Evaluation of geriatric drug -disease interactions in seniors in log -term care in the Czech Republic

Abstract

Introduction: Prescribing of non-geriatric dosing, inappropriate indications and drug-disease interactions in older patients create specific areas of high-risk prescribing in geriatrics that often lead to drug-related complications, particularly in polymorbid older patients using polypharmacy and having higher degree of frailty. The European project SHELTER (Services and Health in the Elderly in Long-TERrm care, 7th FP, 2009–2014) aimed at describing comprehensive characteristics of 4 156 long-term care seniors (including drug prescribing habits) in 7 EU countries (Czech Republic, Italy, Germany, Netherlands, Finland, UK, France) and Israel. This study focuses on retrospective analyses of drug-disease interactions in the Czech sample of seniors of the SHELTER project. Methods: Semi-implicit method (evaluation of complex protocols of geriatric patients from the Czech sample of the European project SHELTER, June-August 2019) was used to retrospectively analyse the prevalence of drug-disease intereactions using expert explicit criteria. Mainly Beers criteria 2003 and 2012, Czech national consensus of potentially inappropriate medications 2013, STOPP/ START criteria version I. and IPET criteria have been applied. In the SHELTER project, seniors were assessed using comprehensive geriatric assessment (RAI-LTCF vers.I) in 10 regionally different Czech (CZ) long-term care facilities (N = 490 seniors, age 65+, all patients residing for long-term (more than 3 months) in evaluated long-term care facilities). For statistical analyses, descriptive statistics has been used, namely chi-square (χ2) test and Fisher´s exact tests (p < 0,05). Results: The highest prevalence of potentially inappropriate drug-disease interactions (64.3 %) was identified using Czech national consensus of potentially inappropriate medications 2013 (CNC), then by Beers 2012 criteria (60.2 %), STOPP/START criteria version I. (44.5 %/52.9 %, respectively) and IPET criteria (30.2 %). The most prevalent prescribing problems were (according to CNC): long-term use of benzodiazepines (BZDs) in depressive patients (7.8 %), constipation caused by opioids without using laxatives-lactulose (7.3 %), long-term use of BZDs in patients suffering from syncopes and falls (1 and more falls in the past 3 months) (6.3 %) and long-term use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and ACE-I without clinical monitoring of kalemia (6.1 %). Conclusion: Application of Czech national consensus (CNC) led to documentation of the highest prevalence of drug-disease interactions in the Czech sample of seniors in long-term care in comparison to foreign explicit criteria. With the help explicit criteria we identified in Czech long-term care facilities more than 60 % of seniors potentially prioritized for complex interventions of clinical pharmacists. In the light of newly approved payments in ambulatory care for interventions of clinical pharmacists in the Czech Republic, services of these specialists should be utilized for complex drug revisions of geriatric patients in primary care, particularly in long-term care, home care, social care and palliative hospices.