Continuous Improvement of the Rational Use of Central Nervous System Disease-Related Drugs in Elderly Inpatients

Abstract

What Is Known? In elderly inpatients, potential inappropriate medication (PIM) is a prominent prescription challenge. However, there is limited information available regarding PIM in patients with central nervous system (CNS) diseases in China. Objective. To evaluate and improve the rational use of drugs for the treatment of CNS diseases in elderly inpatients. Method. A retrospective, cross-sectional study was conducted among elderly inpatients (≥65 years) admitted to the Ninth People’s Hospital of Zhengzhou in China from March 2020 to March 2021. PIM was identified based on the 2019 Beers criteria at admission and discharge. The patients recruited in March 2020 were considered a baseline group, which was used as a comparison to evaluate PIM of CNS disease-related drugs in June 2020, September 2020, December 2020, and March 2021. Results. A total of 1500 patients were included in the evaluation. There was a statistically significant difference in the number of average hospitalization days, drug varieties used, and PIM detection ( $p<0.05$ ), as determined by X2 test. A total of 332 cases of PIM were identified, and 226 cases were detected for the interaction with CNS disease dementia. Multifactor logistic regression analysis showed that male, length of stay ≥15 days, and >10 medication types were risk factors for the occurrence of PIM ( $p<0.05$ ). After clinical supervision and training based on the High-Risk Drug Replacement Program for the Elderly, the rate of irrational medication under medical advice decreased from 34.67% in March 2020 to 14.0% ( $p<0.001$ ) in March 2021. What Is New and Conclusion. There was certain rationality based on the High-Risk Drug Replacement Program for the Elderly, and the rates of selective serotonin reuptake inhibitor, 5-hydroxylamine/norepinephrine re-intake inhibitor, rotenone, quetiapine, and proton pump inhibitor use were improved. These results provide a reference for the continuous improvement of the PIM catalog for elderly patients.