The healthcare industry constantly seeks ways to improve patient safety and reduce unnecessary costs. A retrospective study led by Tomoya Tachi of the Laboratory of Clinical Pharmacy at Gifu Pharmaceutical University has highlighted the financial and health implications of potentially inappropriate prescriptions (PIPs) in elderly patients. Published in the “Biological & Pharmaceutical Bulletin,” the study analyzed PIPs that could have been avoided by adhering to two critical references – Beers Criteria: the Japanese Version (BCJV) and Guidelines for Medical Treatment and Its Safety in the Elderly 2015 (GL2015) – and linked them to avoidable adverse drug reactions and associated medical costs.
The Study and Its Findings
The study included participants aged at least 65 years who were either hospitalized at Gifu Municipal Hospital between October 1 and November 30, 2014, or had outpatient examinations at the same hospital on October 1-2, 2014. A total of 1236 inpatients and 980 outpatients were analyzed to measure the usage rates of drugs listed in the BCJV and GL2015, the incidence rates of adverse drug reactions, and the additional costs incurred per patient due to adverse reactions.
The results were startling. Usage rates of drugs on the BCJV and GL2015 among inpatients were 24.0% and 72.4%, respectively, while adverse reaction rates to these drugs stood at 3.0% and 8.2%. Outpatient figures were similar, with usage rates at 26.2% (BCJV) and 59.9% (GL2015). Adverse reactions occurred at a rate of 4.7% (BCJV) and 3.9% (GL2015). The financial burden due to these adverse reactions ranged significantly, from 12,713 to 163,925 yen per patient.
The study concludes that the appropriate use of drugs, as advised by the BCJV and GL2015, has the potential to prevent adverse drug reactions in the elderly, leading to significant reductions in overall medical costs.
Implications for Healthcare Providers and Patients
This study points toward a significant issue affecting elderly individuals – the high incidence of adverse drug reactions due to potentially inappropriate prescriptions. The Beers Criteria and equivalent guidelines are essential tools designed to assist healthcare providers in making safer prescription choices for the elderly.
“The analysis we conducted shows the importance of following established guidelines to mitigate the risk and cost related to avoidable drug-related adverse reactions,” says Tomoya Tachi. “Adherence to the BCJV and GL2015 may not only enhance the quality of life for elderly patients but could also lead to substantial healthcare savings.”
Policy Considerations
Pharmacotherapy in elderly patients is complicated by the higher incidence of chronic illnesses, polypharmacy, and physiological changes associated with aging. This study reinforces the need for policy mechanisms that ensure healthcare providers in Japan and elsewhere receive ongoing education about PIPs and are encouraged to adhere to established guidelines.
“Understanding and implementing the Beers Criteria and other local guidelines should be a priority for clinicians, pharmacists, and care teams,” notes Hitomi Teramachi, a co-author of the study. “Interventions including electronic health records that flag PIPs can support the healthcare community in this endeavor.”
Challenges and Future Research
While the importance of avoiding PIPs is clear, there remains a gap in translating this knowledge into practice. Future research efforts might focus on the barriers that prevent adherence to prescription guidelines and the development of interventions to overcome these obstacles.
Furthermore, studies that examine the broader impact of PIPs on patient outcomes beyond cost implications are needed. Such research would provide a more comprehensive understanding of the benefits associated with following prescription guidelines for the elderly.
Conclusion
Appropriate drug use in elderly populations is not only a matter of professional practice but also one of patient safety and financial sustainability. The study by Tomoya Tachi et al. serves as a reminder of the potential impacts of inappropriate prescribing and underscores the value of guidelines like the Beers Criteria in maintaining the health and well-being of older adults.
The full study is available in the “Biological & Pharmaceutical Bulletin,” DOI: 10.1248/bpb.b18-00820.
References
1. Tachi, T., Kanematsu, Y., Aoyama, S., Katsuno, H., Otsubo, M., Ueno, A., … Teramachi, H. (2019). Analysis of Adverse Reactions Caused by Potentially Inappropriate Prescriptions and Related Medical Costs That Are Avoidable Using the Beers Criteria: The Japanese Version and Guidelines for Medical Treatment and Its Safety in the Elderly 2015. Biological & Pharmaceutical Bulletin, 42(5), 712-720. doi:10.1248/bpb.b18-00820
2. American Geriatrics Society 2019 Beers Criteria® Update Expert Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674-694. doi:10.1111/jgs.15767
3. O’Mahony, D., O’Sullivan, D., Byrne, S., O’Connor, M. N., Ryan, C., & Gallagher, P. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing, 44(2), 213-218. doi:10.1093/ageing/afu145
4. Steinman, M. A., & Hanlon, J. T. (2010). Managing Medications in Clinically Complex Elders: “There’s Got to Be a Happy Medium”. JAMA, 304(14), 1592-1601. doi:10.1001/jama.2010.1482
5. Onder, G., Petrovic, M., Tangiisuran, B., Meinardi, M. C., Markito-Notenboom, W. P., Somers, A., … Rajkumar, C. (2012). Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older. Archives of Internal Medicine, 172(13), 1013-1019. doi:10.1001/archinternmed.2012.2560
Keywords
1. Beers Criteria Japan
2. Inappropriate Prescriptions Elderly
3. Adverse Drug Reactions Cost
4. Elderly Healthcare Cost Savings
5. Medication Safety Guidelines