. The most frequently used drugs were aspirin, omeprazole and ACE Inhibitors. The number of patients suffered from inappropriate prescribing was significantly higher in control group than in intervention groups according to STOPP & START criteria and Beers criteria. Furthermore, pharmacist intervention significantly improved the prescribing procedure. According to medication appropriateness index (MAI), before the intervention 99.0% of medications and 99.3% of patients met at least 1 criterion of inappropriateness, while after the intervention only 22.8% of medications and 70.6% of patients showed at least 1 criterion of inappropriateness. Average MAI score per patient decreased from 17 in the control group to 4 in the intervention group. Polypharmacy and number of morbidities are associated with the risk of inappropriateness of indicated medicines. All of the above re-highlights the important role of pharmaceutical intervention in the setting of geriatric care. |