(C49) Potential inappropriate medication use among older patients with Parkinson’s disease: A cross sectional analysis of a national health insurance database in China

Publication Number: 993

Background: Parkinson’s disease (PD) is the one of the most common age-related neurodegenerative disorders. Pharmaceutical treatment plays a critical role in alleviating motor and non-motor symptoms to improve quality of life for patients with PD (pwPD). PwPD have complex medical needs yet little is known about potential inappropriate medication (PIM) use among pwPD in China.

Objectives: To quantify PIM prevalence and identify the predictors of PIMs among pwPD in China.

Methods: We conducted a cross-sectional study using China Health Insurance Association (CHIRA) database. CHIRA collected all medical records of a national representative sample (sample ratio 2%) of the total basic medical insurance (BIM) beneficiaries across China every year, using a systematic random sampling strategy. Patients 65+ years of age who had at least two ambulatory visit records with prescriptions of antiparkinsonian drugs and one ambulatory visit record with diagnosis of PD in 2015-2017 were included. PIMs were defined as medications to be avoided and used with caution, and medications that could cause drug-PD interactions and drug-drug interactions listed in American Geriatrics Society 2015 Beers Criteria. The prevalence of PIM was estimated overall, and specifically for medications that can exacerbate motor symptoms or cognitive impairment in pwPD. Potential predictors of PIM were estimated using multivariate logistic regression. Ethical approval was obtained from Peking University Institution Review Board.

Results: A total of 118,478 outpatient prescriptions filled by 14,452 pwPD in 2015-2017 were included. In total, 8,356 (57.8%) patients received at least one PIM; 2,464 (17.1%) patients received at least one PIM that might worsen motor symptoms and 6,201 (42.9%) patients received at least one PIM that could exacerbate cognitive impairment. The prevalence of PIM use was higher in patients who were ≥85 years of age (65.5%; OR, 1.58; 95% CI, 1.38-1.80), compared with patients who aged 75-84 years (59.5%; OR, 1.22; 95% CI, 1.14-1.31) or patients who aged 65-74 years (54.7%, reference group). The odds of receiving PIMs was lower for males (55.0%; OR, 0.77; 95% CI, 0.72-0.82), compared with females (61.4%, reference group). Beneficiaries of the Urban Employee Basic Medical Insurance (56.1%; OR, 0.62; 95% CI, 0.56-0.68) were less likely to receive PIMs, compared with those of the Urban Rural Resident Basic Medical Insurance (67.3%, reference group). Patients residing in the western region (53.2.0%; OR, 0.76; 95% CI, 0.70-0.82) had lower odds of receiving PIMs, compared with those residing in the eastern region (59.9%, reference group) or in the central region (58.5%; OR, 0.94; 95% CI, 0.87-1.02).

Conclusions: Prescribing PIMs for pwPD is common in China. More research is needed to understand the rationale for, clinical impact of and alternatives to PIM in this vulnerable population.