Prevalência e fatores associados ao uso de medicamentos potencialmente inapropriados em idosos internados em um hospital geral

Abstract

The use of inappropriate prescribing in the elderly (PIM) is a public health problem that requires attention, especially in hospitalized patients. Few studies have evaluated in more detail the prevalence of PIM at different moments of hospitalization, as well as the associated factors and the medical specialties involved. Understanding the inappropriate prescribing pattern among the different specialties may help in the identification of drugs that could be replaced by safer options. The present study aims to evaluate the prevalence of PIM in a general tertiary hospital, comparing four different moments and investigating the factors associated with it, including the comparison of prescription patterns among medical specialties. A retrospective cohort study, including all the elderly who were hospitalized between January and May 2015 in the clinical specialties of a general tertiary hospital. All prescripted drugs were collected and divided into four groups: home-use drugs, admission medications, medications added during the subsequent days of hospitalization, and final prescription medications, performed on the last day of hospital stay. The PIM were identified using the Beers 2015 criteria in the four groups, and STOPP 2015 on the first and last day of hospitalization. The medical specialties (medical clinic, cardiology, gastroenterology, infectology, nephrology, neurology, pneumology and others) were also compared in relation to the prevalence of PIM and increase in PIM between the first and the last day of hospitalization. A total of 1900 elderly were included. The patients who did not have home prescription registered in the medical record were excluded of the evaluation of the four groups, totaling 1381 patients. There was an important increase in the number of medications in general and PIM at admission and during hospitalization, and persisted until the last day of hospitalization. The prevalence of PIM was about 38% at home, increasing to 62.2% on admission and 68.9% on the last day. For the comparison of Beers and STOPP and between the specialties on the first and last day of hospitalization, all the 1900 patients were included. The prevalence of PIM increased significantly with both criteria (62.3% to 66.6% with Beers and 43.4% to 50% with STOPP). The most common PIM were insulin on sliding scale, antipsychotics, mineral oil, benzodiazepines, spironolactone and acetylsalicylic acid. Factors associated with PIM were age, use of PIM at home, length of hospitalization and death. Neurology, infectology and pneumology had highest use of PIM, and neurology, pneumology and cardiology had a highest increase in PIM during hospitalization. These findings reinforce the hospital iatrogenic character, emphasizing that the addition of these medications on admission can be perpetuated until the last day of hospitalization. The medical specialty is an important factor associated with PIM. Educational measures and pharmaceutical interventions are important tools that may help to change this situation.