Potentially Inappropriate Medication Use and the Hospitalization Rate among Thai Elderly Patients: a Retrospective Cohort Study

Abstract

AbstractPurposeTo examine the association between potentially inappropriate medications (PIMs) use and the hospitalization rate in elderly Thai patients.MethodsIn this retrospective cohort study, we collected the electronic medical data of elderly patients aged 60 years and older who visited the outpatient department (OPD) at Thammasat University Hospital in Thailand in 2015. The patients were categorized into PIM and non-PIM users according to the Beers 2019 criteria. We calculated descriptive statistics for demographic variables. We also examined the association between PIM use and various different factors with hospitalization rate during follow-up using log-binomial regression. We calculated the relative risk for association between PIM use and other factors with the hospitalization rate.ResultsWe collected data for a total of 32,261 patients. The majority of participants were female (59.65%) and had a mean age of 70.21 years (SD=7.88). Overall, 63.98% of the patients (n=20,641) were PIM users and 49.45% (n=15,952) received polypharmacy (≥5 medications). The most common PIM prescription was proton-pump inhibitors, which were 27.51% of all medications prescribed. We found that PIM use increased the risk of hospitalization by 1.31 times (adjusted RR=1.31, 95% CI: 1.21 – 1.41, p-value < 0.001). Other factors associated with a higher rate of hospitalizations included older age, male gender, polypharmacy, and a higher number of OPD visits.ConclusionPIMs were commonly prescribed to the elderly in the OPD, and were significantly associated with subsequent hospitalization. The provision of an alternative drug list can help physicians avoid prescribing PIMs to the elderly. If PIMs prescription is unavoidable, physicians should closely monitor patients for drug-related problems and deprescribe PIMs when they are no longer indicated.