postdoc School of Pharmaceutical Sciences, Peking University Beijing, China (People's Republic)
Background: Potentially inappropriate medication (PIM) is a major concern for the medication safety. The overall pooled prevalence of PIM by meta-analysis in Chinese elderly outpatients was 29%. However, the actual extent of overall PIM use in primary healthcare facilities at the national level in China was not measured comprehensively.
Objectives: This study aimed to evaluate occurrences and patterns of PIMs among elderly patients in primary healthcare facilities (PHFs).
Methods: We collected outpatient-visit prescriptions from 368 Chinese PHIs in 31 cities in six provinces, between 2017 and 2019. The system of Criteria of PIM for Older Adults in China was applied to identify PIMs. The primary outcome was the prevalence of visits with at least one PIM; secondary outcome was the rate per thousand visits of specific PIMs. Generalized linear models were used to examine the associations between PIMs and independent variables, and marginal effects methods were applied to estimate the mean adjusted PIMs prevalence.
Results: Of 265,654 eligible primary outpatient visits of elderly patients aged 60 or above, 14.0% (37,191/265,654) were exposed to at least one PIM. Higher PIM prevalence was significantly associated with the number of prescribed medications per visit. Patients without medical insurance were more likely to be prescribed with PIMs. A decreasing trend of PIM prescribing for the oldest patients (aged 90 or above) was observed. Overall, 4.3% (11,397/265,654) of elderly patients in primary healthcare facilities were exposed to at least one high-risk PIM, with central nervous system medications and cardiovascular medications being the most commonly prescribed subgroups.
Conclusions: This study calls for efforts to manage PIMs among elderly patients in Chinese primary healthcare facilities, with potentially encouraging directions for future interventions. Tailored training and continuous education for primary healthcare clinicians are urgently needed to promote guideline-based treatment, particularly for patients who aged 80-89 years old, were prescribed with multiple medications, and were without medical insurance.
