Association between potentially inappropriate medications and clinical outcomes in elderly patients with gastrointestinal diseases

Cilj istraživanja bio je odrediti učestalost korištenja potencijalno neprikladnih lijekova u osoba starije životne dobi s bolestima probavnog sustava koristeći sveobuhvatni protokol te odrediti povezanost između utvrđenih potencijalno neprikladnih lijekova i kliničkih ishoda. Istraživanje je provedeno u razdoblju od listopada 2014. do listopada 2015. godine na Odjelu gastroenterologije Klinike za unutarnje bolesti Kliničke bolnice Dubrava, a uključivalo je pacijenti starije od 65 godina s oboljenjem probavnog sustava. Za svakog ispitanika prikupljeni su osnovni podaci, podaci o terapiji propisanoj u bolnici, podaci o osnovnoj dijagnozi i komorbiditetima. U razdoblju od tri do pet mjeseci nakon otpusta iz bolnice ispitanici su kontaktirani telefonskim putem i ispitani o događajima nakon otpusta iz bolnice. Potencijalno neprikladni lijekovi određeni su pomoću sveobuhvatnog protokola hrvatskih autorica, dok je kao referentni izvor za utvrđivanje povezanosti između kliničkih ishoda nakon otpusta iz bolnice i određenih potencijalno neprikladnih lijekova korišten Sažetak opisa svojstava lijekova. U istraživanje je bilo uključeno 60 ispitanika prosječne dobi 74 ± 5,35 (raspon 65-89) godina koji su koristili 7,12 ± 0,45 (raspon 1-17) lijekova te imali dijagnosticirano 5,85 ± 0,38 (raspon 2-14) dijagnoza. Sveobuhvatnim protokolom utvrđeno je da je 36,67% ispitanika koristilo barem jedan potencijalno neprikladan lijek. Najčešće propisivan potencijalno neprikladan lijek bio je diazepam. Kod 35% ispitanika je utvrđeno korištenje kombinacija lijekova koje mogu rezultirati klinički značajnim interakcijama. Najčešće interakcije bile su kombinacija lijekova koji djeluju na središnji živčani sustav. Analizom kliničkih ishoda nakon otpusta iz bolnice proizlazi da su kod 11,67% ispitanika ishodi povezani s primjenom potencijalno neprikladnih lijekova. Iako je pomoću sveobuhvatnog protokola nađena prilično visoka pojavnost potencijalno neprikladnih lijekova, njihova je povezanost s kliničkim ishodima bila slaba.The aim of this study was to determine the frequency of the use of potentially inappropriate medications in elderly patients with gastrointestinal diseases using a comprehensive protocol and also determine the association between identified potentially inappropriate medication and clinical outcomes. Study was conducted from October 2014 to October 2015 at the Department of Gastroenterology of Clinic for Internal Medicine, University Hospital Dubrava, and included patients older than 65 years with the disease of digestive system. For each patient demographic data was collected, data on the treatment prescribed at the hospital, data on primary diagnosis and comorbidities. In the period of three to five months after discharge from hospital patients were contacted by telephone and asked about events after hospital discharge. Potentially inappropriate medications were determined by using a comprehensive croatian protocol, summary of product characteristics (SmPC) was used as a reference source for determining the association between the clinical outcomes after hospital discharge and certain potentially inappropriate medications. The study included 60 adults, average age 74 ± 5,35 (range 65-89) years who have used 7,12 ± 0,45 (range 1-17) drugs and had diagnosed 5,85 ± 0,38 (range 2-14) diagnosis. Comprehensive protocol found that 36,67% of respondents had used at least one potentially inappropriate medication. The most commonly prescribed potentially inappropriate drug was diazepam. For 35% of participant the usage of a combination of drugs that can result in clinically significant interactions was found. The most common interaction was a combination of drugs that act on the central nervous system. The analysis of clinical outcomes after discharge from the hospital shows that 11,67% of the outcomes are associated with the use of potentially inappropriate medications. Although, high incidence of potentially inappropriate medications was identified, the association between potentially inappropriate medications and clinical outcomes was weak