Prescrizioni potenzialmente inappropriate in pazienti anziani non ospedalizzati. Risultati dell’applicazione di criteri impliciti da parte di farmacisti clinici

BACKGROUND: Management of therapy in elderly patients is a critical issue in primary care. The physiopathological status is usually complex, and the prescription of multiple drugs is typically required, with a consequent higher risk of adverse effects. Many tools have been developed to cope with this problem, and identify drugs that are inappropriate in the elderly. The objective of the study was to evaluate the appropriateness of therapies in the elderly according to implicit criteria. METHOD: A prospective study of outpatients aged ≥65 years who visited our outpatient clinic on even calendar dates of the week, from Monday to Friday, from September 1, 2013 to March 31, 2014 was performed. Appropriateness of therapy was evaluated by applying three sets of implicit tools: Lipton Criteria, MAI and POM. A questionnaire was used assess information given to patients by physicians, and adherence to therapy. Information about clinical history and therapy was obtained from electronic medical records. Patient diagnosis and allergies, drugs, dosages, pharmacological indications, and questionnaire results, were entered into a database. The results were expressed in percentage. RESULTS: A total of 265 patients aged ≥65 years were included. Of these, 83% (220/265) had 2 to 6 comorbidities. According to the Lipton, MAI and POM criteria, the prescriptions were appropriate for 97% (1289/1327), 96% (1274/1327), and 94% (1251/1327) respectively. Only 33% (87/265) of the patients reported being thoroughly informed about the prescribed therapy and main side effects, and 67% (178/265) reported full compliance with the dosing schedule. DISCUSSION AND CONCLUSIONS: The overall assessment of the elderly patient, with particular reference to comorbidity, is essential in choosing the best tailored-therapy. For this reason, the support of tools that can make safer therapeutic choices is important. The implicit indicators used allow for a reduction of number of the medications, and inappropriate prescriptions, avoiding drugs with greater potential for interactions, and promoting adherence by patients.