Potentially inappropriate prescriptions for poly-treated patients in long-term care facilities: retrospective pharmacoutilization analysis

Igiene e Sanità Pubblica 2024; 88 (1): 1-18

Roberta Giacometti¹, Antonella Barbieri², Maddalena Galante¹, Rossana Monciino², Alice Mastrogiacomo¹, Luca Rabbiosi², Fabiola Formica<sup>3

1</sup>Pharmacist in Local Health Authority of Vercelli
²Pharmacist Director in Local Health Authority of Vercelli
³Faculty of Medicine student at the University of Pisa

ABSTRACT
BACKGROUND
This study aimed to investigate, among elderly patients in long-term care (LTC)
facilities, potentially inappropriate drug prescriptions, potentially interactions and
verify whether they can be traced back to hospitalisations or accesses to the
Emergency Department (ED). The study data were acquired by means of a case
report form investigating the medication management process in LTCs.
MATERIAL AND METHODS
Analysis of pharmacutilisation in LTCFs patients aged ≥65 years on polypharmacy
or excessive polypharmacy, January-July 2023. Data was extracted from a database
(DB) containing the monthly prescriptions of medicines supplied by direct
distribution (DD) to LTCs. The prevalence of PIMs was evaluated by applying the
Beers and STOPP criteria to the medication profile of each patient.
RESULTS
The overall prevalence of polypharmacy and hyperpolypharmacy was 83% and
17%, respectively. PIMs were defined using Beers and STOPP criteria. The most
frequent PIMs were proton pump inhibitors (19% e 15%), antiplatelets agent
(17% e 13%) and non-associated sulfonamides (14% e 12%). Of the 1,921 PIMs,
121 were contraindicated or very serious (6%) and 1,800 were major (94%).The
most common medicaments involved in drug-drug interaction are furosemide
(21%), sertraline (19%), pantoprazole (16%) e trazodone (15%). LTCs participating
in the study (56%) excluded polypharmacy as a cause of access to the ED and
ADRs. Therefore no case was ever reported (100%).
CONCLUSIONS
Polypharmacy or excessive polypharmacy among elderly patients may increase PIMs and ADRs. A constant review of the therapeutic regimens and deprescribing
decrease inappropriate use of medications and interactions, ADRs, and accesses to
the ED with consequent reduction of pharmaceutical spending.