Analysis of Risk Factors for Inappropriate Prescribing of Psychotropic Drugs in Primary Health Care in Elderly Patients

Abstract

Abstract Backround: Older people are at risk of inappropriate drug prescribing because pharmacodynamics and pharmacokinetics, and consequently the efficacy and safety of drugs, change after patient’s age. Objective: The aim of study is to identify major significant risk factors for Potentially Inappropriate Medicines (PIM) of psychotropic drugs and Potential Prescription Omissions (PPO) of psychotropic drugs in population of patients over 65 years of age with associated pathological conditions according to Screening Tool of Older Person’s potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria. Material and method: The study was designed as a cross-sectional study involving 492 patients and 9 selected general practitioners. It was conducted in period from May 2020 to December 2021, after receiving decision from Ethics Committee of HC Kragujevac. Results: 492 patients, mean age 71.77 ± 5.95, with 62.2% women, participated in the study. 164 PIMs were identified in 139 patients (28.2%). The most common were: use of benzodiazepines over 4 weeks (43.9%) with simultaneous use of different groups of antidepressants (20.3%). Patients with more than two psychotropic drugs have a higher risk for PIM [adjusted OR 2.83, 95% CI (1.98 - 4.140], p <0.001. 439 PPOs were also identified in 270 patients (54.8%). Risk factors for PPO are: age, number of illnesses, total number of medications, number patients, depression presence, patient’s place of residence, cigarettes usage and monthly income level. Conclusion: STOPP/START criteria can have a major impact in recognizing inadequate prescribing of psychotropic drugs at patients over 65 years of age. Patients who use benzodiazepines more than four weeks and / or antidepressants may be at increased risk of PIM psychotropic drugs. The total number of drugs and presence of symptoms of depression bring higher risk of PPO psychotropic drugs.