Potentially inappropriate prescribing in older adults in Mexico

Saturno-Hernández, Pedro Jesús; Poblano-Verástegui, Ofelia; Acosta-Ruiz, Omar; Bautista-Morales, Arturo Cuauhtémoc; Gómez-Cortez, Patricia María; Alcántara-Zamora, José Luis; Gutiérrez-Robledo, Luis Miguel

doi:10.11606/s1518-8787.20210550033110

Brasil

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.20210550033110 linkcopy

Potentially inappropriate prescribing in older adults in Mexico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico.

METHODS Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014–2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing.

RESULTS Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas.

CONCLUSIONS The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.

Old person; Inappropriate Prescribing; Comorbidity; Misuse of Prescription Drugs; Medication-Related Side Effects and Adverse Reactions

Indicator	Formula	Description
I. General indicators of prescriptions in AM ^a
Percentage of AM users with prescription	$\frac{Σ AM with prescription}{Σ Total AM}$	Percentage of AMs who were prescribed pharmacological treatment.
Average number of medications in the AM’s prescription.	$\frac{Σ Medications prescribed to the AM}{Σ AM with prescription}$	The average number of medications on prescriptions. This indicator allows us to know the polypharmacy degree existing in prescriptions in Seguro Popular units.
II. Percentage of contraindicated drugs according to criteria ^b
Percentage of contraindicated drugs prescribed in AM	$\frac{Σ Contraindicated drugs in AM}{Σ Drugs in AM prescription}$	According to the classification, it refers to the contraindicated drugs prescribed divided by the number of drugs in the prescription; if the value is close to 1, it means that most of the drugs in the prescription are contraindicated; if it tends to 0, it means that it is the lowest percentage of contraindicated drugs.
III. Most frequent group of contraindicated drugs prescribed to AM
Percentage of the drugs most prescribed in the contraindicated	$\frac{Σ Contraindicated group in AM}{Σ Medications contraindicated in AM}$	Drugs are categorized according to the type of drug, and divided by total contraindicated drugs.

Year	2014	2015	2016	Total
Total AM in the survey	2,814	2,023	1,234	6,071
Total drugs prescribed among AM	1,996	1,352	710	4,058
Percentage of AM with prescription (95%CI)	70.8 (69.1–72.5)	66.8 (64.8–68.9)	57.4 (54.6–60.1)	66.8 (65.6–67.9)
Average number of medications in the AM’s prescription. (95%CI)	2.7 (2.6–2.8)	2.9 (2.8–2.9)	2.4 (2.3–2.5)	2.7 (2.7–2.8)
Percentage of contraindicated drugs among AM according to Beers criteria^a (95%CI)	60.6 (58.5–62.8)	60.2 (57.6–62.8)	53.8 (50.1–57.5)	59.3 (57.8–60.8)
Percentage of contraindicated drugs among AM according to STOPP criteria^a (95%CI)	69.6 (67.6–71.6)	68.3 (65.9–70.8)	57.0 (53.4–60.7)	67.0 (65.5–68.4)
Percentage of contraindicated drugs among AM according to Prescrire criteria^a (95%CI)	19.8 (18.1–21.6)	22.7 (20.5–24.9)	15.2 (12.6–17.9)	20.0 (18.8–21.2)
Percentage of contraindicated drugs among AM according to BSP* criterion (95%CI)	76.3 (74.4–78.2)	76.4 (74.1–78.7)	64.6 (61.1–68.2)	74.3 (73.0–75.6)

2014		2015		2016		2014–2016
Type of drug	n = 2,539	Type of drug	n = 1,696	Type of drug	n = 673	Type of drug	n = 4,908
NSAIDS	25.0% (23.4–26.7)	NSAIDS	26.4% (24.3–28.5)	NSAIDS	31.8% (28.3–35.3)	NSAIDS	26.4% (25.2–27.7)
Vasodilators	13.7% (12.3–15.0)	Vasodilators	11.1% (9.6–12.6)	Sulfonylureas	8.8% (6.6–10.9)	Vasodilators	12.0% (11.1–12.9)
Sulfonylureas	12.8% (11.5–14.1)	Sulfonylureas	10.8% (9.4–12.3)	Diuretics	8.3% (6.2–10.4)	Sulfonylureas	11.6% (10.7–12.4)
Diuretics	9.4% (8.3–10.5)	Diuretics	9.1% (7.7–10.4)	Proton pump inhibitors	7.7% (5.7–9.7)	Diuretics	9.1% (8.3–10.0)
Beta-blockers	8.5% (7.4–9.6)	Beta-blockers	9.0% (7.6–10.3)	Vasodilators	7.7% (5.7–9.7)	Beta-blockers	8.5% (7.7–9.2)
Calcium channel blockers	7.0% (6.0–8.0)	Calcium channel blockers	7.1% (5.9–8.4)	Beta-blockers	7.0% (5.1–8.9)	Calcium channel blockers	7.0% (6.3–7.7)
Proton pump inhibitors	5.8% (4.9–6.7)	Proton pump inhibitors	5.4% (4.3–6.5)	Calcium channel blockers	6.8% (4.9–8.7)	Proton pump inhibitors	5.9% (5.3–6.6)
Fibrates	3.3% (2.6–4.0)	Fibrates	4.4% (3.4–5.3)	Fibrates	4.6% (3.0–6.2)	Fibrates	3.8% (3.3–4.4)
H2-receptor antagonist	2.8% (2.2–3.5)	H2-receptor antagonist	3.1% (2.2–3.9)	Corticosteroids	2.2% (1.1–3.3)	H2-receptor antagonist	2.8% (2.3–3.3)
Antihistamines	2.4% (1.8–3.0)	Antihistamines	2.2% (1.5–2.9)	H2-receptor antagonist	2.1% (1.0–3.2)	Antihistamines	2.3% (1.9–2.7)

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[TFN3] ^a The indicator is calculated stratifying by older adult population and non-older adult population, for each year the survey was conducted.

[TFN4] ^b The estimator is calculated in the same way for each of the criteria (Beers, STOPP, Prescrire and BSP), stratifying by the number of drugs prescribed to the user in the prescription.