IMPACT OF POLYPHARMACY ON CLINICAL OUTCOME MEASURES IN GERIATRIC

PATIENTPOPULATION IN A TERTIARY CARE HOSPITAL

ABSTRACT
A sharp increase in the chronic diseases for
elderly patients have been observed in the
recent years resulting in polypharmacy which
may lead to drug-drug interactions, ADR’s,
drug related problems and many more issues
in these patients.
Objectives of the study
To assess the incidence of
polypharmacy
To identify factors associated with
exposure to polypharmacy
To assess the rationality of prescriptions
based on Beers criteria 2012
To identify the drug-related problems
based on BEDNURS classification
To identify the adverse drug reactions
occurring in the elderly as a result of
polypharmacy induced DDI’s
Ramya.B,Tanvija.K, Anusha J, Giridhar Kumar J, Shamili K, Raja Sree G, Krishna Sri N, Pavani AL, Siva R Challa
Department of Pharmacology and Pharmacy Practice,
KVSR Siddhartha College of Pharmaceutical Sciences, Siddhartha Nagar, Vijayawada-520010
INTRODUCTION
Polypharmacy is defined as the excessive use of
concurrent drugs; for example, the use of an excessive
number of inappropriate drugs or the use of a number
of drugs in excess of that which is clinically indicated1.
Polypharmacy is a common occurrence in elderly
patients due to a variety of reasons like
Availability of nonprescription drugs
High cost of prescription medications (leads to use of
up to several other “alternatives”
to reach same effect)
Hoarding of old medications
Inadequate patient knowledge of medications and
medical conditions
Increasing number of chronic health conditions
Patients being treated by multiple prescribing
physicians
METHODS AND MATERIALS
It is a prospective, observational study was
conducted in general medicine department of Dr.
Pinnamaneni Siddhartha Institute of Medical
Sciences & Research Foundation following protocol
approval by Institutional ethics committee (IEC) of
KVSR Siddhartha College of Pharmaceutical
Sciences. 274 patients were recruited into the study
based on the inclusion criteria. The medication
profiles were also checked for inappropriate
prescribing according to Beers criteria 2012. Drug-
related problems were assessed based on
BEDNURS classification. The association between
exposure to polypharmacy and each independent
variable was evaluated by calculating the odds ratio
(OR) at 95% CI. Chi-square test was applied for
some of the parameters to prove their statistical
significance by using Graph pad prism 5. P<0.005
was considered to be significant.
RESULTS
The mean age of patients was found to be 62.4 ± 8.8
years, majority of them were males and most of the
patients were fallen in between the age group of 60-69
years. Most of the patients (81.8%) had more than 2
and less than 5 diseases. The mean number of drugs
prescribed in all the prescriptions was found to be 7.4 ±
2.6. Of all these, 3.83% of the total drugs prescribed
were inappropriate as per Beers Criteria. 74.1% of
moderate DDI’s were observed in patients.
DISCUSSION
In the present study, majority of the patient
population were males (51.45) than females. Among
the patient population of our study, the mean age of
the patients was found to be 62.4 ±8.8.Majority of the
people were fallen under the age group of 60-69
years in the present study. Most of the patients in the
present study got admitted in the hospital with more
than two and less than five diseases (81.8%). In a
total patient population of 274 patients, the mean of
the drugs prescribing was found to be 7.4 ±2.6. In a
total patient population of the present study, most of
the patients were diagnosed with Hypertension
(44.16%), followed by Diabetes (36.5%) and a very
little percentage of patients were diagnosed with
ischemic cardiac myopathy (2.55%). In the present
study, majority 375 (18.4%), of the drugs belongs to
the category of cardiovascular diseases, followed by
Vitamins, minerals & dietary supplements 285 (14%),
and others 261 (12.8%). Among 274 patients, 239
patients were observed with polypharmacy. The total
number of drugs used in these 239 patients were
1910. Of 504 drug-related problems, 499 (0.26%)
were directly coupled to a prescribed drug and 5
were classified as need for additional drug or need
for review
CONCLUSIONS
The impact of polypharmacy on consequences like
length of stay, DDI’s, and DRP’s were also found to
be significant in the present study. This study
concludes that medication profile of elderly patients
should be assessed regularly for rationality of drug
therapy in order to maximize the therapeutic
response positively with the lowest number of
medications possible.
REFERENCES
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